益气解毒法治疗脓毒症早期的疗效观察

龚瑞莹+庞永诚+陈斌+邓红+沈琳+任亢宗

摘要：目的观察益气解毒法治疗对脓毒症早期患者的临床疗效。方法采用随机、平行对照的方法将97例脓毒症患者分为治疗组49例和对照组48例。治疗组在西医常规治疗基础上给予黄芪注射液静脉滴注，每次30mL，并联用中药复方清瘟败毒饮，观察疗程7d。分别比较2组治疗前后APACHEⅡ评分，MODS评分，SOFA评分，外周血象，血清CRP、TNF-a、IL-6水平（值）变化和临床疗效积分。结果2组治疗后APACHEⅡ评分均有下降，但治疗组下降更明显（P<0.01）；治疗组7d后总有效率93.88%，对照组为87.50%，经统计学分析有显著性差异（P<0.05）；2组患者与治疗前比较，WBC、N、CRP、TNF-a、IL-6水平（值）均有明显下降（P<0.05，P<0.01），治疗7d后治疗组WBC、N、CRP水平（值）较对照组下降明显，但无统计学差异（P>0.05），TNF-a、IL-6水平（值）较对照组改善更明显（P<0.01）。结论脓毒症早期运用益气解毒法能够有效抑制机体过度炎症反应和过度免疫应答机制，提高脓毒症的临床疗效。

关键词：脓毒症；益气解毒法；免疫调节；中西医结合治疗

中图分类号：R631+.2文献标志码：A文章编号：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

膿毒症是危重患者的主要死亡原因之一。随着对脓毒症病理生理的研究深入，人们逐渐认识到在脓毒症的发生和发展过程中，始终存在着同时导致非特异性炎症反应亢进和特异性免疫功能抑制的双重因素[1]，引起机体致炎/抗炎反应失衡，免疫功能处于紊乱状态[2]。在已往有大量研究证实中医药对免疫机制具有多靶点、双向调节作用，有助于免疫调节和改善预后的基础上，本研究组尝试益气解毒法运用于脓毒症早期治疗。通过本研究旨在探讨中西医结合治疗脓毒症的临床疗效，观察益气解毒法在脓毒症早期的运用价值以及对炎性因子的影响，现将结果报道如下。endprint