益氣解毒法治療膿毒癥早期的療效觀察

龔瑞瑩+龐永誠+陳斌+鄧紅+沈琳+任亢宗

摘要：目的觀察益氣解毒法治療對膿毒癥早期患者的臨床療效。方法采用隨機、平行對照的方法將97例膿毒癥患者分為治療組49例和對照組48例。治療組在西醫常規治療基礎上給予黃芪注射液靜脈滴注，每次30mL，并聯用中藥復方清瘟敗毒飲，觀察療程7d。分別比較2組治療前后APACHEⅡ評分，MODS評分，SOFA評分，外周血象，血清CRP、TNF-a、IL-6水平（值）變化和臨床療效積分。結果2組治療后APACHEⅡ評分均有下降，但治療組下降更明顯（P<0.01）；治療組7d后總有效率93.88%，對照組為87.50%，經統計學分析有顯著性差異（P<0.05）；2組患者與治療前比較，WBC、N、CRP、TNF-a、IL-6水平（值）均有明顯下降（P<0.05，P<0.01），治療7d后治療組WBC、N、CRP水平（值）較對照組下降明顯，但無統計學差異（P>0.05），TNF-a、IL-6水平（值）較對照組改善更明顯（P<0.01）。結論膿毒癥早期運用益氣解毒法能夠有效抑制機體過度炎癥反應和過度免疫應答機制，提高膿毒癥的臨床療效。

關鍵詞：膿毒癥；益氣解毒法；免疫調節；中西醫結合治療

中圖分類號：R631+.2文獻標志碼：A文章編號：1007-2349（2017）11-0027-05

【Abstract】Objective： To observe the clinical effect of Replenishing Qi and Detoxicating Method on early sepsis. Methods： 97 patients were divided into a treatment group （49 cases） and a control group （48 cases） by randomized and parallel control. The treatment group was given intravenous infusion of Astragalus injection on the basis of routine treatment of western medicine， each 30mL， combined with TCM compound Qingwen Baidu Drinking. 7-day was a course of treatment. The value changes of APACHE Ⅱ score， MODS score， SOFA score， peripheral blood， serum CRP， TNF-a， IL-6 level and clinical effect scores of the two groups were compared before and after treatment. Results： After the treatment， APACHE Ⅱ score of the two groups decreased after the treatment， but the treatment group decreased more significantly （P<0.01）. The total effective rate of the treatment group after the 7-day treatment was 93.88% and the rate of the control group was 87.50%. The statistical analysis was very significant difference （P<0.01）. Compared with the prior treatment， the levels of WBC， N， CRP， TNF-a and IL-6 of the two groups were significantly lower （P<0.05） （P<0.01）. Compare with that of the control group， the level of WBC， N and CRP of the treatment group was significantly lower after the 7-day treatment， but there was no statistical difference （P<0.05）， and the level of TNF-a and IL-6 significantly improved （P<0.01）. Conclusion： The use of Replenishing Qi and Detoxicating method in early sepsis can effectively inhibit the mechanism of excessive inflammation and excessive immune response and improve the clinical curative effect of sepsis.

【Key words】sepsis， Replenishing Qi and Detoxicating Method， immunomodulation， integrated treatment of l Chinese and western medicine

膿毒癥是危重患者的主要死亡原因之一。隨著對膿毒癥病理生理的研究深入，人們逐漸認識到在膿毒癥的發生和發展過程中，始終存在著同時導致非特異性炎癥反應亢進和特異性免疫功能抑制的雙重因素[1]，引起機體致炎/抗炎反應失衡，免疫功能處于紊亂狀態[2]。在已往有大量研究證實中醫藥對免疫機制具有多靶點、雙向調節作用，有助于免疫調節和改善預后的基礎上，本研究組嘗試益氣解毒法運用于膿毒癥早期治療。通過本研究旨在探討中西醫結合治療膿毒癥的臨床療效，觀察益氣解毒法在膿毒癥早期的運用價值以及對炎性因子的影響，現將結果報道如下。endprint