清气化痰汤结合西医常规疗法治疗重症肺炎痰热壅肺证临床研究

Efficacy of Qingqi Huatan Decoction combined with western medicine in the treatment of severe pneumonia and its influence on the level of inflammatory factors

目的评价清气化痰汤结合西医常规疗法治疗重症肺炎痰热壅肺证的疗效。方法将符合入选标准的2018年2月-2020年6月张家港市中医医院84例重症肺炎痰热壅肺证患者采用随机数字表法分为2组,每组42例。对照组在常规治疗基础上结合支气管肺泡灌洗(bronchoalveolar lavage,BAL),联合组在对照组基础上加服清气化痰汤。2组均连续治疗7 d。采用临床肺部感染评分(Clinical Pulmonary Infection Score,CPIS)评估肺部感染程度,急性生理和慢性健康状况评分Ⅱ(Acute Physiology and Chronic Health EvaluationⅡ,APACHEⅡ)评估疾病严重程度;采用ELISA法检测血清CRP、IL-6水平,电化学发光法检测降钙素原(PCT)水平,评价临床疗效。结果联合组总有效率为88.1%(37/42)、对照组为69.0%(29/42),2组比较差异有统计学意义(χ^(2)=4.53,P=0.033)。治疗后,联合组CPIS[(2.19±0.42)分比(3.66±0.69)分,t=11.79]、APACHEⅡ[(9.84±1.31)分比(11.25±3.22)分,t=2.63]评分低于对照组(P<0.01);血清CRP、PCT、IL-6水平低于对照组(t值分别为30.32、8.59、6.08,P值均<0.001)。治疗期间2组均未见明显肝肾功能异常。结论清气化痰汤结合西医常规疗法可有效减轻重症肺炎痰热壅肺证患者肺部感染程度,降低炎性细胞因子水平,提高临床疗效。

Objective To evaluate the efficacy of Qingqi Huatan Decoction combined with conventional western medicine therapy in the treatment of severe pneumonia with phlegm-heat obstructing the lung syndrome.Methods A total of 84 patients with severe pneumonia with phlegm-heat obstructing lung syndrome admitted to Zhangjiagang Hospital of Traditional Chinese Medicine from February 2018 to June 2020 were randomly divided into two groups,42 in each group.The control group was treated with bronchoalveolar lavage(BAL)on the basis of routine treatment,and the combined group was treated with Qingqi Huatan Decoction on the basis of the control group.Both groups were treated for 7 days.The Clinical Pulmonary Infection Score(CPIS)was used to evaluate the degree of pulmonary infection,and the Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ)was used to evaluate the severity of the disease.The Serum CRP and IL-6 levels were detected by ELISA,and procalcitonin(PCT)levels were detected by electrochemiluminescence method to evaluate clinical efficacy.Results The total effective rate was 88.1%(37/42)in the combined group and 69.0%(29/42)in the control group,with a statistically significant difference between the two groups(χ^(2)=4.53,P=0.033).After treatment,the CPIS(2.19±0.42 vs.3.66±0.69,t=11.79)and APACHEⅡ(9.84±1.31 vs.11.25±3.22,t=2.63)in the combination group were significantly lower than those in the control group.The serum CRP,PCT,and IL-6 levels in the combination group were significantly lower than those in the control group(t=30.32,8.59,6.08,all Ps<0.001).During the treatment period,there was no obvious abnormality of liver and kidney function in both groups.Conclusion Qingqi Huatan Decoction combined with conventional western medicine therapy can reduce the degree of pulmonary infection in patients with severe pneumonia with phlegm-heat obstructing the lung syndrome,reduce the level of inflammatory cytokines,and improve clinical efficacy.