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目的:研究急性肺损伤(ALI)/急性呼吸窘迫综合征(ARDS)患者使用清肺汤治疗后呼出气冷凝液(EBC)和血清中一氧化氮(NO)改变的临床意义。方法:ICU行机械通气的ALI/ARDS患者54例,随机分为常规治疗组(给予机械通气、液体管理、抗炎、综合营养支持等)和清肺汤治疗组(在常规治疗基础上联用中药清肺汤)。ALI/ARDS患者在第1天及第5天采用改进的德国JAEGER公司Ecoscreen呼出气冷凝液收集器收集EBC标本。54例患者均同步抽取静脉血5ml,在室温下离心留取血清。以ELISA法测定EBC和血清中的NO浓度。同时进行APACHEⅡ评分,记录氧合指数及机械通气时间。结果:①清肺汤治疗组第5天,EBC和血清中NO[(26.71±9.32)μmol/L,(31.28±8.73)μmol/L]均低于常规治疗组[(34.27±9.96)μmol/L,(39.34±9.15)μmol/L],均P<0.05。②清肺汤治疗组治疗前后氧合指数差值(94.74±42.19)mmHg高于常规治疗组(68.41±35.21)mmHg,P<0.05;③清肺汤治疗组机械通气时间(225.06±74.79)h少于常规治疗组(296.42±96.25)h,P<0.05;④清肺汤治疗组APACHEⅡ评分(9.75±4.52)低于常规治疗组(13.02±5.31),P<0.05。结论:ALI/ARDS患者联用中药清肺汤有助于控制炎症反应,减轻肺损伤,可提高临床疗效。
Objective: To investigate the clinical significance of exhaled breath condensate (EBC) and serum nitric oxide (NO) in patients with acute lung injury (ALI) / acute respiratory distress syndrome (ARDS) treated with Qingfei decoction. Methods: Fifty-four ALI / ARDS patients with ICU undergoing mechanical ventilation were randomly divided into routine treatment group (given mechanical ventilation, fluid management, anti-inflammatory, comprehensive nutritional support) and Qingfei decoction group Chinese Qingfei soup). Patients on ALI / ARDS were collected on days 1 and 5 using a modified Ecoscreen exhaled gas condensate collector from JAEGER GmbH, Germany. 54 patients were simultaneously drawn venous blood 5ml, centrifuged at room temperature for serum. The concentrations of NO in EBC and serum were determined by ELISA. At the same time APACHE Ⅱ score, record oxygenation index and mechanical ventilation time. Results: ① In the Qingfei decoction group, NO and [(26.71 ± 9.32) μmol / L, (31.28 ± 8.73) μmol / L] in the EBC group and the serum group were lower than those in the conventional treatment group on the fifth day [(34.27 ± 9.96) μmol / L, (39.34 ± 9.15) μmol / L], all P <0.05. ② The difference of oxygenation index of Qingfei decoction group before and after treatment (94.74 ± 42.19) mmHg was higher than that of the conventional treatment group (68.41 ± 35.21) mmHg, P <0.05; ③ The time of mechanical ventilation of Qingfei decoction group was (225.06 ± 74.79) h (296.42 ± 96.25) h, P <0.05; ④The APACHEⅡ score of Qingfei decoction group (9.75 ± 4.52) was lower than that of routine treatment group (13.02 ± 5.31), P <0.05. Conclusion: ALI / ARDS combined with Qingfei Decoction can help control the inflammatory response, reduce lung injury and improve clinical efficacy.