宣白承气汤治疗肺热腑实型重症肺炎合并胃肠功能障碍的临床研究

Clinical Study on Xuanbai Chengqi Decoction in the Treatment of Severe Pneumonia Complicated with Gastrointestinal Dysfunction of Lung Heat and FU-Organ Repletion Type

目的探讨宣白承气汤对肺热腑实型重症肺炎合并胃肠功能障碍患者呼吸、氧合功能及血清水通道蛋白(AQP)1和AQP5表达水平的影响。方法60例肺热腑实型重症肺炎合并胃肠功能障碍患者随机分为对照组和试验组各30例。对照组采用西医常规治疗,试验组在对照组治疗基础上加服宣白承气汤,2组疗程均为7 d。比较治疗前后2组患者呼吸频率和氧合指数、机械通气使用率、临床疗效评分(CURB-65、CPIS量表)、中医证候积分、胃肠功能指标[腹内压、血清促胃液素(GAS)和血管活性肠肽(VIP)]、血清AQP1和AQP5水平,记录并比较2组患者治疗期间机械通气天数及ICU住院天数。结果治疗后,与对照组比较,试验组患者呼吸频率、中医证候积分、腹内压均显著下降(P<0.05,P<0.01),血清GAS、AQP1和AQP5水平及氧合指数显著提高(P<0.05,P<0.01)。结论宣白承气汤能显著改善患者的呼吸和氧合功能等临床症状,其机制可能与调控AQP1和AQP5有关。

OBJECTIVE To explore the effect of Xuanbai Chengqi Decoction on respiratory and oxygenation functions and the expression levels of serum aquaporin(AQP)1 and AQP5 in patients with severe pneumonia complicated with gastrointestinal dysfunction of lung heat and fu-organ repletion type.METHODS 60 patients with severe pneumonia complicated with gastrointestinal dysfunction of lung heat and fu-organ repletion type were randomly divided into control group and treatment group,with 30 cases each.The control group received standardized Western medicine treatment,and the treatment group was treated with Xuanbai Chengqi Decoction in addition to the control group.Both groups were treated for 7 d.The respiratory rate and oxygenation index,mechanical ventilation utilization rate,the clinical score including CURB-65 and CPIS scores,TCM syndrome score,gastrointestinal function indicators including intra-abdominal pressure,serum gastrin(GAS)and vasoactive intestinal peptide(VIP),AQP1 and AQP5 levels were compared between the two groups before and after treatment.Ventilation utilization and ICU hospitalization days during treatment were compared between the two groups.RESULTS After treatment,compared with the control group,the respiratory rate,TCM syndrome score and intra-abdominal pressure in the treatment group were decreased significantly(P<0.05,P<0.01);meanwhile,the oxygenation index and the levels of serum GAS,AQP1 and AQP5 were increased significantly(P<0.05,P<0.01).CONCLUSION Xuanbai Chengqi Decoction can significantly improve clinical symptoms such as respiratory and oxygenation functions in patients,and its mechanism may be related to the regulation of AQP1 and AQP5.