摘要
目的探究通腑泻肺方联合乌司他丁对脓毒症合并急性呼吸窘迫综合征(ARDS)患者的疗效。方法采用前瞻性对照研究设计,选取2021年4月至2023年11月在河北省沧州中西医结合医院治疗的132例脓毒症合并ARDS患者为研究对象,通过随机数字表法将患者分为乌司他丁组(n=66)和中西结合组(n=66)。乌司他丁组采用乌司他丁治疗,中西结合组则在乌司他丁组的基础上再给予通腑泻肺方免煎颗粒治疗,乌司他丁组和中西结合组均连续治疗7 d。治疗前后分别检测乌司他丁组和中西结合组患者的动脉血气分析指标[动脉血二氧化碳分压(PaCO_(2))、氧合指数、动脉血氧分压(PaO_(2))]和肠黏膜屏障指标[肠型脂肪酸结合蛋白(IFABP)、二胺氧化酶(DAO)、D乳酸]水平,同时比较乌司他丁组和中西结合组的机械通气时间、ICU停留时间及临床疗效。结果治疗后,乌司他丁组和中西结合组的氧合指数和PaO_(2)水平均较治疗前升高,PaCO_(2)、IFABP、DAO和D乳酸水平均较治疗前降低;中西结合组治疗后的氧合指数、PaO_(2)水平[分别为(321.96±72.33)、(70.27±8.15)mmHg(1 mmHg=0.133 kPa)]高于乌司他丁组[分别为(257.08±67.37)、(63.29±6.82)mmHg](t=5.332、5.336,均P<0.05),中西结合组PaCO_(2)、IFABP、DAO和D乳酸水平[分别为(41.08±4.83)mmHg、(6.37±1.12)mg/mL、(1.61±0.32)U/L、(0.93±0.19)mg/L]低于乌司他丁组[分别为(46.51±5.18)mmHg、(9.95±1.86)mg/mL、(3.14±0.77)U/L、(1.68±0.22)mg/L](t=6.229、24.657、14.907、20.961,均P<0.05);中西结合组机械通气时间、ICU停留时间[分别为(5.54±0.66)、(4.71±0.85)d]均短于乌司他丁组[分别为(6.21±0.78)、(5.96±0.92)d](t=5.327、8.107,均P<0.05);乌司他丁组总有效率为75.76%(50/66),低于中西结合组的92.42%(61/66),χ^(2)=6.852,P<0.05。结论通腑泻肺方联合乌司他丁治疗脓毒症合并ARDS患者可有效改善动脉血气分析指标,提高肺部通换气功能,保护肠黏膜屏障,缩短治疗时间,提高临床疗效。
Objective To explore the effect of Tongfu Xiefei Formula combined with ulinastatin on oxygenation indexes and intestinal mucosal barriers of sepsis patients complicated with acute respiratory distress syndrome(ARDS).Methods A prospective controlled study design was adopted.A total of 132 sepsis patients complicated with ARDS who were treated in Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine in Hebei Province from April 2021 to November 2023 were prospectively enrolled in the study and randomly divided into the ulinastatin group with 66 cases and the combination group with 66 cases.The ulinastatin group was given ulinastatin,and the combination group was treated with additional Tongfu Xiefei Formula non-decoction granules on the basis of treatment of the ulinastatin group.Both groups were treated continuously for 7 days.The arterial blood gas indexes(partial pressure of carbon dioxide(PaCO_(2)),oxygenation indexes,and partial pressure of oxygen(PaO_(2)))and intestinal mucosal barrier indexes(intestinal fatty acid binding protein(IFABP),diamine oxidase(DAO)and D-lactate)were measured for the two groups before and after treatment.The mechanical ventilation duration,length of ICU stay and clinical curative effect were compared between the two groups.Results The oxygenation index and PaO_(2)levels of the two groups increased after treatment,and the levels of PaCO_(2),IFABP,DAO and D-lactate of the two groups decreased.The oxygenation index and PaO_(2)levels of the combination group were respectively(321.96±72.33)and(70.27±8.15)mmHg(1 mmHg=0.133 kPa),higher than(257.08±67.37),(63.29±6.82)mmHg of the ulinastatin group(t=5.332,5.336,both P<0.05).The levels of PaCO_(2),IFABP,DAO and D-lactic acid of the combination group were(41.08±4.83)mmHg,(6.37±1.12)mg/mL,(1.61±0.32)U/L and(0.93±0.19)mg/L,respectively,lower than(46.51±5.18)mmHg,(9.95±1.86)mg/mL,(3.14±0.77)U/L and(1.68±0.22)mg/L of the ulinastatin group(t=6.229,24.657,14.907,20.961,all P<0.05).The mechanical ventilation duration and length of ICU stay of the combination group were(5.54±0.66)and(4.71±0.85)d,respectively,shorter than(6.21±0.78)and(5.96±0.92)d of the ulinastatin group(t=5.327,8.107,both P<0.05).The total effective rate was 75.76%(50/66)in the ulinastatin group,lower than 92.42%(61/66)in the combination group(χ^(2)=6.852,P<0.05).Conclusion The combination of Tongfu Xiefei Formula and ulinastatin can effectively improve the arterial blood gas indexes,boost the pulmonary ventilation function,protect the intestinal mucosal barriers,shorten the treatment time and increase the clinical efficacy.
作者
刘珍
李中健
赵书敏
高云霞
LIU Zhen;LI Zhongjian;ZHAO Shumin;GAO Yunxia(Department of Emergency Medicine,Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine in Hebei Province,Cangzhou 061001,China;Department of Diabetes,Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine in Hebei Province,Cangzhou 061001,China)
出处
《中国药物应用与监测》
2026年第2期267-271,共5页
Chinese Journal of Drug Application and Monitoring
基金
河北省中医药管理局2021年度中医药类科研计划课题(2021313)。
关键词
脓毒症
急性呼吸窘迫综合征
血气分析指标
肺功能
临床疗效
sepsis
acute respiratory distress syndrome
blood gas index
pulmonary function
clinical efficacy
