Efficacy of Shengjiang Powder enema in treatment of ventilator associated pneumonia with phlegm heat obstructing the lung and its mechanism
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摘要:目的 观察升降散灌肠治疗痰热蕴肺型呼吸机相关性肺炎的临床疗效及安全性。方法 将62例呼吸机相关性肺炎患者(中医辨证为痰热蕴肺型)随机分为治疗组(n=30)和对照组(n=32)。2组患者均使用西医常规治疗，治疗组在对照组基础上联合使用升降散灌肠。结果 2组白细胞(WBC)计数、C反应蛋白(CRP)、降钙素原(PCT)、急性生理学与慢性健康状况评分Ⅱ(APACHE Ⅱ)、临床肺部感染评分(CPIS)及肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)、白细胞介素-2R (IL-2R)、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)水平均低于治疗前，白细胞介素-10(IL-10)及氧合指数[pa(O2)/FiO2]高于治疗前，差异有统计学意义(P < 0.05)；治疗组WBC、CRP、PCT、APACHE Ⅱ评分、CPIS评分、TNF-α、IL-1β、IL-2R、IL-6、IL-8低于对照组，机械通气时间及ICU住院时间均短于对照组，IL-10及pa(O2)/FiO2高于对照组，差异有统计学意义(P < 0.05)；治疗组有效率高于对照组，差异有统计学意义(P < 0.05)。研究过程中未记录到严重不良事件发生。结论 升降散灌肠能抑制痰热蕴肺型呼吸机相关性肺炎患者炎症反应，降低患者APACHE Ⅱ评分、CPIS评分，缩短ICU住院时间、机械通气时间，提高疗效。Abstract:Objective To observe the clinical efficacy of Shengjiang Powder enema in treatment of ventilator associated pneumonia with phlegm heat obstructing the lung and its safety.Methods Sixty-two patients with ventilator associated with pneumonia (TCM syndrome differentiation as phlegm-heat the lung type) were randomly divided into treatment group (n=30) and control group (n=32). Both groups were treated with conventional western medicine, and the treatment group was combined with shengjiang Powder enema based on the control group.Results White blood cell (WBC) count, C-reactive protein (CRP), procalcitonin (PCT), Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ, clinical pulmonary infection score(CPIS) and the levels of tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), interleukin-2R (IL-2R), interleukin-6 (IL-6) and interleukin-8 (IL-8) were significantly lower, and interleukin-10 (IL-10) as well as oxygenation index[pa(O2)/FiO2] in the two groups were significantly higher than those before treatment (P < 0.05); WBC, CRP, PCT, APACHE Ⅱ score, CPIS score, TNF-α, IL-1β, IL-2R, IL-6, IL-8 in the treatment group were significantly lower, duration of mechanical ventilation and length of ICU stay were significantly shorter, and IL-10 and pa(O2)/FiO2 were significantly higher than those in the control group (P < 0.05). The effective rate of the treatment group was significantly higher than that of control group (P < 0.05). No serious adverse events were recorded during the study.Conclusion Shengjiang Poweran enema can inhibit the inflammatory reaction of patients with ventilator associated pneumonia with phlegm heat obstructing the lung, reduce the APACHE Ⅱ score and CPIS score of patients, shorten the length of ICU stay and mechanical ventilation time, and improve the efficacy.
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表 1 2组患者一般资料比较(x±s)
组别 n 男 女 年龄/岁 高血压 冠心病 糖尿病 慢性支气管炎 APACHE Ⅱ评分/分 治疗组 30 18 12 80.97±1.75 22 14 12 16 16.73±0.39 对照组 32 21 11 76.66±2.34 24 18 16 18 17.34±0.37 APACHE Ⅱ: 急性生理学与慢性健康状况评分Ⅱ。 
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表 2 2组患者临床指标比较(x±s)
指标 治疗组(n=30) 对照组(n=32) 治疗前 治疗后 治疗前 治疗后 WBC/(×109/L) 14.18±0.82 10.35±0.79**# 13.21±0.45 10.52±0.79** CRP/(mg/L) 48.62±8.94 18.71±7.44*# 42.41±7.98 26.10±6.40* PCT/(ng/mL) 4.55±1.53 1.64±0.39**# 4.35±1.46 2.48±0.51* pa(O2)/FiO2 178.83±51.43 346.72±66.56**# 184.62±54.48 291.39±62.51** APACHE Ⅱ评分/分 16.73±0.39 13.77±0.52*# 17.34±0.37 15.28±0.56* CPIS评分/分 6.77±0.15 5.03±0.22*# 6.41±0.10 6.13±0.17* WBC: 白细胞; CRP: C反应蛋白; PCT: 降钙素原; pa(O2)/FiO2: 氧合指数; APACHE Ⅱ: 急性生理学与慢性健康状况评分Ⅱ;
CPIS: 临床肺部感染评分。与治疗前比较, * P＜0.05, * * P＜0.01; 与对照组比较, #P＜0.05。
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表 3 2组患者治疗指标比较(x±s)
d 组别 n ICU住院时间 机械通气时间 治疗组 30 13.46±3.21* 6.76±2.87* 对照组 32 16.12±3.67 10.23±3.25 与对照组比较, * P＜0.05。
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表 4 v
组别 n 显效 有效 无效 总有效 治疗组 30 8(26.67) 18(60.00) 4(13.33) 26(86.67)* 对照组 32 4(12.50) 14(43.75) 14(43.75) 18(56.25) 与对照组比较, * P＜0.05。
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表 5 2组患者炎症介质水平比较(x±s)
pg/mL 指标 治疗组(n=30) 对照组(n=32) 治疗前 治疗后 治疗前 治疗后 TNF-α 39.30±0.58 16.12±0.76**## 39.82±0.48 19.26±0.54** IL-1β 8.23±0.36 4.60±0.10**## 8.57±0.34 7.03±0.28** IL-2R 1 074.03±12.45 835.17±11.48**## 1 074.94±10.81 910.94±8.67** IL-6 58.41±0.64 14.97±0.43*## 58.65±0.65 20.91±0.71* IL-8 96.77±1.19 20.98±0.76*## 96.47±1.16 28.94±0.92* IL-10 7.87±0.31 15.38±0.77*## 7.77±0.32 11.25±0.36* TNF-α: 肿瘤坏死因子-α; IL-1β: 白细胞介素-1β; IL-2R: 白细胞介素-2R; IL-6: 白细胞介素-6; IL-8: 白细胞介素-8;
IL-10: 白细胞介素-10。与治疗前比较, * P＜0.05, * * P＜0.01; 与对照组比较, #P＜0.05, ##P＜0.01。
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