四逆升降散干预“肝-脾轴”改善脓毒症急性肺损伤预后的临床研究

Clinical Study on the Intervention of Sepsis-Induced Acute Lung Injury Prognosis by Sini Shengjiang Powder through Modulating the Liver-Spleen Axis

目的探讨四逆升降散通过干预“肝-脾轴”来改善脓毒症急性肺损伤预后的临床疗效。方法选取70例脓毒症急性肺损伤患者,随机分为治疗组与对照组各35例。在常规的西医集束化治疗基础上,对照组患者予四逆升降散安慰剂,治疗组患者予四逆升降散方,治疗周期均为1周。分别比较两组受试者治疗前、治疗第3天、治疗第7天血清白三烯B4(LTB4)、肿瘤坏死因子-α(TNF-α)、氧分压(PaO_(2))、二氧化碳分压(PaCO_(2))、氧合指数(P/F)、乳酸(Lac)、血清丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、总胆红素(TBil)、谷氨酰胺转氨酶(GGT)水平;治疗前、治疗第7天肝左叶厚度、肝左叶长度、肝右叶最大斜径、肝右叶前厚度、肝右叶前后径、脾脏厚度、脾脏长度;随访两组住院天数及28 d生存率。结果治疗组治疗3、7 d后PaO_(2)、P/F较治疗前明显升高(P<0.05),治疗3 d后Lac较治疗前下降(P<0.05),治疗7 d后肝左叶长度、脾脏厚度较治疗前下降(P<0.05)。对照组治疗后均未见明显改善作用(P>0.05)。两组治疗3、7 d后LTB4、TNF-α、Lac组间比较均有显著差异(P<0.05),治疗7 d后PaO_(2)、P/F、肝左叶厚度均有改善,组间比较均有显著差异(P<0.05)。治疗组28 d生存率明显高于对照组,有显著差异(P<0.05),住院天数未见明显差异(P>0.05)。结论四逆升降散可以通过改善脓毒症急性肺损伤患者通气功能状况,提高生存率,改善临床症状,提高临床疗效;“肝-脾轴”在脓毒症急性肺损伤中存在一定的临床作用。

Objective:To investigate the clinical efficacy of Sini Shengjiang Powder in improving the prognosis of septic acute lung injury by modulating the Liver-Spleen Axis.Methods:70 patients with sepsis acute lung injury were randomly divided into treatment group and control group,each with 35 cases.All participants received standard western medicine bundle therapy.The control group received a placebo of Sini Shengjiang Powder,while the treatment group received the actual Sini Shengjiang Powder.The treatment was one week.Comparisons were made between the two groups regarding serum levels of leukotriene B4(LTB4),tumor necrosis factor-α(TNF-α),partial pressure of oxygen(PaO_(2)),partial pressure of carbon dioxide(PacO_(2)),oxygenation index(P/F ratio),lactate(Lac),serum alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBil),and gammaglutamyl transferase(GGT)before treatment,on day 3,and on day 7 of treatment.Additionally,the thickness and length of the left liver lobe,maximum oblique diameter,anterior-posterior diameter of the right liver lobe,thickness of the spleen,and length of the spleen were measured before treatment and on day 7.Follow-up included hospital stay duration and 28 days survival rates for both groups.Results:In the treatment group,the PaO_(2) and P/F ratio significantly increased after 3 and 7 days of treatment(P<0.05),and Lac decreased after 3 days of treatment(P<0.05).The thickness of the left liver lobe and the thickness of the spleen decreased after 7 days of treatment(P<0.05).No significant improvements were observed in the control group(P>0.05).Significant differences were noted between the two groups in LTB4,TNF-α,and Lac levels after 3 and 7 days of treatment(P<0.05).Improvements in PaO_(2),P/F ratio,left liver lobe length,and spleen thickness were observed,with significant differences between the groups after 7 days of treatment(P<0.05).The 28 day survival rate was significantly higher in the treatment group compared with the control group(P<0.05),but no significant dfference was observed during hospital stay(P>0.05).Conclusion:Sini Shengjiang Powder can improve ventilation function in patients with sepsis-induced acute lung injury,enhance patient survival rates,and improve clinical symptoms,thus increasing clinical efficacy.The clinical study indicates that the Liver-Spleen Axis plays a role in sepsis-induced acute lung injury.