解毒清热宣肺方联合支气管镜肺泡灌洗治疗急性重症肺炎临床研究

Clinical Study on Jiedu Qingre Xuanfei Prescription Combined with Bronchoalveolar Lavage for Acute Severe Pneumonia

目的:观察解毒清热宣肺方联合支气管镜肺泡灌洗治疗急性重症肺炎的临床疗效及对肺泡灌洗液炎症指标的影响。方法:选取100例急性重症肺炎患者,按随机数字表法分为联合组和灌洗组各50例。灌洗组给予支气管镜肺泡灌洗治疗,联合组在灌洗组的基础上联合解毒清热宣肺方治疗。2组均连续治疗2周。比较2组临床疗效,治疗前后中医证候评分、肺泡灌洗液炎症指标[核因子-κB (NF-κB)、巨噬细胞炎症蛋白(MIP-2)、高迁移率族蛋白B1 (HMGB1)]、呼吸力学指标[气道阻力(Raw)、呼吸做功(WOB)]水平。结果:联合组总有效率为94.00%,灌洗组为86.00%,2组比较,差异无统计学意义(P>0.05)。治疗后,2组发热咳嗽、咳痰黄稠、气短气促、舌红脉滑数等证候评分均较治疗前降低(P<0.05),且联合组各项证候评分均显著低于灌洗组(P<0.05)。治疗后,2组NF-κB、MIP-2、HMGB1水平较治疗前显著降低(P<0.05),且联合组上述各项炎症指标水平均低于灌洗组(P<0.05)。治疗后,2组Raw、WOB水平均较治疗前降低(P<0.05),且联合组Raw、WOB水平均低于灌洗组(P<0.05)。结论:解毒清热宣肺方联合支气管镜肺泡灌洗治疗急性重症肺炎疗效肯定,可改善患者中医证候及呼吸功能,有效抑制肺部炎症反应。

Objective:To observe the clinical effect of Jiedu Qingre Xuanfei Prescription combined with bronchoalveolar lavage with the bronchoscope for acute severe pneumonia and its effect on inflammatory indicators in bronchoalveolar lavage fluid.Methods:A total of 100 cases of patients with acute severe pneumonia were selected and divided into the combination group and the lavage group according to the random number table method,with 50 cases in each group.The lavage group was treated with bronchoalveolar lavage with the bronchoscope,and the combination group was additionally treated with Jiedu Qingre Xuanfei Prescription based on the treatment of the lavage group.Both groups were treated continuously for 2 weeks.Traditional Chinese medicine(TCM) syndrome scores and the levels of inflammatory indicators in bronchoalveolar lavage fluid [nuclear factor(NF-κB),macrophage inflammatory protein 2(MIP-2),high mobility group protein B1(HMGB1)] and respiratory mechanics indicators [airway resistance(Raw),work of breathing(WOB)] before and after treatment,as well as clinical effects,were compared between the two groups.Results:The total effective rate was 94.0% in the combination group and 86.00% in the lavage group,and there was no significant difference being found in the comparison of the two groups(P>0.05).After treatment,the scores of fever and cough,cough with thick and yellow phlegm,short breath and panting,red tongue and slippery pulse,and other syndromes in the two groups were decreased when compared with those before treatment(P<0.05),and each TCM syndrome score in the combination group was significantly lower than that in the lavage group(P<0.05).After treatment,the levels of NF-κ,MIP-2,and HMGB1 in the two groups were significantly decreased when compared with those before treatment(P<0.05),and the above inflammatory indicators in the combination group were significantly lower than those in the lavage group(P<0.05).After treatment,the levels of Raw and WOB in the two groups were decreased when compared with those before treatment(P<0.05),and the two levels in the combination group were lower than those in the lavage group(P<0.05).Conclusion:Jiedu Qingre Xuanfei Prescription combined with bronchoalveolar lavage with the bronchoscope has a definite curative effect in the treatment of acute severe pneumonia,which can improve TCM syndromes and respiratory function,and effectively inhibit pulmonary inflammatory reactions.