摘要
目的观察自拟中药清肺化瘀通腑方对脓毒症相关急性呼吸窘迫综合征(ARDS)机械通气患者氧合指数、呼吸力学参数、炎症指标及免疫功能的影响.方法采用前瞻性随机对照研究方法,选择2023年1月至2024年1月南京中医药大学附属医院重症医学科收治的脓毒症相关ARDS,中医辨证符合肺热移肠证的68例患者作为研究对象.按随机数字表法将患者分为试验组和对照组,每组34例.最终两组各脱落4例,试验组纳入30例,对照组纳入30例.两组入院后均给予西医常规治疗,试验组在西医常规治疗基础上给予清肺化瘀通腑方[组方:酒黄芩10 g、桑白皮10 g、葶苈子15 g、全瓜蒌10 g、酒地龙10 g、桃仁10 g、丹参10 g、莪术6g、生大黄(后下)3g、枳实10 g、厚朴10 g、炙甘草3g]每日1剂,浓煎为每袋100 mL,分2次鼻饲;对照组在西医常规治疗基础上给予等量温开水,每日2次鼻饲,两组均连续治疗7d.比较两组患者治疗前后氧合指数、呼吸力学参数、炎症因子及免疫细胞水平的差异.结果两组治疗前氧合指数、呼吸力学参数、炎症指标及免疫细胞水平比较差异均无统计学意义;治疗后氧合指数、自然杀伤细胞(NK细胞)水平均较治疗前明显升高,平台压(Pplat)、驱动压(ΔP)、超敏C-反应蛋白(hs-CRP)、降钙素原(PCT)、白细胞介素(IL-6、IL-8、IL-1β)、肿瘤坏死因子-α(TNF-α)、CD4^(+)/CD8^(+)均较治疗前明显降低;试验组治疗后氧合指数、NK细胞均明显高于对照组[氧合指数(mmHg,1 mmHg≈0.133 kPa):331.32±90.89比238.64±83.26,NK细胞:0.20(0.12,0.25)比0.10(0.08,0.09),均P<0.05],Pplat、ΔP、hs-CRP、PCT、IL-6、IL-8、TNF-α、CD4^(+)/CD8^(+)均明显低于对照组[Pplat(cmH_(2)O,1 cmH2O≈0.098 kPa):16(15,19)比22(19,24),ΔP(cmH_(2)O):11±2比14±3,hs-CRP(mg/L):21.32(11.63,31.84)比41.36(17.41,89.02),PCT(μg/L):0.13(0.08,0.21)比0.45(0.14,1.35),IL-6(ng/L):16.25(10.72,49.96)比66.70(25.82,195.64),IL-8(ng/L):5.48(0.84,12.60)比26.23(23.10,50.16),TNF-α(ng/L):0.77(0.72,1.20)比1.10(0.92,1.48),CD4^(+)/CD8^(+):1.76(1.43,2.00)比2.12(1.77,4.03),均P<0.05].结论清肺化瘀通腑方可有效改善脓毒症相关ARDS机械通气患者氧合指数,降低Pplat、ΔP,减轻炎症反应,调节免疫功能.
Objective To observe the effects of the traditional Chinese medicine Qingfeihuayutongfu prescription on oxygenation index,respiratory mechanics,inflammatory markers,and immune function in mechanically ventilated patients with sepsis-associated acute respiratory distress syndrome(ARDS).Methods A prospective randomized controlled trial was conducted.Sixty-eight patients with sepsis-associated ARDS,who met the TCM syndrome pattern of lung-heat transferring to intestines syndrome,admitted to the department of intensive care unit(ICU)of the Affiliated Hospital of Nanjing University of Chinese Medicine between January 2023 and January 2024,were enrolled as study subjects.Patients were randomly divided into an experimental group and a control group using a random number table,with 34 patients in each group.Four patients dropped out from each group,resulting in 30 patients being analyzed in each group.Both groups received conventional Western medical treatment after admission.The experimental group additionally received Qingfeihuayutongfu prescription[composition:Scutellaria baicalensis 10 g,Mori Cortex 10 g,Descurainiae Semen 15 g,Trichosanthis Fructus 10 g,Lumbricus 10 g,Persicae Semen 10 g,Salviae Miltiorrhizae Radix 10 g,Curcumae Rhizoma 6 g,Rheum palmatum 3 g(decocted later),Aurantii Fructus Immaturus 10 g,Magnoliae Officinalis Cortex 10 g,Glycyrrhizae Radix praeparata 3 g].The decoction was concentrated to 100 mL per bag.One dose was administered daily,divided into 2 nasogastric feedings.The control group received an equivalent volume of warm water twice daily via nasogastric tube in addition to conventional Western treatment.Treatment continued for 7 days in both groups.Differences in oxygenation index,respiratory mechanics parameters,inflammatory cytokines,and immune cell levels before and after treatment were compared between the two groups.Results Prior to treatment,no statistically significant differences were observed between the two groups in oxygenation index,respiratory mechanics parameters,levels of inflammatory cytokines or immune cell counts.Following treatment,both groups exhibited a significant increase in oxygenation index and natural killer cell(NK cell),alongside significant decreases in plateau pressure(Pplat),driving pressure(ΔP),hypersensitive C-reactive protein(hs-CRP),procalcitonin(PCT),interleukins(IL-6,IL-8,IL-1β),tumour necrosis factor-α(TNF-α),and CD4^(+)/CD8^(+)ratio compared to baseline.Post-treatment comparison between groups revealed that the experimental group had a significantly higher oxygenation index and NK cell than the control group[oxygenation index(mmHg,1 mmHg≈0.133 kPa):331.32±90.89 vs.238.64±83.26,NK cell:0.20(0.12,0.25)vs.0.10(0.08,0.19),both P<0.05].Conversely,the experimental group demonstrated significantly lower values than the control group for Pplat,ΔP,hs-CRP,PCT,IL-6,IL-8,TNF-α,CD4^(+)/CD8^(+)[Pplat(cmH_(2)O,1 cmH2O≈0.098 kPa):16(15,19)vs.22(19,24),ΔP(cmH_(2)O):11±2 vs.14±3,hs-CRP(mg/L):21.32(11.63,31.84)vs.41.36(17.41,89.02),PCT(μg/L):0.13(0.08,0.21)vs.0.45(0.14,1.35),IL-6(ng/L):16.25(10.72,49.96)vs.66.70(25.82,195.64),IL-8(ng/L):5.48(0.84,12.60)vs.26.23(23.10,50.16),TNF-α(ng/L):0.77(0.72,1.20)vs.1.10(0.92,1.48),CD4^(+)/CD8^(+):1.76(1.43,2.00)vs.2.12(1.77,4.03),all P<0.05].Conclusion The Qingfeihuayutongfu prescription can effectively improves the oxygenation index,reduces Pplat andΔP,mitigates inflammation,and modulates immune function in mechanically ventilated patients with sepsis-associated ARDS.
作者
程璐
原佳雯
陆沁云
杭宇豪
鲁俊
王德祥
Cheng Lu;Yuan Jiawen;Lu Qinyun;Hang Yuhao;Lu Jun;Wang Dexiang(Department of Intensive Care Unit,Affiliated Hospital of Nanjing University of Chinese Medicine,Nanjin 210029,Jiangsu,China)
出处
《中国中西医结合急救杂志》
2025年第2期149-154,共6页
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
基金
国家自然科学基金(82074379)
江苏省中医药科技发展计划(QN202004)
南京中医药大学自然科学基金(XZR2021008)。
关键词
脓毒症
急性呼吸窘迫综合征
清肺化瘀通腑方
氧合指数
呼吸力学
炎症因子
免疫细胞
S]epsis
Acute respiratory distress syndrome
Qingfeihuayutongfu prescription
Oxygenation index
Respiratory mechanics
Inflammatory factorI
mmune cell
