作者：尹琴，徐庆，张建中，彭怀文，王越

单位：

1.安徽省六安市中医院ICU2.安徽省六安市中医院心内科

Units：

ICU, Liuan Traditional Chinese Medicine Hospital;Department of Cardiology, Liuan Traditional Chinese Medicine Hospital;

关键词：

感染; 重症肺部感染; 参苏饮; 千金苇茎汤; 炎症因子; 预后;

Keywords：

Infections;Severe pulmonary infection;Shensuyin;Qianjin Weijing decoction;Inflammatory factors;Prognosis;

CLC：

DOI：

10.12114/j.issn.1008-5971.2022.00.290

Funds：

摘要：

目的 探讨参苏饮合千金苇茎汤对重症肺部感染患者炎症因子水平及短期预后的影响。方法 选取2019年1月至2022年1月六安市中医院收治的重症肺部感染患者90例为研究对象，采用随机数字表法分为对照组和观察组，每组45例。对照组采用常规治疗，观察组在对照组基础上加用参苏饮合千金苇茎汤，两组均治疗1周。比较两组治疗前后中医证候评分，临床疗效，治疗前后炎症因子[C反应蛋白（CRP）、降钙素原（PCT）、白介素6(IL-6)、白介素10(IL-10)、肿瘤坏死因子α(TNF-α)]水平、急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分、临床肺部感染评分（CPIS），机械通气时间、ICU住院时间及28 d病死率。结果 治疗后，对照组、观察组气促、乏力、神疲、自汗评分分别低于本组治疗前，且观察组低于对照组（P<0.05）。观察组总有效率为88.9%(40/45)，高于对照组的71.1%(32/45)(P<0.05)。治疗后，对照组、观察组CRP、PCT、TNF-α水平分别低于本组治疗前，IL-6、IL-10水平分别高于本组治疗前，且观察组CRP、PCT、TNF-α水平低于对照组，IL-6、IL-10水平高于对照组（P<0.05）。治疗后，对照组、观察组APACHEⅡ评分、CPIS分别低于本组治疗前，且观察组低于对照组（P<0.05）。观察组机械通气时间、ICU住院时间短于对照组（P<0.05）；两组28 d病死率比较，差异无统计学意义（P>0.05）。结论 参苏饮合千金苇茎汤能有效改善重症肺部感染患者临床症状，提高治疗有效率，降低CRP、PCT、TNF-α水平，升高IL-6、IL-10水平，减轻炎症反应、病情及肺部感染程度，进而促进患者康复。但本研究并未发现参苏饮合千金苇茎汤能有效降低重症肺部感染患者28 d病死率。

Abstract：

Objective To explore the effect of Shensuyin and Qianjin Weijing decoction on the levels of inflammatory factors and short-term prognosis in patients with severe pulmonary infection. Methods A total of 90 patients with severe pulmonary infection who were admitted to Liuan Traditional Chinese Medicine Hospital from January 2019 to January 2022 were selected as the research objects, and divided into the control group and the observation group by random number table method, with 45 cases in each group. The control group was given routine treatment, while the observation group was given Shensuyin and Qianjin Weijing decoction on the basis of the control group. Both groups were treated for 1 week. The TCM syndrome scores before and after treatment, clinical efficacy, levels of inflammatory factors [C-reactive protein（CRP）, procalcitonin（PCT）, interleukin-6（IL-6）, interleukin-10（IL-10）, tumor necrosis factor alpha（TNF-α） ], assessment of acute physiology and chronic health status Ⅱ（APACHE Ⅱ） score, clinical pulmonary infection score（CPIS） before and after treatment, the mechanical ventilation time, ICU stay and 28-day mortality were compared between the two groups. Results After treatment, the scores of shortness of breath, fatigue, mental fatigue and spontaneous sweating in the control group and observation group were lower than those before treatment respectively, and those in the observation group were lower than those in the control group（P < 0.05）. The total effective rate of the observation group was 88.9%（40/45）, which was higher than 71.1%（32/45） of the control group（P < 0.05）. After treatment, the levels of CRP, PCT and TNF-α in the control group and the observation group were lower than those before treatment, the levels of IL-6 and IL-10 were higher than those before treatment respectively, and the levels of CRP, PCT, TNF-α in the observation group were lower than those in the control group, while the levels of IL-6 and IL-10 in the observation group were higher than those in the control group（P < 0.05）. After treatment, APACHE Ⅱ score and CPIS in the control group and observation group were lower than those before treatment, and those in the observation group were lower than those in the control group（P < 0.05）. The mechanical ventilation time and ICU stay in the observation group were shorter than those in the control group（P < 0.05）; there was no significant difference in the 28-day mortality between the two groups（P > 0.05）. Conclusion Shensuyin and Qianjin Weijing decoction can effectively improve the clinical symptoms of patients with severe pulmonary infection, improve the effective rate of treatment, reduce the levels of CRP, PCT, TNF-α, increase the levels of IL-6 and IL-10, reduce the inflammatory response, the disease condition and the severity of pulmonary infection, and then promote the recovery of patients. However, this study did not find that Shensuyin and Qianjin Weijing decoction can effectively reduce the 28-day mortality of patients with severe pulmonary infection.

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