联合凉膈散治疗脓毒症ARDS的疗效及其对血清CC-16、Ang-2、vWF的影响

Efficacy of combined Lianggesan in the treatment of sepsis ARDS and its effect on serum CC-16,Ang-2 and vWF

目的研究联合凉膈散治疗脓毒症急性呼吸窘迫综合征(ARDS)的疗效及其对血清Clara细胞分泌蛋白-16(CC-16)、血管生成-2(Ang-2)、血管性血友病因子(vWF)的影响。方法前瞻性选择2021年7月至2023年6月在河北省沧州中西医结合医院治疗的脓毒症ARDS患者98例,按照随机数字表法将其分为试验组与对照组,每组各49例。对照组行常规对症治疗,试验组行常规对症治疗+凉膈散治疗。比较两组治疗7 d后临床疗效;两组治疗7 d后机械通气时间、入住ICU时间;治疗前及治疗7 d后病情严重程度[急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)]、血气分析指标[动脉血氧分压(PaO_(2))、氧合指数(PaO_(2)/FiO_(2))及动脉血氧饱和度(SaO_(2))]、血清CC-16、Ang-2、vWF水平。结果试验组总有效率为91.84%,高于对照组(73.47%),差异有统计学意义(P<0.05)。试验组机械通气时间、入住ICU时间分别为(5.62±0.58)、(8.76±0.90)d,均小于对照组[(8.94±0.92)、(13.87±1.53)d],差异均有统计学意义(P<0.05)。治疗7 d后,试验组APACHEⅡ评分为(9.79±1.04)分,低于对照组[(13.59±1.57)分],PaO_(2)、PaO_(2)/FiO_(2)、SaO_(2)分别为(94.29±9.65)mmHg、(326.08±35.86)mmHg、1.03±0.12,均高于对照组[(80.38±8.42)mmHg、(268.69±28.75)mmHg、0.88±0.09],差异均有统计学意义(P<0.05)。治疗7 d后,试验组血清CC-16、Ang-2、vWF水平分别为(42.73±4.45)ng/L、2083(1879,2205)pg/mL、(4.95±0.52)μg/mL,均低于对照组[(49.35±5.14)ng/L、2749(2562,3075)pg/mL、(5.53±0.58)μg/mL],差异均有统计学意义(P<0.05)。结论联合凉膈散治疗脓毒症ARDS可改善患者症状,缩短其恢复时间,改善患者血气分析指标,降低血清CC-16、Ang-2、vWF水平,疗效显著。

Objective To study the efficacy of combined Lianggesan in the treatment of sepsis acute respiratory distress syndrome(ARDS)and its effect on serum clara cell secretory protein-16(CC-16),angiogeny-2(Ang-2)and von Willeophilia factor(vWF).Methods A total of 98 cases of ARDS patients with sepsis treated in Cangzhou Hospital of Integrated TCM-WM·Hebei from July 2021 to June 2023 were prospectively selected and divided into the experimental group(n=49)and the control group(n=49)according to random number table method.The control group received symptomatic treatment,the experimental group received symptomatic treatment+Lianggesan treatment.The clinical efficacy of the two groups was compared after 7 d of treatment.At 7 d after treatment,mechanical ventilation time and ICU admission time were observed in the two groups.The severity of the disease[acute physiology and chronic health status evaluationⅡ(APACHEⅡ)],blood gas analysis indexes[arterial partial oxygen pressure(PaO_(2)),oxygenation index(PaO_(2)/FiO_(2)),arterial oxygen saturation(SaO_(2))],serum CC-16,Ang-2,vWF levels before and 7 days after treatment were compared between the two groups.Results The total effective rate in the experimental group was 91.84%,which was higher than that in the control group(73.47%),and the difference was statistically significant(P<0.05).The duration of mechanical ventilation and ICU stay in the experimental group were(5.62±0.58)d and(8.76±0.90)d,respectively,which were shorter than those in the control group[(8.94±0.92)d and(13.87±1.53)d],and the differences were statistically significant(P<0.05).At 7 d after treatment,the APACHEⅡscore in the experimental group was(9.79±1.04)points,which was lower than that in the control group[(13.59±1.57)points],the PaO_(2),PaO_(2)/FiO_(2),and SaO_(2) in the experimental group were(94.29±9.65)mmHg,(326.08±35.86)mmHg,and 1.03±0.12,respectively,which were higher than those in the control group[(80.38±8.42)mmHg,(268.69±28.75)mmHg,0.88±0.09],and the differences were statistically significant(P<0.05).At 7 d after treatment,the levels of serum CC-16,Ang-2,and vWF in the experimental group were(42.73±4.45)ng/L,2083(1879,2205)pg/mL,and(4.95±0.52)μg/mL,respectively,which were lower than those in the control group[(49.35±5.14)ng/L,2749(2562,3075)pg/mL,and(5.53±0.58)μg/mL],the differences were statistically significant(P<0.05).Conclusion Combined Lianggesan can improve the symptoms,shorten the recovery time,improve the blood gas analysis index,and reduce the serum CC-16,Ang-2 and vWF levels in the treatment of ARDS with sepsis.