百合固金汤联合参麦注射液对呼吸机相关性肺炎老年患者疗效及相关指标的影响(1)
摘 要 目的：探討百合固金汤联合参麦注射液对呼吸机相关性肺炎老年患者疗效及相关指标的影响。方法：选择2018年4月-2019年10月诸暨市中医医院重症医学科(ICU)收治的75例气管插管或切开行机械通气后发生呼吸机相关性肺炎的老年患者，按随机数字表法分为对照组、参麦组、百合固金汤+参麦组，每组各25例。对照组患者给予注射用哌拉西林钠他唑巴坦钠4.5 g，静脉滴注，q8 h以抗感染+盐酸氨溴索注射液4 mL，静脉注射，bid以化痰+多索茶碱注射液20 mL，qd以解痉平喘+维持水电解质酸碱平衡等常规治疗。参麦组患者在对照组治疗基础上给予参麦注射液100 mL，静脉滴注，qd。百合固金汤+参麦组患者在参麦组治疗基础上给予百合固金汤200 mL，早晚2次鼻饲。各组均以7 d为 1个疗程，连续治疗2个疗程。观察3组患者治疗前后急性生理与慢性健康状况(APACHE)Ⅱ评分，外周血中C反应蛋白(CRP)、降钙素原(PCT)水平，支气管中CD68细胞计数，同时记录患者机械通气时间、ICU住院时间及不良反应发生情况。结果：治疗前，3组患者APACHEⅡ评分，外周血中CRP、PCT水平，支气管中CD68细胞计数比较，差异均无统计学意义(P>0.05)。治疗14 d后，3组患者的APACHEⅡ评分，外周血中CRP、PCT水平均显著低于同组治疗前，支气管中CD68细胞计数均显著高于同组治疗前，且支气管中CD68细胞计数3组间排序为百合固金汤+参麦组>参麦组>对照组(P<0.05或P<0.01);治疗7 d时，患者外周血中CRP、PCT水平3组间排序为百合固金汤+参麦组<参麦组<对照组(P<0.05);但治疗14 d时，3组间的APACHEⅡ评分，外周血中CRP、PCT水平比较，差异均无统计学意义(P>0.05)。治疗后，患者机械通气时间、ICU住院时间3组间排序为百合固金汤+参麦组<参麦组<对照组(P<0.05或P<0.01)。3组患者不良反应发生率比较，差异无统计学意义(P>0.05)。结论：在常规治疗的基础上，百合固金汤联合参麦注射液可改善呼吸机相关性肺炎老年患者的肺巨噬细胞免疫功能，早期抑制肺部炎症进展，减少机械通气时间，缩短住院时间，且安全性较好。
关键词 呼吸机相关性肺炎;老年;百合固金汤;参麦注射液;免疫功能;疗效;安全性
ABSTRACT OBJECTIVE： To investigate the effects of Baihe gujin decoction combined with Shenmai injection on therapeutic efficacy and related indexes in elderly patients with ventilator-associated pneumonia. METHODS： A total of 75 elderly patients with ventilator-associated pneumonia who were admitted to the Intensive Care Unit (ICU) of Zhuji Hospital of TCM from Apr. 2018 to Oct. 2019 were included. They were randomly divided into control group， Shenmai group， Baihe gujin decoction+Shenmai group， with 25 cases in each group. Control group was given conventional treatments as Piperacillin sodium tazobactam sodium injection 4.5 g， ivgtt， q8 h for anti-infective treatment+Ambroxol hydrochloride injection 4 mL， iv， bid for expectorant+Doxofylline injection 20 mL， qd for relieving spasm and asthma+maintaining water，electrolyte and acid-base balance. Shenmai group was given Shenmai injection 100 mL， ivgtt， qd， on the basis of control group. Baihe gujin decoction+Shenmai group was given Baihe gujin decoction 200 mL nasally， morning and evening， on the basis of Shenmai group. Each group took 7 days as a course of treatment， and the treatment was continued for 2 courses. Acute physiology and chronic health status (APACHE) Ⅱ score， C-reactive protein (CRP) in peripheral blood， procalcitonin (PCT)， bronchial CD68 count were observed in 3 groups before and after treatment while the mechanical ventilation time， hospitalization time in the ICU and ADR recorded. RESULTS： Before treatment， there was no statistically significant difference in APACHE Ⅱ score， the levels of CRP and PCT， bronchial CD68 count among 3 groups (P>0.05). After 14 days of treatment， APACHE Ⅱ score， CRP and PCT levels of all 3 groups were significantly lower than before treatment; bronchial CD68 count was significantly higher before treatment， the order of bronchial CD68 cell count was Baihe gujin decoction+Shenmai group>Shenmai group>control group (P<0.05 or P<0.01); after 7 days of treatment， the order of CRP and PCT levels was Baihe gujin decoction+Shenmai group0.05). After treatment， the order of mechanical ventilation time and ICU hospitalization time was Baihe gujin decoction+Shenmai group0.05). CONCLUSIONS： Based on routine treatment， Baihe gujin decoction combined with Shenmai injection can improve the immune function of lung macrophages in the elderly patients with ventilator-associated pneumonia， inhibite pulmonary inflammation progress， reduce mechanical ventilation time， shorten the length of hospital stay with good safety., http://www.100md.com(周雪莱 杨园 戴薇 宣志红 王益斐)
关键词 呼吸机相关性肺炎;老年;百合固金汤;参麦注射液;免疫功能;疗效;安全性
ABSTRACT OBJECTIVE： To investigate the effects of Baihe gujin decoction combined with Shenmai injection on therapeutic efficacy and related indexes in elderly patients with ventilator-associated pneumonia. METHODS： A total of 75 elderly patients with ventilator-associated pneumonia who were admitted to the Intensive Care Unit (ICU) of Zhuji Hospital of TCM from Apr. 2018 to Oct. 2019 were included. They were randomly divided into control group， Shenmai group， Baihe gujin decoction+Shenmai group， with 25 cases in each group. Control group was given conventional treatments as Piperacillin sodium tazobactam sodium injection 4.5 g， ivgtt， q8 h for anti-infective treatment+Ambroxol hydrochloride injection 4 mL， iv， bid for expectorant+Doxofylline injection 20 mL， qd for relieving spasm and asthma+maintaining water，electrolyte and acid-base balance. Shenmai group was given Shenmai injection 100 mL， ivgtt， qd， on the basis of control group. Baihe gujin decoction+Shenmai group was given Baihe gujin decoction 200 mL nasally， morning and evening， on the basis of Shenmai group. Each group took 7 days as a course of treatment， and the treatment was continued for 2 courses. Acute physiology and chronic health status (APACHE) Ⅱ score， C-reactive protein (CRP) in peripheral blood， procalcitonin (PCT)， bronchial CD68 count were observed in 3 groups before and after treatment while the mechanical ventilation time， hospitalization time in the ICU and ADR recorded. RESULTS： Before treatment， there was no statistically significant difference in APACHE Ⅱ score， the levels of CRP and PCT， bronchial CD68 count among 3 groups (P>0.05). After 14 days of treatment， APACHE Ⅱ score， CRP and PCT levels of all 3 groups were significantly lower than before treatment; bronchial CD68 count was significantly higher before treatment， the order of bronchial CD68 cell count was Baihe gujin decoction+Shenmai group>Shenmai group>control group (P<0.05 or P<0.01); after 7 days of treatment， the order of CRP and PCT levels was Baihe gujin decoction+Shenmai group