升陷汤加味对脓毒症所致急性呼吸窘迫综合征血管外肺水指数和肺损伤预测评分的影响

Effect of modified Shengxian Decoction on extravascular lung water index and lung injury prediction score of patients with acute respiratory distress syndrome caused by sepsis

目的探讨升陷汤加味对脓毒症所致急性呼吸窘迫综合征(ARDS)患者血管外肺水指数(EVLWI)和肺损伤预测评分(LIPS)的影响。方法前瞻性队列研究。将符合入选标准的2019年1月-2021年5月上海中医药大学附属曙光医院宝山分院200例脓毒症所致ARDS患者,采用随机数字表法分为2组,每组100例。对照组采用西医常规疗法治疗,观察组在对照组基础上服用升陷汤加味治疗。2组均治疗7 d。采用全自动血气分析仪检测pH值、吸入氧浓度(FiO_(2))、PaO_(2)、PaCO_(2),计算氧合指数;采用ELISA法检测血清超敏C反应蛋白(hs-CRP)、IL-6,双抗体夹心免疫发光法检测降钙素原(PCT);采用急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)、LIPS评估肺损伤严重程度及预后;采用液体复苏中连续心排血量监测技术监测患者EVLWI和心脏指数(CI),观察并记录机械通气时间和重症监护室住院时间。结果治疗后,观察组PaCO_(2)[(37.15±5.42)mmHg比(38.24±3.24)mmHg,t=2.03]低于对照组(P<0.05);氧合指数[(292.34±78.91)比(236.54±70.58),t=5.27]高于对照组(P<0.05);血清hs-CRP[(35.21±6.73)mg/L比(48.97±8.52)mg/L,t=12.67]、IL-6[(40.57±8.51)ng/L比(47.61±9.97)ng/L,t=5.37]、PCT[(0.75±0.21)μg/L比(1.14±0.38)μg/L,t=8.98]水平低于对照组(P<0.01);APACHEⅡ[(11.14±0.54)分比(14.67±0.89)分,t=33.91]、LIPS[(2.21±0.73)分比(4.59±0.88)分,t=20.82]、EVLWI[(6.19±0.42)ml/kg比(8.24±0.78)ml/kg,t=23.14]低于对照组(P<0.01);CI[(4.49±1.27)L(/min·m^(2))比(3.61±0.88)L(/min·m^(2)),t=5.70]高于对照组(P<0.01)。治疗期间,观察组机械通气时间和重症监护室住院时间均较对照组缩短(t值分别为3.66、5.74,P<0.01)。结论升陷汤加味可降低脓毒症所致ARDS患者炎症因子水平及EVLWI、LIPS评分,改善血气分析指标,缩短机械通气时间和重症监护室住院时间。

Objective To observe the effect of modified Shengxian Decoction on extravascular lung water index(EVLWI)and lung injury prediction score(LIPS)in patients with acute respiratory distress syndrome(ARDS)caused by sepsis.Methods Prospective cohort study.A total of 200 patients with ARDS caused by sepsis who were hospitalized in Baoshan Branch,Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from January 2019 to May 2021 were selected and divided into the observation group and control group by random number table method,with 100 in each group.The patients in the control group were given rountin western medicine treatment according to the guidelines,and the patients in the observation group were treated with modified Shengxian Decoction on the basis of the treatment in the control group.Both groups were treated for 7 days as a course of treatment.The PH value,oxygen volume index(FiO_(2)),oxygen partial pressure(PaO_(2)),arterial carbon dioxide partial pressure(PaCO_(2))of the two groups before and after treatment,calculate the oxygenation index(PaO_(2)/FiO_(2))were observed and compared.The C-reactive protein(hs-CRP),interleukin-6(IL-6)levels were observed by ELISA,the procalcitonin(PCT)levels was detected by double antibody sandwich immunoluminescence method.The APACHEⅡscore and LIPS score,EVLWI and cardiac index(CI)of the two groups were observed and compared.The mechanical ventilation time and ICU hospitalization time of the two groups were compared.Results After treatment,the PaCO_(2) level[(37.15±5.42)mmHg vs.(38.24±3.24)mmHg,t=2.03]of the observation group was significantly lower than that of the control group,and the oxygenation index(292.34±78.91 vs.236.54±70.58,t=5.27)was significantly higher than that of the control group(P<0.05).After treatment,the levels of hs-CRP[(35.21±6.73)mg/L vs.(48.97±8.52)mg/L,t=12.67],IL-6[(40.57±8.51)ng/L vs.(47.61±9.97)ng/L,t=5.37]and PCT[(0.75±0.21)μg/L vs.(1.14±0.38)μg/L,t=8.98]in the observation group were significantly lower than those in the control group(P<0.01).After treatment,the APACHEⅡscore[11.14±0.54 vs.14.67±0.89,t=33.91],LIPS score(2.21±0.73 vs.4.59±0.88,t=20.82),and EVLWI[(6.19±0.42)ml/kg vs.(8.24±0.78)ml/kg,t=23.14]of the observation group were significantly lower than those in the control group,and the CI level[(4.49±1.27)L/(min·m^(2))vs.(3.61±0.88)L/(min·m^(2)),t=5.70]was significantly higher than that of the control group(P<0.01).The mechanical ventilation time and ICU stay in the observation group were shorter than those in the control group(t=3.66,5.74,P<0.01).Conclusion The modified Shengxian Decoction can reduce the level of inflammation indexes in patients with ARDS caused by sepsis,reduce EVLWI and LIPS scores,improve blood gas analysis indexes,and shorten the time of mechanical ventilation and ICU hospitalization.