麻杏石甘汤对重症肺炎肺功能及微观指标的影响
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摘要
目的:分析麻杏石甘汤化裁辨治对重症肺炎患者肺功能、微观指标、病情进展影响性,为重症肺炎治疗方案选择提供参考。方法:选取2015年2月至2017年1月郑州市第九人民医院收治的重症肺炎患者112例,按照入组顺序编号,单号为对照组,双号为观察组,每组56例。对照组采用常规西药治疗,观察组患者在常规西药治疗的基础上加用麻杏石甘汤化裁辨治。2组均连续治疗2周(1个疗程)。比较2组治疗前、治疗后肺功能指标:呼吸频率(RR)、用力肺活量(FVC)、第1秒用力呼吸容积(FEV1)、动脉血氧分压(PaO_2)、动脉血二氧化碳(Pa CO_2)、最大呼气中段流量(ma MMF)、氧合指数(IO)。微观指标:红细胞分布宽度(RWD)、血小板分布宽度(PWD)、高迁移率族蛋白B1(HMGB1)、肿瘤坏死因子-α(TNF-α)、降钙素原(PCT)、白细胞介素-6(IL-6)。病情变化指标:APACHEⅡ评分、CPIS评分、PIS评分情况。比较2组治疗过程中药物不良反应和预后结果。结果:2组治疗后APACHEⅡ评分、CPIS评分、PIS评分均较治疗前明显下降,且观察组明显低于对照组(P <0. 05); 2组治疗后RR、FVC、FEV1、ma MMF、IO较治疗前均升高,且观察组高于对照组(P <0. 05); 2组治疗后,观察组RWD、PWD、HMGB1、TNF-α、PCT、IL-6均较治疗前明显下降,且观察组低于对照组(P <0. 05);2组治疗过程中药物不良反应率比较,差异无统计学意义(P> 0. 05);观察组患者30 d内死亡4例,死亡率7. 14%,对照组死亡7例,死亡率12. 50%,观察组死亡率明显低于对照组(P <0. 05)。结论:麻杏石甘汤辅助西药化裁治疗重症肺炎能降低患者炎性反应、呼吸功能,减缓病情进展,更具优势,可有效提升患者预后,且安全性高,具有较高临床价值。
Objective: To analyze the effects of Maxing Shigan Decoction on pulmonary function,microscopic indexes and disease progression in patients with severe pneumonia,and to provide reference for the choice of treatment scheme for severe pneumonia.Methods: A total of 112 cases of severe pneumonia treated in Ninth People's Hospital of Zhengzhou from February 2015 to January2017 were numbered according to the order of entry,and the odd number was the control group and the even number was the observation group,with 56 cases in each group. The control group was treated with routine therapy of Western medicine,on the basis of which the observation group was treated with Maxing Shigan Decoction. Two groups of patients were treated continuously for 2 weeks as a course of treatment. The pulmonary function indexes before and after treatment were compared between the two groups,including respiratory rate (RR),forced vital capacity (FVC),forced breathing volume (FEV1),arterial oxygen partial pressure (PaO_2),arterial blood carbon dioxide (PaCO_2),maximum exhalation middle segment flow (ma MMF),oxygen index (IO); microscopic indexes,including red blood cell distribution width (RWD),platelet distribution width (PWD),high mobility group protein B1 (HMGB1),tumor necrosis factor-alpha (TNF-alpha),calcitonin (PCT),interleukins-6 (IL-6); and condition change index,including APACHE II score,CPIS score,and PIS score. The adverse drug reactions during treatment were compared between the two groups. The outcome of the two groups was compared. Results: 1) The APACHE II score,CPIS score and PIS score of the two groups were significantly decreased after the treatment,and the scores of patients in the observation group were significantly lower than those of the control group (P < 0. 05); 2) RR,FVC,FEV1,ma MMF and IO of the two groups were increased after the treatment,and those of the observation group were higher than those of the control group (P < 0. 05); 3) after the treatment,the RWD,PWD,HMGB1,TNF-α,PCT and IL-6 in the observation group were significantly decreased and were lower than those of the control group (P < 0. 05); 4) there was no significant difference in the rate of adverse drug reactions in the two groups (P >0. 05); 5) The mortality rate in the observation group was 7. 14% with 4 cases. The mortality rate in the control group was12. 50% with 7 cases. The mortality in the observation group was significantly lower than that in the control group (P < 0. 05).Conclusion: Maxing Shigan Decoction in the treatment of severe pneumonia patients combined with Western medicine can reduce the inflammatory state of the patients,improve the immune function,respiratory function,slow down the disease progression,and improve the prognosis of the patients effectively,with high safety and high clinical value.
Objective: To analyze the effects of Maxing Shigan Decoction on pulmonary function,microscopic indexes and disease progression in patients with severe pneumonia,and to provide reference for the choice of treatment scheme for severe pneumonia.Methods: A total of 112 cases of severe pneumonia treated in Ninth People's Hospital of Zhengzhou from February 2015 to January2017 were numbered according to the order of entry,and the odd number was the control group and the even number was the observation group,with 56 cases in each group. The control group was treated with routine therapy of Western medicine,on the basis of which the observation group was treated with Maxing Shigan Decoction. Two groups of patients were treated continuously for 2 weeks as a course of treatment. The pulmonary function indexes before and after treatment were compared between the two groups,including respiratory rate (RR),forced vital capacity (FVC),forced breathing volume (FEV1),arterial oxygen partial pressure (PaO_2),arterial blood carbon dioxide (PaCO_2),maximum exhalation middle segment flow (ma MMF),oxygen index (IO); microscopic indexes,including red blood cell distribution width (RWD),platelet distribution width (PWD),high mobility group protein B1 (HMGB1),tumor necrosis factor-alpha (TNF-alpha),calcitonin (PCT),interleukins-6 (IL-6); and condition change index,including APACHE II score,CPIS score,and PIS score. The adverse drug reactions during treatment were compared between the two groups. The outcome of the two groups was compared. Results: 1) The APACHE II score,CPIS score and PIS score of the two groups were significantly decreased after the treatment,and the scores of patients in the observation group were significantly lower than those of the control group (P < 0. 05); 2) RR,FVC,FEV1,ma MMF and IO of the two groups were increased after the treatment,and those of the observation group were higher than those of the control group (P < 0. 05); 3) after the treatment,the RWD,PWD,HMGB1,TNF-α,PCT and IL-6 in the observation group were significantly decreased and were lower than those of the control group (P < 0. 05); 4) there was no significant difference in the rate of adverse drug reactions in the two groups (P >0. 05); 5) The mortality rate in the observation group was 7. 14% with 4 cases. The mortality rate in the control group was12. 50% with 7 cases. The mortality in the observation group was significantly lower than that in the control group (P < 0. 05).Conclusion: Maxing Shigan Decoction in the treatment of severe pneumonia patients combined with Western medicine can reduce the inflammatory state of the patients,improve the immune function,respiratory function,slow down the disease progression,and improve the prognosis of the patients effectively,with high safety and high clinical value.
引文
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[10]王东升.蒿芩麻杏石甘汤配合拔罐治疗小儿肺炎支原体肺炎临床疗效观察[D].北京:北京中医药大学,2017.
[11]刁云锋,张士俊,赵万勇,等.血必净注射液对重症肺炎患者血浆IL-6和TNF-α水平的影响[J].中草药,2017,48(6):1188-1191.
[12]韩健.白虎汤联合还原型谷胱甘肽治疗重症肺炎伴高热临床研究[J].中医学报,2017,32(2):201-205.
[13]杨桦,陈霁虹.合用千金苇茎汤治疗重症肺炎疗效观察[J].浙江中医药大学学报,2011,35(1):38-39,48.
[14]霍红梅,陈丽珠,陈杰奎.布地奈德雾化吸入联合麻杏石甘汤加减对肺炎高热小儿血清CRP影响及临床疗效研究[J].辽宁中医药大学学报,2016,18(7):186-188.
[15]程瑞蓉.麻杏石甘汤联合支气管肺泡灌洗治疗婴幼儿重症肺炎临床研究[J].河南中医,2016,36(2):198-199.
[16]翁维杰,黄崇林.麻杏石甘汤联合西药治疗重症肺炎疗效观察[J].新中医,2015,47(4):51-52.
[17]王斌梁,孔一名,张蓉映.重症肺炎患者下呼吸道内s TREM-1、TNF-α及IL-10水平的变化[J].中国现代医生,2012,50(28):8-10.
[18]王凤英,李良业,韩卢丽,等.中药肠道净化治疗重症肺炎的临床疗效及对TNF-α、s ICAM-1的影响[J].新中医,2010,42(12):11-12.
[19]白雪.观察麻杏石甘汤合千金苇茎汤加味治疗重症肺炎的临床疗效[J].世界最新医学信息文摘(连续型电子期刊),2018,18(21):146.
[2]何峻,胡松.经纤维支气管镜肺泡灌洗治疗重症肺炎的临床研究[J].中国中医药咨讯,2011,3(17):89-90.
[3]赵兴峰.宣白承气汤加减联合西医常规治疗痰热壅肺型重症肺炎的临床疗效及对炎症因子白细胞介素6、超敏C反应蛋白、肿瘤坏死因子α水平的影响[J].河北中医,2018,40(4):558-561.
[4]Brown SM,Jones BE,Jephson AR,et al.Validation of the Infectious Disease Society of America/American Thoracic Society 2007 guidelines for severe community-acquired pneumonia[J].Crit Care Med,2009,37(12):3010-3016.
[5]中国中医药管理局.中医病症诊断疗效标准[S].南京:南京大学出版社,1994:25.
[6]吕波,陈立,李兰,等.通腑理肺汤结肠透析联合肺泡灌洗对重症肺炎合并脓毒症TNF-α、IL-6的影响[J].中医药学报,2018,46(1):83-87.
[7]杨轶男,王海燕,朝鲁门其其格.氧合指数及肺泡动脉氧分压差监测对小儿重症肺炎的临床价值分析[J].中国医药导报,2018,15(1):72-75.
[8]刘道莹,刘笛,尹昆.重症肺炎患者血清NT-proBNP和HMGB1水平的变化及其意义[J].中国现代医学杂志,2017,27(17):58-61.
[9]陈锋.丹参酮ⅡA磺酸钠注射液联合阿奇霉素治疗重症肺炎患者的临床观察[J].包头医学院学报,2017,33(6):31-32,44.
[10]王东升.蒿芩麻杏石甘汤配合拔罐治疗小儿肺炎支原体肺炎临床疗效观察[D].北京:北京中医药大学,2017.
[11]刁云锋,张士俊,赵万勇,等.血必净注射液对重症肺炎患者血浆IL-6和TNF-α水平的影响[J].中草药,2017,48(6):1188-1191.
[12]韩健.白虎汤联合还原型谷胱甘肽治疗重症肺炎伴高热临床研究[J].中医学报,2017,32(2):201-205.
[13]杨桦,陈霁虹.合用千金苇茎汤治疗重症肺炎疗效观察[J].浙江中医药大学学报,2011,35(1):38-39,48.
[14]霍红梅,陈丽珠,陈杰奎.布地奈德雾化吸入联合麻杏石甘汤加减对肺炎高热小儿血清CRP影响及临床疗效研究[J].辽宁中医药大学学报,2016,18(7):186-188.
[15]程瑞蓉.麻杏石甘汤联合支气管肺泡灌洗治疗婴幼儿重症肺炎临床研究[J].河南中医,2016,36(2):198-199.
[16]翁维杰,黄崇林.麻杏石甘汤联合西药治疗重症肺炎疗效观察[J].新中医,2015,47(4):51-52.
[17]王斌梁,孔一名,张蓉映.重症肺炎患者下呼吸道内s TREM-1、TNF-α及IL-10水平的变化[J].中国现代医生,2012,50(28):8-10.
[18]王凤英,李良业,韩卢丽,等.中药肠道净化治疗重症肺炎的临床疗效及对TNF-α、s ICAM-1的影响[J].新中医,2010,42(12):11-12.
[19]白雪.观察麻杏石甘汤合千金苇茎汤加味治疗重症肺炎的临床疗效[J].世界最新医学信息文摘(连续型电子期刊),2018,18(21):146.