摘要
目的观察痰热清注射液对急性肺损伤（ALI）患者血清炎症介质水平的影响。方法收集新乡市中心医院2013年12月至2017年12月临床确诊的ALI患者136例，将患者按随机数字表法分为常规治疗组和痰热清治疗组，每组68例；以同期本院50例健康体检者作为健康对照组。常规治疗组和痰热清治疗组患者均进行原发病治疗，联合激素和抗菌药物抗感染、营养和补液以及对症支持等综合疗法。痰热清治疗组在常规治疗基础上将痰热清注射液20mL加入0．9％氯化钠注射液或5％葡萄糖注射液250mL中2h内静脉滴注（静滴），每日1次。于入组后7d后评价各指标的差异。采用酶联免疫吸附试验（ELISA）和放射免疫分析法（RIA）检测3组受试者血清白细胞介素（IL-1、IL-6）和肿瘤坏死因子-α（TNF-α）水平；并记录常规治疗组和痰热清治疗组患者动脉血氧分压（PaO2）、动脉血二氧化碳分压（PaCO2）、氧合指数（PaO]FiO，）、pH值水平以及体循环阻力（SVR）及肺血管阻力（PVR）的变化。结果常规治疗组和痰热清治疗组治疗前血清IL和TNF-α水平均明显高于健康对照组[IL-1（ng／L）：128．45±27．91、131．12±26．26比24．55±6．12，IL-6（ng／L）：65．77±7．21、64．08±7．05比19．13±4．55，TNF-α（ng／L）：41．24±7．01、40．07±6．76比10．62±2．65，均P〈0．05]。常规治疗组和痰热清治疗组治疗后IL-1、IL-6、TNF—d、PaCO，、SVR和PVR均较治疗前明显降低，PaO：和PaO]FiO2均较治疗前明显升高，但以痰热清治疗组上述指标的变化较常规治疗组更显著[IL-1（ng／L）：75．67±18．58比101．22±21．13，IL-6（ng／L）：42.05α5．31比54．02±6．89，TNF-α（ng／L）：19．63±5．19比30．35±4．55，PaO2（mmHg，1mmHg=0．133kPa）：93．06±7．95比72．66±8．04，PaCO2（mmHg）：42．32±2．44比50．25±3．43，PaO2／FiO2（mmHg）：316．28±16．73比256．33±14．25，SVR（kPa·s·L^-1）：0．73±0．09比0．81±0．10，PVR（kPa·s·L^-1）：0．08±0．02比0．10±0．02，均P〈0．05]，pH值基本恢复正常（常规治疗组为7．37±0．27，痰热清治疗组为7．41±0．31）。结论痰热清注射液能降低ALI患者血清炎症介质水平，显著改善患者血气分析和血流动力学指标，降低炎症反应。
Objective To investigate the effect of Tanreqing injection on the concentrations of serum inflammatory mediators in patients with acute lung injury （ALI）. Methods One hundred and thirty-six patients with ALI by clinical diagnosis admitted to Xinxiang Central Hospital from December 2013 to December 2017 were enrolled, they were randomly divided into a conventional treatment group and a Tanreqing treatment group, 68 cases in each group; in the mean time, 50 healthy subjects having undertaken physical examinations in this hospital were assigned in the healthy control group. In the conventional and Tanreqing treatment groups, the primary diseases of patients were treated, combined with corticosteroid and antiseptic drugs to combat against infection, and nutrition support, fluid supplement and symptomatic therapy were also used. The patients in the Tanreqing treatment group beside received conventional treatment, additionally they were treated with Tanreqing injection 20 mL in 0.9% Sodium Chloride solution or 5% Glucose 250 mL intravenous drip in 2 hours, once daily. And, the difference of each index was evaluated on the 7th day after the patient entering the group. The concentrations of serum interleukin （IL-1, IL-6） and tumor necrosis factor- α （TNF- α） were detected for the patients in two groups and controls by using the enzyme linked immunosorbent assay （ELISA） and radioimmunoassay （RIA）, respectively. Meanwhile, the changes of arterial partial pressure of oxygen （PaO2）, arterial partial pressure of carbon dioxide （PaCO2）, oxygenation index （PaO2/FiO2）, pH value, systemic vascular resistance （SVR） and pulmonary vascular resistance （PVR） were observed in the conventional and Tanreqing treatment groups. Results The concentrations of serum IL and TNF-ct in the conventional and Tanreqing treatment groups before treatment were significantly higher than those in healthy controls [IL-1 （ng/L）： 128.45 ± 27.91,131.12 ± 26.26 vs. 24.55±6.12, IL-6 （ng/L）： 65.77±7.21, 64.08±7.05 vs. 19.13±4.55, TNF-α （ng/L）： 41.24±7.01, 40.07±6.76 vs. 10.62± 2.65, all P 〈 0.05]. Moreover, the levels of IL-1, IL-6, TNF-α, PaCO2, SVR and PVR in the conventional and Tanreqing treatment groups after treatment were significantly lower than those before treatment, and the levels of PaO2 and PaO2/FiO2 were obviously increased compared with those before treatment, and the changes of the above indicatorswere more significant in the Tanreqing treatment group [IL-1 （ng/L）： 75.67± 18.58 vs. 101.22±21.13, IL-6 （ng/L）： 42.05±5.31 vs. 54.02±6.89, TNF-α （ng/L）： 19.63±5.19 vs. 30.35±4.55, PaO2 （mmHg, 1 mmHg = 0.133 kPa）： 93.06 ± 7.95 vs. 72.66 ± 8.04, PaCO2 （mmHg）： 42.32 ± 2.44 vs. 50.25 ± 3.43, PaO2/FiO2 （mmHg）： 316.28 ± 16.73 vs. 256.33± 14.25, SVR （kPa·s · L-1）： 0.73±0.09 vs. 0.81± 0.10, PVR （kPa · s · L-1）： 0.08±0.02 vs. 0.10±0.02, all P 〈 0.05]. The pH value was restored to normal （eonventional treatment group was 7.37 ± 0.27, Tanreqing treatment group was 7.41 ±0.31）. Conclusion Tanreqing injection ean reduce the concentrations of serum inflammatory mediators, significantly improve the blood gas and hemodynamic indexes, and reduce inflammatory reaction in the patients with ALl.
作者
郭利敏
郭珊
徐震
马欢欢
Guo LM;Guo S;Xu Z;Ma HH(Department of Clinical Laboratory,Xinxiang Central Hospital,Xinxiang 453000,Henan,Chin;Department of Respiratory Medicine,Xinxiang Central Hospital,Xinxiang 453000,Henan,Chin;Department of Critical Care Medicine,Xinxiang Central Hospital,Xinxiang 453000,Henan,China)
出处
《中国中西医结合急救杂志》
CAS
CSCD
北大核心
2018年第3期242-245,共4页
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
基金
河南省新乡市重点科技攻关计划项目（ZG15020）
