泻肺通腑汤结合西医常规疗法治疗脑外伤后肺部铜绿假单胞菌感染痰热腑实证临床研究

Clinical study on Xiefei Tongfu Decoction combined with conventional western medicine therapy for the patients with pulmonary pseudomonas aeruginosa infection after brain trauma and syndrome of phlegm-heat and bowel-repletion

目的评价泻肺通腑汤结合西医常规疗法治疗脑外伤后肺部铜绿假单胞菌感染痰热腑实证患者的疗效。方法将符合入选标准的2018年8月-2021年5月本院脑外伤后肺部铜绿假单胞菌感染患者90例,采用随机数字表法分为2组,每组45例。对照组给予西药常规疗法治疗,研究组对照组基础上加用泻肺通腑汤治疗。2组均施于机械氧供给、营养支持及支气管肺泡灌洗。在此基础上,对照组静脉滴注硫酸依替米星与美罗培南,研究组加服泻肺通腑汤。2组均连续治疗7 d。分别于治疗前后进行中医证候评分;采用ELISA法检测CRP、IL-6水平,荧光法检测WBC;采用肺功能测量仪检测FVC、FEV1,计算FEV1/FVC值;观察并记录治疗期间的不良反应,评价临床疗效。结果研究组总有效率为91.11%(41/45)、对照组为73.33%(33/45),2组比较差异有统计学意义(χ^(2)=4.97,P=0.027)。研究组治疗后咳嗽、痰壅、发热、气促评分及总分均低于对照组(t值分别为9.65、9.81、8.62、9.11、9.34,P值均<0.001)。治疗后,研究组血清CRP[(95.66±11.67)mg/L比(107.82±12.99)mg/L,t=4.67]、IL-6[(25.16±6.46)ng/L比(33.45±7.33)ng/L,t=5.69]水平及WBC[(9.35±2.02)×10^(9)/L比(13.12±2.18)×10^(9)/L,t=8.51]均低于对照组(P<0.01);FEV1[(2.34±0.31)L比(1.92±0.33)L,t=6.22]、FVC[(3.45±0.46)L比(2.96±0.37)L,t=5.57]、FEV1/FVC[(68.82±8.64)%比(64.86±9.56)%,t=2.18]均高于对照组(P<0.01或P<0.05)。治疗期间,研究组不良反应发生率为4.44%(2/45)、对照组为11.11%(5/45),2组比较差异无统计学意义(χ^(2)=1.39,P=0.238)。结论泻肺通腑汤结合西医常规疗法可有效改善脑外伤后肺部铜绿假单胞菌感染痰热腑实证患者的临床症状,减轻炎症反应,改善肺功能。

Objective To analyze the effects of Xiefei Tongfu Decoction on syndrome of phlegm-heat and bowel-repletion in patients with pulmonary pseudomonas aeruginosa infection after brain trauma.Methods A total of 90 patients with pulmonary pseudomonas aeruginosa infection after traumatic brain injury received treatment in our hospital from August 2018 to May 2021 were selected and randomly divided into control group(n=45)and study group(n=45)by the random digital table method.The control group was treated with conventional western medicine,and the study group was treated with Xiefei Tongfu decoction and conventional western medicine.The TCM syndrome scores,inflammatory factor levels,like C-reactive protein(CRP),interleukin-6(IL-6),white blood cell count(WBC),and lung function indexes,like forced vital capacity(FVC),forced expiratory volume rate in the first second(FEV1),expiratory volume percentage in forced vital capacity(FEV1/FVC)were compared between the two groups before and after treatment.The clinical effect and adverse events of the two groups were compared.Results The total effective rate was 91.11%(41/45)in the study group and 73.33%(33/45)in the control group,with a statistically significant difference between the two groups(χ^(2)=4.97,P=0.027).After treatment,the scores of dizziness,headache,forgetfulness,insomnia and total scores in the study group were significantly lower than those in the control group(t values were 9.65,9.81,8.62,9.11,9.34,all Ps<0.01).After treatment,CRP[(95.66±11.67)mg/L vs.(107.82±12.99)mg/L,t=4.67],IL-6[(25.16±6.46)ng/L vs.(33.45±7.33)ng/L,t=5.69],WBC[(9.35±2.02)×10^(9)/L vs.(13.12±2.18)×10^(9)/L,t=8.51]in the control group were significantly lower than those in the control group(P<0.01).After treatment,the FEV1[(2.34±0.31)L vs.(1.92±0.33)L,t=6.22],FVC[(3.45±0.46)L vs.(2.96±0.37)L,t=5.57],FEV1/FVC[(68.82±8.64)%vs.(64.86±9.56)%,t=2.18]in the control group significantly higher than those in the control group(P<0.01 or P<0.05),and no serious adverse events occurred in any groups,and there was no significant difference between the two groups(χ^(2)=1.39,P=0.238).Conclusion The Xiefei Tongfu Decoction has a significant effect on patients with pulmonary pseudomonas aeruginosa infection after brain trauma,which can improve symptoms,relieve inflammatory response and enhance lung function with safety.