涤痰汤治疗脑卒中肺部感染的疗效及对患者炎症反应的影响

Therapeutic effect of Ditan decoction in the treatment of pulmonary infection in patients after stroke and its influence on the inflammatory reaction

目的探讨涤痰汤治疗脑卒中肺部感染的疗效及对患者炎症反应的影响。方法采用随机数表法将60例脑卒中肺部感染患者分为对照组与治疗组,各30例。2组均给予常规治疗,对照组在此基础上给予阿托伐他汀钙片、阿司匹林肠溶片,同时予以膈肌起搏、呼吸肌训练及体外震动排痰等康复治疗,治疗组在对照组基础上给予涤痰汤进行治疗,2组均治疗4周。比较2组治疗4周后的临床疗效,治疗前、治疗4周后的中医症状评分、血栓弹力图、炎症指标及治疗期间的安全性。结果治疗4周后,与对照组比较,治疗组总有效率(93.33%,28/30)高于对照组(73.33%,22/30)(P<0.05)。治疗4周后,2组口舌歪斜、感觉消失或减退、半身不遂、不语或言语蹇涩、咳嗽、发热、咳痰、喘息评分、血细胞凝集块形成速率(α角)、最大血块强度(MA)及血清肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、C反应蛋白(CRP)水平低于治疗前,且治疗组咳嗽、发热、咳痰、喘息评分、α角、MA与血清TNF-α、IL-6、IL-8、CRP水平低于对照组(P<0.05);2组血小板凝集块形成时间(K值)、凝血反应时间(R值)高于治疗前,治疗组高于对照组(P<0.05)。对照组和治疗组治疗期间的总不良反应发生率比较无统计学差异(P>0.05)。结论涤痰汤可有效改善脑卒中肺部感染患者中医症状,抑制血栓形成,减轻炎症反应,疗效显著,安全性良好。

Objective To explore the therapeutic effect of Ditan decoction in the treatment ofpulmonary infection in patients after stroke and its influence on the inflammatory reaction.Methods A total of 60 stroke patients with pulmonary infection were divided into a control group and a treatment group using a random number table method,with 30 cases in each group.Both groups were given a routine treatment,while the control group was given atorvastatin calcium tablets,aspirin enteric coated tablets on that basis,as well as diaphragm pacing,respiratory muscle training,external vibration sputum excretion and other rehabilitation treatments,and the treatment group was given Ditan decoction on the basis ofthe control group,both for 4 weeks.The clinical efficacy after 4 weeks oftreatment,the scores oftraditional Chinese medicine symptoms,thromboelastograms,inflammatory indexes before and after 4 weeks of treatment and the safety during treatment of the two groups were compared.Results Compared with the control group,the total effective rate of the treatment group after 4 weeks of treatment was higher(93.33%vs 73.33%,P<0.05).After 4 weeks of treatment,the scores of skewed mouth and tongue,loss or reduction of sensation,hemiplegia,silence or stuttering,cough,fever,expectoration and wheezing,blood cell agglutination rate(a angle),maximum blood clot strength(MA)and the serum levels of tumor necrosis factor-a(TNF-α),interleukin-6(IL-6),mterleukin-8(IL-8)and C-reactive protein(CRP)in both groups were lower than those before treatment,and the scores of cough,fever,expectoration,wheezing,a angle,MA and the serum levels of TNF-α,IL-6,IL-8 and CRP in the treatment group were lower than those in the control group(P<0.05).The platelet clot formation time(K value)and coagulation reaction time(R value)in the two groups were higher than those before treatment,and those in the treatment group were higher than those in the control group(P<0.05).During treatment,there was no significant difFerence in the incidence of total adverse reactions between the control group and the treatment group(P>0.05).Conclusion Ditan decoction can effectively improve the traditional Chinese medicine symptoms of stroke patients with pulmonary infection,inhibit the formation of thrombosis,reduce their inflammatory reactions,having a significant efficacy and higher safety.