大承气汤对脓毒症肺损伤患者肺保护作用的研究

目的探讨大承气汤对脓毒症肺损伤患者的肺保护作用。方法选择2017年12月—2018年12月江苏省中西医结合医院急重症医学科收治的阳明腑实证脓毒症合并肺部损伤患者40例,随机分为大承气汤组和对照组,每组20例。2组患者均行气管插管或气管切开进行机械通气,并给予无差别常规治疗,在此基础上,大承气汤组给予大承气汤鼻饲,对照组给予温开水鼻饲,均连续5 d。记录2组患者治疗第1,3,5天肺静态顺应性、氧合指数、肺泡动脉氧分压差、超声肺水评分及血清肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)、白细胞介素-1(IL-6)、C反应蛋白(CRP)水平,同时记录2组患者机械通气时间、住ICU时间、住院时间、28 d病死率。结果治疗第3天,2组患者肺静态顺应性、肺泡动脉氧分压差、超声肺水评分及血清CRP、IL-1水平和对照组氧合指数与治疗第1天比较差异均无统计学意义(P均>0.05),而大承气汤组氧合指数明显高于第1天(P<0.05);治疗第5天,2组患者肺静态顺应性、氧合指数均明显升高(P均<0.05),肺泡动脉氧分压差、超声肺水评分及血清CRP、IL-1水平均明显降低(P均<0.05),且大承气汤组患者各指标改善情况均明显优于对照组(P均<0.05)。2组患者治疗第3天和第5天血清TNF-α、IL-6水平均明显低于治疗第1天(P均<0.05),且大承气汤组患者均明显低于对照组(P均<0.05)。大承气汤组患者机械通气时间、住院时间明显短于对照组(P均<0.05),2组患者住ICU时间、28 d病死率比较差异无统计学意义(P均>0.05)。结论大承气汤可减轻脓毒症合并肺损伤患者全身炎症反应,减轻肺部水肿渗出情况,改善患者肺功能。

Lung protective effect of Dachengqi Decoction in patients with septic lung injury

Objective It is to explore the lung protective effect of Dachengqi Decoction on patients with sepsis-induced lung injury.Methods 40 patients with sepsis complicating with lung injury of syndrome of Yangming fu-viscera excess who were treated in the ICU of Jiangsu Provincial Hospital of Integrated Traditional Chinese and Western Medicine from December 2017 to December 2018 were randomly divided into Dachengqi Decoction group and control group,20 cases in each group.The patients in both groups underwent tracheal intubation or tracheotomy for mechanical ventilation,and were given conventional treatment with no difference.On this basis,the Dachengqi Decoction group was given a nasal feed of Dachengqi decoction,and the control group was given a nasal feed of warm boiled water,both groups were treated for 5 days.The pulmonary static compliance,oxygenation index,alveolar arterial oxygen partial pressure difference,ultrasound pulmonary water score,and the levels of serum tumor necrosis factor-α(TNF-α),interleukin-1β(IL-1β),interleukin-1(IL-6),and C-reactive protein(CRP)of the patients were recorded in the 2 groups on the 1st,3rd and 5th days after treatment.At the same time,the mechanical ventilation time,ICU stay time,hospital stay,and 28-day mortality rate of the two groups were recorded.Results On the 3rd day of treatment,there was no statistical difference in pulmonary compliance,alveolar arterial oxygen pressure difference,ultrasound lung water score,levels of serum CRP,IL-1 in the two groups and,and oxygenation index in the control group compared with those on the 1st day of treatment(P>0.05),and the oxygenation index of the Dachengqi Decoction group was significantly higher than that on the 1st day(P<0.05);on the fifth day of treatment,the pulmonary static compliance and oxygenation index of the two groups were significantly increased(P<0.05),the alveolar arterial oxygen partial pressure difference,ultrasound lung water score,and serum CRP and IL-1 levels were significantly reduced(P<0.05),and the improvements of all indicators of the Dachengqi Decoction group were significantly better than those of the control group(P<0.05).The levels of serum TNF-αand IL-6 on the 3rd and 5th day of treatment in the two groups were significantly lower than those on the 1st day of treatment(P<0.05),and the indicators in the Dachengqi Decoction group were significantly lower than those in the control group(P<0.05).The mechanical ventilation time and hospital stay of the patients in Dachengqi Decoction group were significantly shorter than those in the control group(P<0.05).There was no significant difference in ICU time and 28-day mortality between the two groups(P>0.05).Conclusion Dachengqi Decoction can alleviate systemic inflammatory response,reduce pulmonary edema and exudation,and improve pulmonary function in patients with sepsis and lung injury.