宣肺调肠方治疗脑出血术后肺炎痰热腑实型患者的临床研究

A clinical study on the effect of Xuanfei Tiaochang decoction in the treatment of pneumonia patients with heat-phlegm and sthenic-fu type after brain hemorrhage surgery

目的:探讨宣肺调肠方对脑出血术后并发肺炎痰热腑实证患者的有效性及安全性,以期改善临床症状,提高疗效。方法:以42例脑出血术后合并肺炎痰热腑实证患者为研究对象,将其随机分为试验组(常规治疗加宣肺调肠方)和对照组(常规治疗),疗程为5天,对比两组的治疗有效率、中医证候积分、呼吸功能、肠道功能、炎症指标。结果:(1)试验组的治疗总有效率比对照组高,但两组间差异无统计学意义(P>0.05)。(2)两组治疗后的中医证候积分差异无统计学意义(P>0.05),但治疗前后组内差异有统计学意义(P<0.05)。(3)呼吸功能指标:(1)治疗后两组间临床肺部感染评分量表(Clinical Pulmonary Infection Score,CPIS)评分、pH、动脉血氧分压(Partial Pressure of Oxygen,PaO_(2))、动脉血二氧化碳分压(Partial Pressure of Carbon Dioxide,PaCO_(2))、PaO_(2)/吸入氧体积分数(Fraction of Inspire Oxygen,FiO_(2))差异均无统计学意义(P>0.05)。(2)两组治疗后乳酸(Lac)水平、试验组治疗前后的CPIS评分和Lac差值的差异有统计学意义(P<0.05)。(4)肠道功能指标:治疗后两组间的肠内营养耐受性评分和胃肠功能衰竭(Gas-trointestinal Failure,GIF)评分差异有统计学意义(P<0.05)。(5)炎症指标:治疗后两组间的C反应蛋白(C-reactive Protein,CRP)、降钙素原(Procalcitonin,PCT)、白细胞介素(Interleukin,IL)-6、肿瘤坏死因子(Tumor Necrosis Factor,TNF)-α相比,差异均无统计学意义(P>0.05),试验组患者治疗后的白细胞计数(White Blood Cell Count,WBC)低于对照组(P<0.05)。(6)安全性评价情况:两组不良事件发生率及各组治疗后出现血常规、肝肾功能异常情况相比,差异不具有统计学意义(P>0.05)。结论:宣肺调肠方联合常规治疗可以提高脑出血术后合并肺炎痰热腑实证患者的肠内营养耐受性,改善胃肠功能,降低Lac指标,降低中医证候积分,改善临床症状。

Objective:To explore the effectiveness and safety of Xuanfei Tiaochang decoction(宣肺调肠方)in treating pneumonia patients with heat-phlegm and sthenic-fu type after cerebral hemorrhage operation,in order to relieve clinical symptoms and improve curative effect.Methods:A total of 42 patients with pneumonia of heat-phlegm and sthenic-fu type after cerebral hemorrhage were randomly divided into the experimental group(took conventional treatment plus Xuanfei Tiaochang decoction)and the control group(took conventional treatment).The course of treatment was 5 days.The treatment efficiency,TCM symptom score,respiratory function,intestinal function and inflammation indexes were compared between the two groups.Results:(1)The total effective rate of the treatment in the experimental group was higher than that in the control group,while the difference was not statistically significant(P>0.05).(2)There was no significant difference in TCM symptom scores between the two groups after treatment(P>0.05),but the difference between the two groups after treatment was statistically significant compared with that before treatment(P<0.05).(3)Respiratory function indexes:①The difference in CPIS scores,pH,PaO_(2),PaCO_(2) and PaO_(2)/FiO_(2) between the two groups after treatment was not statistically significant(P>0.05).②There was a statistically significant difference in Lac between the two groups after treatment as well as in CPIS score and Lac before and after treatment in the experimental group(P<0.05).(4)Intestinal function indicators:There were significant differences in enteral nutrition tolerance score and GIF score between the two groups after treatment(P<0.05).(5)Inflammation indexes:There was no significant difference in WBC,CRP,PCT,IL-6 and TNF-αbetween the two groups after treatment(P>0.05).(6)Safety evaluation indexes:There was no significant difference in the incidence of adverse events,and blood routine,liver and kidney function abnormalities between the two groups after treatment(P>0.05).Conclusion:Xuanfei Tiaochang decoction combined with conventional treatment can improve enteral nutrition tolerance and gastrointestinal function,reduce Lac index and TCM syndrome score,and relieve clinical symptoms in patients with cerebral hemorrhage complicated with phlegm-heat and sthenic-fu type syndrome after pneumonia.