摘要
目的观察清热解毒汤联合西医常规治疗对脓毒症的疗效,并探讨其作用机制。方法45例患者采用前瞻性研究方法,按严重程度分为脓毒症组、严重脓毒症组、脓毒症休克组各15例,收集并分析比较其相关资料。结果脓毒症组ICU住院时间、机械通气时间均短于脓毒症休克组(均P<0.05)。入院时,脓毒症组的急性生理学及慢性健康状况Ⅱ评分(APACHEⅡ)评分低于脓毒症休克组,而白细胞计数(WBC)、淋巴细胞绝对值(L)则高于脓毒症休克组;脓毒症组的血浆乳酸(Lac)低于严重脓毒症组;严重脓毒症组的APACHEⅡ评分低于脓毒性休克组,而L则高于脓毒症休克组(均P<0.05)。中西医联合治疗后第1日各指标都呈好转趋势,脓毒性休克组的APACHEⅡ评分均高于脓毒症、严重脓毒症组;脓毒症组的血小板(PLT)低于严重脓毒症组(均P<0.05)。入院第3日,脓毒症组的APACHEⅡ评分低于脓毒性休克组;脓毒症组与严重脓毒症组的Lac下降至正常,但脓毒症休克组上升,脓毒症休克组的Lac高于严重脓毒症组(均P<0.05)。入院第5日,脓毒症组的序贯器官衰竭评分(SOFA)评分、APACHEⅡ评分、Lac均低于脓毒性休克组;严重脓毒症组的APACHEⅡ评分、Lac均低于脓毒性休克组;脓毒症组的PCT低于严重脓毒症组(均P<0.05)。入院第7日,脓毒症组的SOFA评分、APACHEⅡ评分、PCT、Lac均低于脓毒性休克组;严重脓毒症组的SOFA评分、PCT、Lac亦低于脓毒性休克组;脓毒症组的PCT低于严重脓毒症组(均P<0.05)。进一步应用受试者工作特征对第5日有意义指标SOFA评分、APACHEⅡ评分、PCT、Lac在脓毒症组与严重脓毒症组、脓毒症休克组的诊断价值进行评价,计算SOFA评分、APACHEⅡ评分、PCT、Lac中AUC分别为0.859、0.859、0.844、0.688,进行相关性分析发现SOFA评分与APACHEⅡ评分,SOFA评分与Lac,APACHEⅡ评分与Lac呈显著相关性。结论清热解毒汤联合常规西医治疗能降低炎性指标,临床上可形成优势互补,特别是对脓毒症、严重脓毒症患者。
Objective:To observe the efficacy of Qingre Jiedu Decoction combined with conventional treatment of Western medicine on sepsis,and to investigate its mechanism of action.Methods:45 patients were divided into three groups according to the severity,i.e.,sepsis group,severe sepsis group,and septic shock group,15 cases in each group.Relevant data were collected,analyzed and compared.Results:The ICU stay time and mechanical ventilation time in the sepsis group were shorter than those in the septic shock group(all P<0.05).On admission,the APACHEⅡ score of the sepsis group was lower than that of the septic shock group,while WBC and L were higher than those of the septic shock group;the Lac of the sepsis group was lower than that of the severe sepsis group;the APACHEⅡ score of the severe sepsis group was lower than that of the septic shock group,while the L was higher than that of the septic shock group(all P<0.05).On the first day after the combined treatment of traditional Chinese and western medicine,all indicators showed a trend of improvement.The APACHEⅡ scores in the septic shock group were higher than those in the sepsis and severe sepsis groups;the PLT in the sepsis group was lower than that in the severe sepsis group(all P<0.05).On the 3rd day of admission,the APACHEⅡ score of the sepsis group was lower than that of the septic shock group;the Lac of the sepsis group and the severe sepsis group decreased to normal,but the septic shock group increased,and the Lac of the septic shock group was higher than the severe sepsis group(all P<0.05).On the 5th day of admission,the SOFA score,APACHEⅡ score and Lac of the sepsis group were lower than those of the septic shock group;the APACHEⅡ score and Lac of the severe sepsis group were lower than those of the septic shock group;PCT was lower than the severe sepsis group(all P<0.05).On the 7th day of admission,the SOFA score,APACHEⅡ score,PCT,and Lac of the sepsis group were lower than those of the septic shock group;the SOFA score,PCT,and Lac of the severe sepsis group were also lower than those of the septic shock group;the PCT of the septic group was lower than that of the severe sepsis group(all P<0.05).Receiver operating characteristics were further used to evaluate the diagnostic value of meaningful indexes SOFA score,APACHEⅡ score,PCT,Lac in sepsis group,severe sepsis group,and septic shock group on the 5th day.AUC in the SOFA score,APACHEⅡ score,PCT and Lac were 0.859,0.859,0.844,and 0.688,respectively.Further correlation analysis found that SOFA score and APACHEⅡ score,SOFA score and Lac,APACHEⅡ score and Lac were significantly correlated.Conclusion:Qingre Jiedu Decoction combined with conventional Western medical treatment can reduce inflammatory indicators,and can form complementary advantages clinically,especially in the sepsis group and severe sepsis group.
作者
罗运山
吴东南
何龙秀
王美操
饶明清
Luo Yunshan;Wu Dongnan;He Longxiu;Wang Meicao;Rao Mingqing(Laibin People's Hospital,Guangxi,Laibin 546100,China)
出处
《中国中医急症》
2022年第9期1433-1436,共4页
Journal of Emergency in Traditional Chinese Medicine
基金
广东省中医药局课题(20201348)。
关键词
脓毒症
中西医结合
清热解毒汤
热毒炽盛型
Sepsis
Combination of traditional Chinese and Western medicine
Qingre Jiedu Decoction
Blazing heat-toxin pattern
