基于“瘀热”理论探讨桃仁承气汤治疗脓毒症急性呼吸窘迫综合征有效性的临床研究

Clinical Study on Efficacy of Taoren Chengqi Decoction(桃仁承气汤)in Treatment of Septic ARDS Based on Theory of“Blood Stasis and Heat”

目的探讨桃仁承气汤治疗脓毒症急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)的临床疗效。方法纳入脓毒症ARDS(毒瘀营血证)患者46例,随机分为对照组(23例)和中药治疗组(23例)。对照组给予常规西医治疗,中药组在常规西医治疗的基础上加用桃仁承气汤,观察7 d。观察治疗有效率、中医证候评分、急性生理和慢性健康评分(acute physiology and chronic health evaluation II,APACHE II)、脓毒症相关器官功能衰竭评分(sepsis-related organ failure assessment,SOFA)、氧合指数、C-反应蛋白(C-reactive protein,CRP)、降钙素原(procalcitonin,PCT)、白细胞介素-6(interleukin-6,IL-6)、凝血常规、组织因子(tissue factor,TF)、纤溶酶原激活物抑制剂-1(plasminogen activator inhibitor-1,PAI-1)、血液流变学。结果中药治疗组患者治疗有效率明显高于对照组(P<0.05),中药治疗组患者中医证候评分、APACHE II评分和SOFA评分低于对照组(P<0.05)。中药治疗组患者氧合指数高于对照组(P<0.05),中药治疗组患者CRP、PCT、纤维蛋白原(Fib)水平较治疗前下降(P<0.05)。中药治疗组患者全血黏度值(mPas)1、mPas 5、全血低切还原黏度低于较对照组(P<0.05)。结论桃仁承气汤治疗脓毒症ARDS患者是有效的,它可改善患者临床症状、氧合状况、减轻患者全身炎症反应、改善患者血液高凝状态、改善器官功能、减轻病情严重程度。

Objective To observe the clinical effect of Taoren Chengqi Decoction(桃仁承气汤)on sepsis patients with acute respiratory distress syndrome(ARDS).Methods Forty-six patients with septic ARDS were enrolled and randomly divided into the control group(23 cases)and the traditional Chinese medicine treatment group(23 cases).The control group was treated with conventional western medicine,and the traditional Chinese medicine group was treated with Taoren Chengqi Decoction on the basis of conventional western medicine for 7 days.The treatment efficiency,TCM syndrome scores,acute physiology and chronic health evaluation II(APACHE II)score,sepsis-related organ failure assessment(SOFA score),oxygenation index,C-reactive protein(CRP),procalcitonin(PCT),interleukin-6(IL-6),coagulation indexes,tissue factor(TF),plasminogen activator inhibitor-1(PAI-1)and hemorheology were observed.Results The effective rate in the traditional Chinese medicine treatment group was significantly higher than that in the control group(P<0.05),and the TCM syndrome scores,APACHE II score and SOFA score in the traditional Chinese medicine treatment group were lower than those in the control group(P<0.05).The oxygenation index in the traditional Chinese medicine treatment group was higher than that in the control group(P<0.05),and the levels of CRP,PCT and Fib in the traditional Chinese medicine treatment group were lower than those before treatment(P<0.05).The whole blood viscosity(mPas)1,mPas 5 and low shear reduction viscosity in the traditional Chinese medicine treatment group were lower than those in the control group(P<0.05).Conclusion Taoren Chengqi Decoction is effective in the treatment of septic ARDS.It can improve patients′clinical symptoms,oxygenation status and organ functions,and it also can reduce the patients′blood hypercoagulability,systemic inflammatory and the severity of the disease.