补气养阴活血法对脓毒症患者急性肺损伤的影响

目的:观察补气养阴活血中药对脓毒症患者急性肺损伤的影响。方法:选择脓毒症并发急性肺损伤/急性呼吸窘迫综合征患者50例,随机分为对照组(26例,失访2例)和观察组(24例,失访1例),对照组按脓毒症指南给予综合治疗,观察组另外加用补气养阴活血中药(予参麦注射液和丹参酮ⅡA注射液静滴)治疗。分别在入院第1(D1)、3(D3)、7(D7)天留取患者动脉血行血气分析并计算氧合指数,留取外周静脉血,行肺泡灌洗并留取支气管肺泡灌洗液(BALF)测定血清及BALF中肿瘤坏死因子-α(TNF-α)和白介素-10(IL-10)的浓度,并记录患者急性生理学与慢性健康状况评分系统(APACHE)Ⅱ评分、ICU住院时间。结果:与D1比较,D3、D7时两组患者氧合指数均升高,APACHEⅡ评分降低;D7时两组患者血清和BALF中的TNF-α降低,IL-10浓度升高(均P0.05);与D3比较,D7时两组患者氧合指数均升高,APACHEⅡ评分降低,血清和BALF中的TNF-α降低,IL-10浓度升高(均P0.05)。与对照组比较,D7时观察组患者氧合指数升高,APACHEⅡ降低,血清和BALF中的TNF-α降低,IL-10浓度升高(均P0.05)。观察组ICU住院时间比对照组缩短(P0.05)。结论:补气养阴活血法能减轻脓毒症所导致急性肺损伤,改善患者病情及缩短ICU住院时间,其机制可能与补气养阴活血中药治疗可调节炎症反应有关。

Effect on Acute Lung Injury in Patients with Sepsis by Supplementing Qi Nourishing Yin And Promoting Blood Flow

Objective：To investigate the protective effect of supplementing qi, nourishing yin and promoting blood flow （ SQNYPBF ）method on sepsis-induced acute lung injury. Methods ： Fifty patients with sepsis-induced acute lung injury/acute respiratory distress syndrome （ ALI/ARDS ） were randomly divided into control group （ 26 cases, 2 patients lost to follow up ） and observation group （ 24 cases, 1 patient lost to follow up ）. Patients in both groups were treated according to international guidelines for sepsis, while cases in observation group were treated with SQNYPBF （ They were intravenously dripped with Shenmai Injection and Sulfotanshinone Sodium Injection, once a day, for 7 successive days ） in addition. On admission （ D1 ）, day 3 （ D3 ） and day 7 （ D7 ）, arterial blood samples were taken for blood gas analysis and the oxygenation index （ OI ）was calculated. The concentrations of TNF-α and IL-10 in the broncho alveolar lavage fluid （ BALF ）and serum were detevted by ELISA. And acute physiology and chronic health evaluation（ APACHE ）11 scores and the ICU length of stay were assessed. Results ： Compared with the baseline value at D1, OI was significantly increased and APACHE Ⅱ scores were decreased at D3 and D7 in both groups, and TNF-ot concentrations in the BALF and serum were decreased and IL-10 concentrations in the BALF and serum were increased at D7 in both groups （P〈0.05）. The OI was significantly higher and APACHE IT scores were lower at D7 than that at D3 in both groups （P〈0.05）. Compared to D3, TNF-α concentrations in the BALF and serum were decreased and IL-10 concentrations in the BALF and serum were increased at D7 （P〈O.05）. Compared with the control group, the OI was significantly increased at D7 and APACHEII scores and TNF- α concentrations in the BALF and serum were decreased at D7, and IL-10 concentrations in the BALF and serum were increased at D7 （ P〈0.05 ）. The ICU length of stay in observation group was shorter than