安宫牛黄丸联合地塞米松治疗热射病的临床观察

Clinical Value of Angong Niuhuang Pill Combined with Dexamethasone in Treating Heat Stroke

目的研究安宫牛黄丸联合地塞米松用于热射病的临床价值。方法选取2015年6月—2019年10月因热射病住院的患者80例,按照随机数表法分为观察组与对照组,各40例。其中对照组给予常规治疗,观察组在对照组治疗基础上加用安宫牛黄丸及地塞米松。两组患者均治疗7 d后评定疗效,对比两组患者入院后2 h内体温及意识恢复时间,入院后2 h、3 d、7 d急性生理学及慢性健康状况评分系统(APACHE-Ⅱ)评分,两组患者尿素氮(Blood urea nitrogen,BUN)、肌酐(Creatinine,Cr)、丙氨酸氨基转移酶(Alanine aminotransferase,ALT)、肌红蛋白(Myoglobin,MYO)、D-二聚体(D-dimer,D-D)、超敏C反应蛋白(High sensitivity C-reactive protein,hs-CRP)、肿瘤坏死因子(Tumor necrosis factor-α,TNF-α)、白细胞介素-6(Interleukin-6,IL-6)水平。结果观察组治疗后总有效率为90.00%,明显高于对照组72.50%,差异有统计学意义(P<0.05)。入院30 min后观察组体温与对照组比较,差异无统计学意义(P>0.05);入院60 min、90 min、120 min后观察组体温明显低于对照组,差异有统计学意义(P<0.05);且观察组意识恢复时间明显短于对照组,差异有统计学意义(P<0.05)。对照组治疗2 h、3 d、7 d后APACHE-Ⅱ评分组内比较,差异无统计学意义(P>0.05),观察组治疗3 d后APACHE-Ⅱ评分明显低于本组治疗2 h后,治疗7 d后APACHE-Ⅱ评分明显低于本组治疗2 h、3 d后,差异有统计学意义(P<0.05),治疗2 h、3 d、7 d后观察组APACHE-Ⅱ评分均明显低于对照组,差异有统计学意义(P<0.05)。治疗后观察组BUN、Cr、ALT、MYO、D-D、hs-CRP、TNF-α、IL-6水平明显低于对照组,差异有统计学意义(P<0.05)。结论安宫牛黄丸联合地塞米松治疗热射病可有效帮助患者降低体温、加快患者意识恢复,并有效改善患者临床指标水平,值得临床推广应用。

Objective To observe the clinical value of Angong Niuhuang Pill Combined with dexamethasone in the treatment of heat stroke.Methods A total of 80 patients who were hospitalized due to heat stroke from June 2015 to October 2019 were selected and divided into observation group and control group according to the random number table method,with 40 cases in each group.The control group was given conventional treatment,and the observation group was given Angong Niuhuang Pills and dexamethasone on the basis of the treatment of the control group.Both groups of patients were evaluated for curative effect after 7 days of treatment.The body temperature and recovery time of consciousness within 2 hours after admission were compared between the two groups.Acute physiology and chronic health evaluation(APACHE II)score system with in 2 h,3 d,7 d after admission,compared two groups of patients with urea nitrogen(BUN),creatinine(Cr),alanine aminotransferase(ALT),myoglobin(MYO),D-dimer(DD),levels.The levels of hypersensitive C-reactive protein(Hs-CRP),tumor necrosis factor(TNF-α)and interleukin-6(IL-6)were compared between the two groups before and 7 days after treatment.Results The total effective rate after treatment in the observation group was 90.00%,which was significantly higher than 72.50%in the control group.The difference was statistically significant(P<0.05).There was no significant difference in body temperature between the observation group and the control group 30 min after admission(P>0.05).The body temperature of the observation group was significantly lower than that of the controlgroup at 60 min,90 min,and 120 min after admission,and the difference was statistically significant(P<0.05);and the recovery time of consciousness in the observation group was significantly shorter than that in the control group,and the difference was statistically significant(P<0.05).The APACHE-Ⅱscore of the control group after 2 h,3 days and 7 days of treatment was not statistically significant(P>0.05).The APACHE-Ⅱscore of the observation group after 3 d of treatment was significantly lower than that of this group after 2 h of treatment.After 7 days of treatment,the APACHE-Ⅱscore was significantly lower than that of this group after 2 hours and 3 days of treatment.The difference was statistically significant(P<0.05).After 2 hours,3 days,and 7 days of treatment,the observation group′s APACHE-Ⅱscores were all Significantly lower than the control group,the difference was statistically significant(P<0.05).After treatment,the levels of BUN,Cr,ALT,MYO,D-D,hs-CRP,TNF-α,and IL-6 in the observation group were significantly lower than those in the control group,and the difference was statistically significant(P<0.05).Conclusion Angong Niuhuang Pill combined with dexamethasone in the treatment of HS can effectively help patients reduce body temperature,accelerate patients′consciousness recovery,and effectively improve patients′MYO and D-D levels,which has clinical application value.