托补并用治疗危重症患者肺部感染（气阴两虚、痰热壅肺）疗效的临床观察

【作者】 邱实；

【导师】 杨志旭；

【作者基本信息】 北京中医药大学 ， 中西医结合临床， 2012， 硕士

【摘要】 研究目的：危重症患者肺部感染是最常见的感染之一,发病率高,病死率亦高。随着细菌耐药率的提高,超级细菌的出现,新一代抗生素研发困难,并且新抗生素的研制并不能从根本上解决问题,使用不久就会产生耐药,治疗肺部感染成为了一个非常棘手的问题,中医药治疗逐渐被大家所重视。本研究通过对西医常规治疗结合中药托毒排脓、攻补兼施治疗危重症患者肺部感染疗效的临床观察,进一步研究中医通过促进排痰对重症患者肺部感染干预性治疗的临床有效性,为改善患者临床症状提供更好的方法并为该方的推广提供一定临床依据。研究方法：收集38例2010年12月-2011年12月期间入住中国中医科学院西苑医院ICU,符合肺部感染(肺炎)中医辨证属气阴两虚、痰热壅肺证的住院患者,用随机分组对照的临床试验方法将其分为中药加西医常规治疗组(治疗组)19例,西医常规治疗组(对照组)19例,治疗组：中药自拟方(托毒排脓、攻补兼施)加西药常规治疗,对照组：单纯西药常规治疗。治疗一周(7天),分别在治疗第1天、第7天填写CRF表,记录观察监测数据,治疗后,进行治疗组和对照组治疗前后临床疗效、CPIS评分、中医症状评分比较,以及对比白细胞(WBC)计数、中性粒细胞百分比(N%)、C反应蛋白(CRP)、血氧分压、血二氧化碳分压、胸片结果以及排痰量治疗前后的变化。比较两组的疗效何者更具有优势,并客观评价中药自拟方(托毒排脓、攻补兼施)对危重症患者肺部感染干预性治疗的临床疗效。统计数据均采用SPSS17.0统计软件,比较计量资料用t检验或秩和检验(方差不齐时),比较计数资料用Fisher’s检验(n<40),用配对样本t检验进行治疗前后的组内比较,独立样本t检验进行治疗后的组间比较。P<0.05有统计学差异。P<0.01具有显著统计学差异。研究结果：1.治疗后两组的临床疗效比较,治疗组有效率84.2%,对照组有效率66.7%,分析得出治疗组临床疗效较对照组更好；2.治疗后分别进行两组治疗前后中医症状评分的组内比较,P治=0.00(P<0.01),P对=0.00(P<0.01),有显著差异,说明治疗组和对照组均可以显著降低患者中医症状评分；两组治疗后评分比较,P=0.023(P<0.05),有差异,说明治疗组较对照组能更好的改善中医症状评分；3.治疗后分别进行两组CPIS评分治疗前后的组内比较,P治=0.00(P<0.01),P对<0.00(P<0.01),有显著差异,说明治疗组和对照组均可以显著降低患者CPIS评分；两组组间治疗后评分比较,P=0.01(P<0.05),差异有统计学意义；4.经治疗后,两组患者WBC计数、CRP、中性粒细胞百分比、二氧化碳分压、排痰量均下降,血氧分压升高,除WBC计数变化两组间无统计学差异,其余治疗组均优于对照组；5.胸片肺部炎症吸收改善结果两组进行比较分析,P=0.092(P>0.05),统计学无差异。但是治疗组有效率明显高于对照组,认为治疗组在促进肺部炎性吸收方面优于对照组,只是统计无差异。结论：1.在西医常规治疗的基础上加用中药托毒排脓、攻补兼施治疗危重症患者肺部感染,可以降低肺部感染的严重程度,改善临床症状,有较好的临床治疗效果。2.对于实验室相关指标,虽然对白细胞的变化治疗组较对照组无明显统计学差异,但是中性粒细胞下降趋势治疗组比对照组下降明显,说明此方对降低WBC计数和中性粒细胞有一定的优势。只是统计学上无差异。3.此方可以降低危重症患者肺部感染炎性反应。4.此方有很好的促进痰液排出的效果。更多还原

【Abstract】 Research purpose:Critically ill patients with pulmonary infection disease are very important and one of the most common infections, high incidence, the mortality is high. With the improvement of resistant bacteria, super bacteria, the emergence of a new generation of antibiotic research difficulties, and the development of new antibiotics and can’t fundamentally solve a problem, use will soon produce resistance, the treatment of lung infection became a very difficult problem, traditional Chinese medicine is gradually to attention. By researching the conventional treatment in combination with Chinese traditional medicine to western medicine "row poison attack, for what the sepsis treatment critically ill patients with pulmonary infection disease clinical observation of the curative effect, and further to study TCM by promoting a row of phlegm to critically ill patients lung infection of the clinical effectiveness intervention treatment, to improve the clinical symptoms and provide better method for the promotion of the party to provide certain scientific basis.Research Method:The data of38cases of December2010-December2011in traditional Chinese medicine academy of sciences in China during the ICU hospital, accord with pulmonary infection (pneumonia) of TCM syndrome differentiation of weak of Qi and Yin, phlegm heat of hospitalized patients with lung card warm, with random grouping antitheses clinical test methods are classified into the western medicine of Chinese medicine for the routine treatment group (treatment group)19cases, western medicine conventional treatment group (control group)19cases, the treatment group:Chinese medicine drafts oneself party (Thomas row poison attack, for what the sepsis) and western medicine conventional treatment group:pure western medicine routine treatment. Treatment for a week (7days), respectively, in the treatment of day1day7days fill in CRF form, record observation monitoring data, after treatment, the treatment group and control group before and after treatment, clinical curative effect of traditional Chinese medicine CPIS score, compared the symptom score, and contrast white blood cells (WBC) counting, neutrophils percentage (N%), c-reactive protein (CRP), blood oxygen partial pressure, blood pressure, chest radiograph carbon dioxide points result and row sputum volume changes before and after treatment. Compared with two groups of curative effect is to have an advantage more, and an objective evaluation of the traditional Chinese medicine to party (Thomas row poison attack, for what the sepsis) to critically ill patients with pulmonary infection disease intervention the clinical efficacy of treatment. Statistical data are used SPSS17.0statistical software, compared with measuring data t test or rank and inspection (variance not neat), more count material with Fisher’s inspection (n<40), with matching t test before and after treatment for samples of the comparison in the group, independent t test sample treatment between the group after comparison. P<0.05statistically significant. P<0.01has statistically significant differences.Research Results:1. After treatment the clinical curative effect of two groups compared, and the effective rate was84.2%in treatment group and control group in the effective rate was66.7%, analysis of the treatment group clinical curative effect is better than control group;2. After treatment are two groups before and after treatment of TCM symptom scores in the group compared to P=0.00(P<0.01), Pto=0.00(P<0.01), there are significant differences, explain treatment group and control group can significantly reduce patients symptom scores of traditional Chinese medicine; The two groups after treating score more,,P=0.023(P<0.05), there is difference between the treatment group, a control group that can improve symptom scores of traditional Chinese medicine;3. After treatment, the two groups CPIS score before and after treatment within the group compared to P=0.00(P<0.01), Pto=0.00(P<0.01), there are significant differences, explain treatment group and control group can be significantly reduced CPIS score patients; Two way after comparison between treatment score, P=0.01(P<0.05), the difference was statistically significant;4. After treatment, the two groups of patients WBC count, CRP, neutrophils percentage, carbon dioxide points pressure, row sputum volume decreased, blood oxygen partial pressure increases, except the WBC count change is no statistical difference between the two groups, and the rest of the treatment group than in control group were;5. Chest radiograph lung inflammation absorption improve results two groups the comparative analysis, F=0.092(P>0.05), there is no difference statistics. But the treatment group efficient obviously is higher than those in the control group, think the treatment group in promoting lung inflammatory absorb is better than control group, but no difference statistics.Conclusion:1. In the western conventional treatment based on traditional Chinese medicine combined with "row poison attack, for what the sepsis treatment in patients of critical pulmonary infection, reduce the severity of the lung infection, can improve the clinical symptoms, and have a good clinical treatment effect.2. For laboratory, although the change of the white treatment group than the control group no significant difference, but neutrophils down trend treatment group than in the control group down significantly, indicating that this party to reduce the WBC count and neutrophils has certain advantages. Just there was no statistically difference.3. The party can reduce the inflammatory reaction of critically ill patients with pulmonary infection disease.4. The party has a good promote sputum eduction effect.更多还原