基于升降散加减的清透解毒方对脓毒症毒热证患者临床疗效的影响

Effect of Qingtou Jiedu decoction based on Shengjiang powder on clinical efficacy in treating sepsis of toxic heat syndrome

目的 观察基于升降散加减的清透解毒方治疗脓毒症毒热证的临床疗效.方法 采用前瞻性研究方法.选择2018年5月至2020年12月浙江中医药大学附属第一医院急诊科、急诊重症监护病房(EICU)收治的84例中医辨证分型属于毒热证的脓毒症患者作为研究对象,按随机原则分为西医常规治疗组和中药治疗组,每组42例.西医常规治疗组给予脓毒症常规西医治疗;中药治疗组在西医常规治疗基础上加用清透解毒方(组成:僵蚕9 g、蝉衣6 g、片姜黄6 g、制大黄5 g、水牛角30 g、黄芩12 g、连翘10 g、苦杏仁10 g、瓜蒌皮10 g、青蒿10 g、茯苓15 g、滑石12 g),每日2次,连用7 d.收集患者确诊当日及治疗3 d和7 d后的中医临床四诊信息、相关实验室检查结果及危重症相关评分,并比较两组上述指标的差异.结果 治疗3 d后中药治疗组体温即开始较西医常规治疗组明显下降〔℃:36.9(36.1,39.5)比37.5(36.3,39.0),P<0.05〕.治疗7 d后中药治疗组中医症状积分较西医常规治疗组明显降低〔分:4.4(0.0,18.0)比7.1(2.0,24.0),P<0.05〕,中医疗效总有效率明显升高〔92.9%(39/42)比73.8%(31/42),P<0.05〕.随时间延长,两组治疗后白细胞计数(WBC)、C-反应蛋白(CRP)、降钙素原(PCT)、血乳酸(Lac)、序贯器官衰竭评分(SOFA)、快速SOFA(qSOFA)、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)均较治疗前降低,且中药治疗组WBC在治疗3 d和7 d后、Lac在治疗3 d后均较西医常规治疗组下降明显〔WBC(×10^(9)/L):治疗3 d后为7.80(0.90,30.80)比10.70(0.80,40.80),治疗7 d后为6.55(2.10,18.80)比10.60(1.00,35.90);Lac(mmol/L):1.00(0.30,6.00)比1.67(0.70,9.20),均P<0.05〕;但两组治疗后CRP、PCT、qSOFA、SOFA和APACHEⅡ评分比较差异均无统计学意义.结论 清透解毒方联合西医治疗可以进一步降低患者WBC、Lac水平,改善患者中医症状,早期即改善患者体温,具有切实的临床疗效,对中西医结合治疗脓毒症具有一定的指导意义.

Objective To observe the clinical effect of Qingtou Jiedu decoction based on modified Shengjiang Powder in the treatment of patients with sepsis and toxic heat syndrome of traditional Chinese medicine(TCM).Methods A prospective research method was conducted.From May 2018 to December 2020,84 patients with sepsis and toxic heat syndrome confirmed by TCM differentiation method admitted and treated in the department of emergency and emergency intensive care unit(EICU)of the First Affiliated Hospital of Zhejiang Chinese Medical University were divided into a western medicine routine treatment group and a traditional Chinese medicine(TCM)treatment group according to random numher table method,with 42 cases in each group.Western medicine routine treatment group was given routine western medicine treatment,while in the TCM treatment group,based on the treatment of the control group,Qingtou Jiedu Decoction was added(composition of the prescription:stiff silkworm 9 g,cicada slough 6 g,turmeric 6 g,rhubarb root 5 g,buffalo horn 30 g,al skullcap root(scutellaria root)12 g,weeping forsylhia capsule 10 g,bitter apricot seed 10 g,snakegourd peel(tricosanthes rind)10 g,sweet wormwood herb 10 g,indian bread(poria)15 g,and talc 12 g),twice a day for 7 days.The clinical information of the four diagnoses in TCM,related laboratory examination results and critical illness scores of the patients were collected on the day of diagnosis,3 and 7 days after treatment,and the differences of the above indexes between the two groups were compared.Results Compared with the routine treatment group of western medicine,7 days after treatment,the TCM symptom score in the TCM treatment group was significantly lower[4.4(0.0,18.0)vs.7.1(2.0,24.0),P<0.05],and the total effective rate of TCM group was significantly higher[92.9%(39/42)vs.73.8%(31/42),P<0.05];3 days after treatment,the body temperature of the TCM treatment group was significantly lower than that of the routine western niedicinp treatment group[℃:36.9(36.1,39.5)vs.37.5(36.3,39.0),P<0.05].With the extension of time,the white blood cell count(WBC),C-reactive protein(CRP),procalcitonin(PCT),blood lactic acid(Lac),sequential organ failure assessment(SOFA)score,quick SOFA(qSOFA),acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)score of the two groups after treatment were lower than those before treatment;compared with routine western medicine treatment group,the WBC of the TCM treatment group was decreased on 3 and 7 days after treatment,and Lac was decreased significantly 3 days after treatment[WBC(×10^(9)/L):7.80(0.90,30.80)vs.10.70(0.80,40.80)on the 3rd day after treatment and 6.55(2.10.18.80)vs.10.60(1.00,35.90)on the 7th day after treatment;Lac(mmol/L):1.00(0.30,6.00)vs.1.67(0.70,9.20),all P<0.05]on the 3 days after treatment;however,there were no significant differences in CRP,PCT levels and qSOFA,SOFA and APACHE Ⅱ scores between the two groups after treatment.Conclusions Qingtou Jiedu decoction combined with western medicine in the treatment of patients with sepsis and toxic heat syndrome of TCM can further reduce the levels of WBC and Lac,improve the manifestations of syndrome of TCM,and improve the body temperature in the early stage.It has practical clinical therapeutic effect and has certain guiding significance for the treatment of sepsis with integrated traditional Chinese and western medicine.