凉膈散加味方治疗脓毒症致急性呼吸窘迫综合征的效果

Curative effect of Liangge powder modified prescription on acute respiratory distress syndrome caused by sepsis

目的探讨凉膈散加味方对脓毒症致急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)的疗效。方法将80例脓毒症致ARDS患者随机分为对照组(乌司他丁治疗)和试验组(凉膈散加味方联合乌司他丁治疗),比较两组治疗前后动脉二氧化碳分压(pressure of arterialcarbon dioxide,PaCO_(2))、氧分压(partial pressure of oxygen,PaO_(2))、氧合指数(PaO_(2)/FiO_(2))、C-反应蛋白(C-reactive protein,CRP)、白介素(interleukin,IL)-6、肿瘤坏死因子(tumor necrosis factor,TNF)-α、血管外肺水(extravascular lung water index,EVLWI)和肺血管通透性指数(pulmonary vascular permeability index,PVPI)、预后情况及安全性。结果治疗后,试验组总有效率高于对照组(P<0.05)。试验组PaO_(2)及PaO_(2)/FiO_(2)均高于治疗前及对照组(P<0.05),PaCO_(2)、血清CRP、IL-6、TNF-α及EVLWI、PVPI均降低,且低于对照组(P<0.05);试验组机械通气时间、重症监护室住院时间短于对照组(P<0.05);28 d病死率、治疗后急性生理学及慢性健康状况Ⅱ评分及序贯性器官功能衰竭评分低于对照组(P<0.05)。两组不良反应发生率差异无统计学意义(P>0.05)。结论凉膈散加味方联合乌司他丁可有效提高脓毒症致ARDS患者呼吸功能,减轻其炎症反应,纠正低氧血症,缩短机械通气及住院时间,降低病死率,改善预后,且安全性良好。

Objective To investigate the curative effect of Liangge powder modified prescription on acute respiratory distress syndrome(ARDS)caused by sepsis.Methods Eighty patients with ARDS caused by sepsis were randomly divided into control group(ulinastatin treatment)and experimental group(Liangge powder modified prescription combined with ulinastatin treatment).The arterial carbon dioxide pressure(PaCO_(2))and partial pressure of oxygen(PaO_(2)),oxygenation index(PaO_(2)/FiO_(2)),C-reactive protein(CRP),interleukin(IL)-6,tumor necrosis factor(TNF)-α,extravascular lung water index(EVLWI),pulmonary vascular permeability index(PVPI),prognosis and safety were compared between the two groups before and after treatment.Results After treatment,the total effective rate of experimental group was higher than that of control group(P<0.05).PaO_(2) and PaO_(2)/FiO_(2) in the experimental group were higher than before treatment and the control group(P<0.05).The PaCO_(2),serum CRP,IL-6,TNF-α,EVLWI and PVPI in the experimental group were lower than those of the control group(P<0.05).The mechanical ventilation time and ICU stay time of the experimental group were shorter than those of the control group(P<0.05).The mortality rate of 28 d,acute physiology and chronic health evaluation II and sequential organ failure assessment score after treatment were lower than those of control group(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion Liangge powder modified prescription combined with ulinastatin in the treatment of ARDS caused by sepsis can effectively improve the respiratory function of patients,reduce inflammation,correct hypoxemia,shorten mechanical ventilation and hospital stay,reduce mortality,improve prognosis,and have good safety.