论文部分内容阅读
目的:观察清瘟败毒饮合凉隔散辨证内服辅助治疗对脓毒症热毒炽盛证患者炎症反应、肠屏障功能、凝血功能和血液流变学的影响,以探讨中药对脓毒症患者预后的作用。方法:将118例患者采用区组、分层随机分为对照组和观察组。对照组采用早期目标导向的液体复苏,抗感染,机械通气,营养支持治疗,控制血糖,预防应激性溃疡,抑制毛细血管微栓形成、纠正电解质紊乱、酸碱失衡等综合干预措施。观察组在对照组治疗的基础上采用血必净注射液,100 mg/次,溶于5%的葡萄糖注射液250 m L,静脉滴注,2次/d;和清瘟败毒饮合凉隔散辨证,1剂/d,内服或胃管给药;两组疗程均为7 d。预后评估指标采用急性生理及慢性健康评分(APACHEⅡ),感染相关器官功能衰竭估计(SOFA)和血清降钙素原(PCT)3个指标;检测治疗前后肿瘤坏死因子-α(TNF-α),白细胞介素-6(IL-6),白细胞介素-10(IL-10),白细胞介素-1β(IL-1β)炎症因子;检测治疗前后凝血酶原时间(PT),血浆凝血酶时间(TT),部分凝血酶原时间(APTT),D-二聚体(D-D),血小板(PLT),纤维蛋白(FIB)和血液流变学指标;肠屏障功能指标采用包括血清D-乳酸和内毒素;进行治疗前后热毒炽盛证评分。结果:观察组中医证候疗效总有效率为77.97%,高于对照组的42.37%(χ~2=15.594,P<0.01);两组在治疗后APACHEⅡ和SOFA评分呈下降趋势(F_(对照)=6.73,F_(观察)=7.412,P<0.05),经配对t检验,观察组在治疗第3天和第7天的APACHEⅡ和SOFA评分均低于对照组(P<0.01);在第7天,观察组血清TNF-α,IL-1β,IL-6水平均低于对照组,IL-10水平高于对照组(P<0.01);观察组血清D-乳酸、内毒素和PCT水平均低于对照组(P<0.01);观察组全血高切黏度、全血低切黏度、血浆黏度、红细胞聚集指数、红细胞变性指数改善均优于对照组(P<0.01);观察组患者FIB,D-D和PLT水平均低于对照组(P<0.01)。结论:在西医综合干预措施的基础上,加用血必净注射液静脉滴注、清瘟败毒饮合凉隔散辨证治疗脓毒症热毒炽盛证患者,能抑制早期炎症反应,控制细菌和毒素移位,能改善凝血功能紊乱状态和机体微循环,降低APACHEⅡ,SOFA评分和血清PCT水平,减轻了病情,起到改善预后的作用。
Objective: To observe the effect of Qingwenbaidu decoction combined with Liangzhesan dialectical internal medicine adjuvant therapy on inflammatory reaction, intestinal barrier function, coagulation function and hemorheology in patients with sepsis with thermo-toxic flaccid syndrome to explore the effect of traditional Chinese medicine on patients with sepsis The role of prognosis. Methods: One hundred and eighty-eight patients were divided into control group and observation group by randomization. The control group adopted the early target-oriented liquid resuscitation, anti-infection, mechanical ventilation, nutritional support treatment, blood sugar control, prevention of stress ulcer, inhibition of capillary micro-thrombosis, correct electrolyte imbalance, acid-base imbalance and other comprehensive intervention measures. The observation group was treated with Xuebijing injection 100 mg / time, dissolved in 5% dextrose 250 μL, intravenous drip 2 times / d on the basis of the treatment of the control group; Alzheimer syndrome, 1 / d, oral or gastric administration; two courses of treatment were 7 d. The indexes of prognosis were APACHEⅡ, SOFA and PCT. The levels of tumor necrosis factor-α (TNF-α), tumor necrosis factor-α Interleukin-6, IL-10 and IL-1β were measured before and after treatment. Prothrombin time (PT), plasma thrombin time (TT), partial thromboplastin time (APTT), D-dimer (DD), platelet (PLT), fibrin (FIB) and hemorheology indexes. Endotoxin; before and after treatment of heat-toxic flaccid card score. Results: The total effective rate of TCM syndromes in observation group was 77.97%, higher than 42.37% in control group (χ ~ 2 = 15.594, P <0.01); APACHEⅡ and SOFA scores decreased in both groups after treatment (F_ (control ) = 6.73, F_ (observation) = 7.412, P <0.05). According to the paired t-test, APACHEⅡ and SOFA scores of the observation group on the 3rd and 7th day of treatment were lower than those of the control group (P <0.01) The level of serum IL-10 and TNF-α, IL-1β and IL-6 in the observation group were lower than those in the control group on the 7th day (P <0.01) (P0.01) .High shear viscosity, low shear viscosity, plasma viscosity, erythrocyte aggregation index and erythrocyte degeneration index in the observation group were all better than those in the control group (P0.01). The patients in the observation group FIB, DD and PLT levels were lower than the control group (P <0.01). Conclusion: Based on the comprehensive intervention of Western medicine, intravenous injection of Xuebijing injection, Qingwenbaidu decoction combined with Liangzhesan syndrome differentiation treatment of patients with sepsis with heat-toxic flaming syndrome can inhibit early inflammatory response and control bacteria And toxin translocation, can improve coagulation disorders and microcirculation, reduce APACHE Ⅱ, SOFA score and serum PCT levels, reduce the disease, play a role in improving the prognosis.