参附汤对脾肾阳虚型低T_3综合征危重症患者干预的临床研究

目的研究参附汤对脾肾阳虚型伴发低T_3综合征的危重症患者的临床疗效。方法采用随机数字表法,将110例中医辨证分型为脾肾阳虚证伴发低T_3综合征的危重症患者随机分为2组。对照组(n=55)采用常规西医治疗方案,治疗组(n=55)在常规西医治疗的基础上加用参附汤,两组患者分别治疗7 d。测定患者血清三碘甲状腺原氨酸(T_3)、甲状腺素(T_4)、促甲状腺激素(TSH)水平,进行急性生理学及慢性健康状况评分Ⅱ(APACHE Ⅱ),统计患者住院时间,记录转归情况,进行中医证候疗效评价。结果两组患者在治疗后APACHE Ⅱ、中医证候疗效积分均较治疗前降低,血清T_3水平较治疗前升高(P0.001);与对照组比较,治疗组的APACHE Ⅱ、中医证候疗效积分降低更显著(P0.05、0.001),血清T_3水平升高更显著(P0.05);与对照组比较,治疗组患者住院时间显著缩短(P0.05),预后得到改善,中医临床疗效评价亦优于对照组(P0.05)。结论参附汤可提高脾肾阳虚型伴发低T_3综合征的危重症患者的血清T_3水平,提高临床疗效,缩短住院时间,改善中医证候及临床预后。

Clinical study on intervention of Shenfu Decoction in critically ill patients with spleen-kidney yang deficiency type low triiodothyronine syndrome

Objective To evaluate the efficacy of Shenfu Decoction in treatment of critically ill patients with spleen-kidney yang deficiency type low triiodothyronine syndrome (LT₃S). Methods Totally 110 critically ill patients with spleen-kidney yang deficiency type LT₃S were randomized into two groups. Control group used standard Western treatment; Treatment group was given the combination of Western treatment and Shenfu Decoction; each group was treated for 7 d. The therapeutic effect indexes were serum T₃, serum T₄, serum TSH, APACHE II score, hospital day, results of treatment, and therapeutic efficacy of TCM syndromes. Results After treatment, the APACHE II score in control and treatment groups have been significantly improved (P < 0.05, 0.001). Compared with control group, the score in treatment group declined more drastically, and difference between two groups was statistically significant (P < 0.05); The serum T₃ levels have been significantly improved in both groups and improved more in treatment group, and the difference between two groups was statistically significant (P < 0.05); The hospital day of treatment group was shorter than control group after treatment, and the difference between two groups was statistically significant (P < 0.05); The symptoms score progressed in both groups after treatment and have been significantly improved in treatment group, and the difference between two groups was statistically significant (P < 0.05); The treatment group had more significant clinical curative effect after treatment (P < 0.05). Conclusion Shenfu Decoction in critically ill patients with spleen-kidney yang deficiency type LT₃S could improve the clinical curative effect, progress the TCM syndromes and results of treatment, and shorten the hospital stay.