论安宫牛黄丸在重症救治中的应用
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摘要
安宫牛黄丸为中医急救用药,临床广泛应用于多种急性病证导致的高热昏迷。笔者结合重症医学科的使用经验,对于安宫牛黄丸的临床应用进行了归纳总结:一是安宫牛黄丸为清热解毒辟秽开窍之品,与紫雪丹、至宝丹功效类似而各有侧重;第二,重症患者可通过胃管、空肠管等方式给药,不受限于胃肠功能,化安宫牛黄丸之水温宜控制在40～60℃;第三,安宫牛黄丸之日用量依病情需要可用0.5～6丸不等,日用量超过2丸时应警惕毒性成分之蓄积;第四,安宫牛黄丸可根据病情需要,与苏合香丸、至宝丹等联合使用,亦可与紫雪散、牛黄清心丸序贯使用;第五,安宫牛黄丸可用于多种原发或继发的脑病,证候表现为热邪内闭的皆可酌情使用;第六,安宫牛黄在重症患者使用中,应严格掌握适应证用药,误用会导致病情加重,救误时应注重芳化温通。
Angong Niuhuang Pill,an emergency treatment drug in traditional Chinese medicine,is widely used for high fever and coma caused by many acute diseases. Combined with the experience of critical care medicine,the clinical application of Angong Niuhuang Pill is summarized as following: 1)Angong Niuhuang Pill,like Zixue Decoction and Zhibao Decoction,can clear away heat and toxic materials,activate spirit to resuscitate brain,but each has its special effects. 2)Severe patients can be administered,not restricted by gastrointestinal function,by stomach tube and jejunum tube to drink Chinese medicine. Besides,the temperature of water that dissolve Angong Niuhuang Pill should be controlled from 40 ℃ to 60 ℃. 3)The daily dosage of Angong Niuhuang Pill can vary from 0.5 pill to 6 pills according to patient′s condition. If the daily dosage exceeds 2 pills,the accumulation of toxic components should be monitored. 4)Angong Niuhuang Pill can be combined with Suhexiang Pill and Zhibao Decoction,or with Zixue Decoction and Niuhuang Qingxin Pill. 5)Angong Niuhuang Pill can be used in many kinds of primary or secondary encephalopathy,especially suitable for the syndrome of heat blocked in the pericardium. 6)For severe patients,it is necessary to strictly grasp the indication of the drug,as drug abuse will lead to the aggravation of the disease. If it happens,aromatic resuscitation drugs and warming Yang drugs should be used actively.
Angong Niuhuang Pill,an emergency treatment drug in traditional Chinese medicine,is widely used for high fever and coma caused by many acute diseases. Combined with the experience of critical care medicine,the clinical application of Angong Niuhuang Pill is summarized as following: 1)Angong Niuhuang Pill,like Zixue Decoction and Zhibao Decoction,can clear away heat and toxic materials,activate spirit to resuscitate brain,but each has its special effects. 2)Severe patients can be administered,not restricted by gastrointestinal function,by stomach tube and jejunum tube to drink Chinese medicine. Besides,the temperature of water that dissolve Angong Niuhuang Pill should be controlled from 40 ℃ to 60 ℃. 3)The daily dosage of Angong Niuhuang Pill can vary from 0.5 pill to 6 pills according to patient′s condition. If the daily dosage exceeds 2 pills,the accumulation of toxic components should be monitored. 4)Angong Niuhuang Pill can be combined with Suhexiang Pill and Zhibao Decoction,or with Zixue Decoction and Niuhuang Qingxin Pill. 5)Angong Niuhuang Pill can be used in many kinds of primary or secondary encephalopathy,especially suitable for the syndrome of heat blocked in the pericardium. 6)For severe patients,it is necessary to strictly grasp the indication of the drug,as drug abuse will lead to the aggravation of the disease. If it happens,aromatic resuscitation drugs and warming Yang drugs should be used actively.
引文
[1]潘雪英.探讨温度对雄黄中三氧化二砷含量的影响[J].中国药师,2005,8(9):797-798.
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[3]林瑾,王海曼,李昂,等.多器官功能障碍综合征患者胃肠功能损伤流行病学调查[J].中国临床医学,2009,16(6):863-864.
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[5]李珺,袁倬斌,韩树波,等.安宫牛黄丸中汞、砷的存在形式及其吸收与排泄[J].首都医科大学学报,2006,27(5):647-651.
[6]陆远富,吴芹,刘杰.安宫牛黄丸药理和毒理实验研究进展[J].成都医学院学报,2010,5(4):306-310.
[7]Xia F,Li A,Chai Y.UPLC/Q-TOFMS-Based metabolomics approach to reveal the protective role of other herbs in AnGong-Niu-Huang wan against the hepatorenal toxicity of cinnabar and realgar[J].Front Pharmacol,2018,13(9):618.
[8]张娟娟,王英,张雎扬.危重患者抗生素的药代动力学[J].国际呼吸杂志,2013,33(20):1547-1550.
[9]李俊,张丹,吴清和,等.安宫牛黄丸对脓毒症大鼠血浆内毒素水平的影响[J].时珍国医国药,2010,21(6):1320-1321.
[10]许再玲.安宫牛黄丸和肝安治疗重型极重型流行性乙型脑炎80例[J].浙江中医杂志,1995,30(7):302-303.
[11]张文燕,曲勇.安宫牛黄丸治疗高血压脑出血临床观察[J].中国中医急症,2005,14(11):1045,1072.
[12]冯跃明,杨辉.安宫牛黄丸治疗急性脑梗死昏迷患者促醒作用的观察[J].中国实验方剂学杂志,2015,21(6):179-182.
[13]徐杰丰,张茂.美国神经学会关于减轻心肺复苏后脑损伤的临床实践指南概要[J].中华急诊医学杂志,2017,26(8):857-858.
[14]梁月俭.清开灵并安宫牛黄丸治疗肺性脑病临床观察[J].中国中医急症,2006,15(6):614-615.王汉蓉,岑小波,等.安宫牛黄丸治疗肺性脑病的系统评价[J].中草药,2003,34(1):95-96.
[15]杨茂兰,张文三.安宫牛黄丸保留灌肠治疗肝性脑病32例[J].中西医结合肝病杂志,2000,10(1):64.
[16]张所乐,程剑华,赵德慧,等.安宫牛黄丸并中医辨证治疗中晚期原发性肝癌20例临床疗效观察[J].江西中医药,1991,22(2):37-38.
[17]王永恒.安宫牛黄丸在颅脑损伤中对意识障碍恢复的疗效观察[J].中西医结合杂志,1989,9(12):726-727,708-709.
[18]刘令锁,孙喜波,王其瑞.安宫牛黄丸对重型脑损伤患者降温止抽和促醒作用的临床观察[J].中西医结合实用临床急救,1999,6(1):38-39.
[19]王少锦,齐岚平,田新乐.安宫牛黄丸在脑弥漫性轴索损伤中的应用[J].中成药,2006,28(3):376-378.
[2]韩红,王厚力,于学忠,等.胃肠功能障碍/衰竭与危重病[J].中国医学科学院学报,2008,30(2):224-227.
[3]林瑾,王海曼,李昂,等.多器官功能障碍综合征患者胃肠功能损伤流行病学调查[J].中国临床医学,2009,16(6):863-864.
[4]许敏怡,熊秀萍,沈瑜倩.中医药在危重症患者胃肠功能障碍中的应用[J].中国中医急症,2013,22(11):1876-1877.
[5]李珺,袁倬斌,韩树波,等.安宫牛黄丸中汞、砷的存在形式及其吸收与排泄[J].首都医科大学学报,2006,27(5):647-651.
[6]陆远富,吴芹,刘杰.安宫牛黄丸药理和毒理实验研究进展[J].成都医学院学报,2010,5(4):306-310.
[7]Xia F,Li A,Chai Y.UPLC/Q-TOFMS-Based metabolomics approach to reveal the protective role of other herbs in AnGong-Niu-Huang wan against the hepatorenal toxicity of cinnabar and realgar[J].Front Pharmacol,2018,13(9):618.
[8]张娟娟,王英,张雎扬.危重患者抗生素的药代动力学[J].国际呼吸杂志,2013,33(20):1547-1550.
[9]李俊,张丹,吴清和,等.安宫牛黄丸对脓毒症大鼠血浆内毒素水平的影响[J].时珍国医国药,2010,21(6):1320-1321.
[10]许再玲.安宫牛黄丸和肝安治疗重型极重型流行性乙型脑炎80例[J].浙江中医杂志,1995,30(7):302-303.
[11]张文燕,曲勇.安宫牛黄丸治疗高血压脑出血临床观察[J].中国中医急症,2005,14(11):1045,1072.
[12]冯跃明,杨辉.安宫牛黄丸治疗急性脑梗死昏迷患者促醒作用的观察[J].中国实验方剂学杂志,2015,21(6):179-182.
[13]徐杰丰,张茂.美国神经学会关于减轻心肺复苏后脑损伤的临床实践指南概要[J].中华急诊医学杂志,2017,26(8):857-858.
[14]梁月俭.清开灵并安宫牛黄丸治疗肺性脑病临床观察[J].中国中医急症,2006,15(6):614-615.王汉蓉,岑小波,等.安宫牛黄丸治疗肺性脑病的系统评价[J].中草药,2003,34(1):95-96.
[15]杨茂兰,张文三.安宫牛黄丸保留灌肠治疗肝性脑病32例[J].中西医结合肝病杂志,2000,10(1):64.
[16]张所乐,程剑华,赵德慧,等.安宫牛黄丸并中医辨证治疗中晚期原发性肝癌20例临床疗效观察[J].江西中医药,1991,22(2):37-38.
[17]王永恒.安宫牛黄丸在颅脑损伤中对意识障碍恢复的疗效观察[J].中西医结合杂志,1989,9(12):726-727,708-709.
[18]刘令锁,孙喜波,王其瑞.安宫牛黄丸对重型脑损伤患者降温止抽和促醒作用的临床观察[J].中西医结合实用临床急救,1999,6(1):38-39.
[19]王少锦,齐岚平,田新乐.安宫牛黄丸在脑弥漫性轴索损伤中的应用[J].中成药,2006,28(3):376-378.