Thirty Cases of Severe Traumatic Ventilator-associated Pneumonia with Phlegm-heat Obstructing the Lung Pattern Treated by Modified <italic style="font-style: italic">Xuanbai Chengqi Decoction</italic> （加味宣白承气汤）

WANG Zhibing; YU Kejing; LIU Qianqian; ZHOU Xiaoyan; SHEN Jianguo

doi:10.13288/j.11-2166/r.2023.03.010

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Thirty Cases of Severe Traumatic Ventilator-associated Pneumonia with Phlegm-heat Obstructing the Lung Pattern Treated by Modified Xuanbai Chengqi Decoction （加味宣白承气汤）

更新时间：2023-01-29

- Thirty Cases of Severe Traumatic Ventilator-associated Pneumonia with Phlegm-heat Obstructing the Lung Pattern Treated by Modified Xuanbai Chengqi Decoction （加味宣白承气汤）
- Journal of Traditional Chinese Medicine Vol. 64, Issue 3, Pages: 269-274(2023)
- 作者机构：
  
  河北省沧州中西医结合医院，河北省沧州市运河区黄河西路31号，061000
- 作者简介：
- 基金信息：
- DOI：10.13288/j.11-2166/r.2023.03.010
  CLC：
- Received：20 April 2022，
  
  Revised：2022-10-20，
  
  Published：02 February 2023
- 稿件说明：
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王知兵,于克静,刘倩倩等.加味宣白承气汤辅助治疗重症创伤呼吸机相关性肺炎痰热壅肺证患者30例临床观察[J].中医杂志,2023,64(03):269-274.

WANG Zhibing,YU Kejing,LIU Qianqian,et al.Thirty Cases of Severe Traumatic Ventilator-associated Pneumonia with Phlegm-heat Obstructing the Lung Pattern Treated by Modified Xuanbai Chengqi Decoction （加味宣白承气汤）[J].Journal of Traditional Chinese Medicine,2023,64(03):269-274.
王知兵,于克静,刘倩倩等.加味宣白承气汤辅助治疗重症创伤呼吸机相关性肺炎痰热壅肺证患者30例临床观察[J].中医杂志,2023,64(03):269-274. DOI： 10.13288/j.11-2166/r.2023.03.010.

WANG Zhibing,YU Kejing,LIU Qianqian,et al.Thirty Cases of Severe Traumatic Ventilator-associated Pneumonia with Phlegm-heat Obstructing the Lung Pattern Treated by Modified Xuanbai Chengqi Decoction （加味宣白承气汤）[J].Journal of Traditional Chinese Medicine,2023,64(03):269-274. DOI： 10.13288/j.11-2166/r.2023.03.010.

摘要

目的

观察加味宣白承气汤辅助治疗重症创伤呼吸机相关性肺炎痰热壅肺证患者的临床疗效。

方法

将60例重症创伤呼吸机相关性肺炎痰热壅肺证患者随机分为治疗组和对照组各30例，对照组给予西医基础治疗，治疗组在对照组治疗基础上给予加味宣白承气汤，每日1剂，两组疗程均为7天。分别于治疗前及治疗后第3天、第5天、第7天测量两组患者呼吸力学指标［包括平台压（Pplat）、气道阻力（Raw）、静态顺应性（Cst）］，氧合指数（PaO

/FiO

）；于治疗前及治疗后第7天比较两组患者临床肺部感染评分（CPIS）及降钙素原（PCT）、超敏C反应蛋白（CRP）水平。评价结局指标，包括28天无机械通气时间、ICU住院时间及28天死亡率，治疗过程中观察两组患者不良反应。

结果

治疗组在治疗后第3天、第5天和第7天，PaO

/FiO

及Cst较治疗前明显升高（

＜0.05），而Pplat及Raw较治疗前明显降低（

＜0.05）。第5天PaO

/FiO

、Cst高于第3天（

＜0.01），而Pplat、Raw低于第3天（

＜0.01）；第7天PaO

/FiO

、Cst高于第3天和第5天（

＜0.05或

＜0.01），而Pplat、Raw低于第3天和第5天（

＜0.01）。对照组在第3天、第5天、第7天PaO

/FiO

及Cst均较治疗前升高（

＜0.05），而Pplat及Raw较治疗前降低（

＜0.05）。第5天PaO

/FiO

、Cst明显高于第3天（

＜0.01），而Raw明显低于第3天（

＜0.01）；第7天PaO

/FiO

、Cst高于第3天和第5天（

＜0.01），而Pplat、Raw低于第3天和第5天（

＜0.05）。同时间组间比较，治疗后第3天、第5天、第7天，治疗组PaO

/FiO

高于对照组、而Raw低于对照组（

＜0.05）。治疗后第5天及第7天治疗组Pplat明显低于对照组（

＜0.05）。治疗后第7天与对照组比较，治疗组CPIS评分明显降低（

＜0.05），28天无机械通气时间延长（

＜0.01）、ICU住院时间缩短（

＜0.05）。

结论

与单纯西医治疗比较，辅以加味宣白承气汤治疗重症创伤呼吸机相关性肺炎痰热壅肺证，能够延长患者28天无机械通气时间、缩短ICU住院时间，这可能与改善CPIS评分、氧合情况、呼吸力学指标有关。

Abstract

Objective

To observe the clinical effect of Modified

Xuanbai Chengqi Decoction

（加味宣白承气汤） in treating ventilator-associated pneumonia （VAP） in severe trauma patients phlegm-heat obstructing the lung pattern.

Methods

Sixty severe trauma patients with VAP and phlegm-heat obstructing the lung pattern were randomly divided into treatment group （30 cases） and control group （30 cases）. The control group received basic treatment， and the treatment group was given Modified

Xuanbai Chengqi Decoction

in addition， one dose per day. Both group were treated for 7 days. The respiratory mechanics indicators including plateau pressure （Pplat）， airway resistance （Raw） and static compliance （Cst）， as well as oxygenation index （PaO

/FiO

）， were measured before treatment and on the 3rd， 5th， and 7th day of treatment. The clinical pulmonary infection score （CPIS）， procalcitonin （PCT） and high-sensitivity C-reactive protein （CRP） levels were compared before and on the 7th day of treatment. The outcomes including 28-day ventilation-free time， length of ICU stay and 28-day mortality were evaluated， and the adverse reactions were recorded. Rusults　In the treatment group， the PaO

/ FiO

and Cst level significantly increased on the 3rd， 5th and 7th day of treatment （

＜0.05）， while Pplat and Raw levels significantly decreased （

＜0.05）. PaO

/ FiO

and Cst level on the 5th day were higher than those on the 3rd day （

＜0.01）， while Pplat and Raw levels were lower （

＜0.01）. There were higher PaO

/ FiO

and Cst level on the 7th day than on the 3rd and 5th day （

＜0.05 or

＜0.01 ）， but lower Pplat and Raw levels （

＜0.01）. In the control group， PaO

/ FiO

and Cst levels were higher on the 3rd， 5th and 7th days than those before treatment （

＜0.05）， while Pplat and Raw levels were lower （

＜ 0.05）. Higher PaO

/ FiO

and Cst level （

＜0.01）， as well as lower Raw level （

＜0.01） was found on the 5th day than on the 3rd day. PaO

/ FiO

and Cst level on 7th day were higher than those on 3rd day and 5th days （

＜ 0.01）， while Pplat and Raw levels were lower （

＜0.05）. When compared between groups， PaO

/ FiO

on the 3rd， 5th and 7th days were higher in the treatment group， while Raw level was lower （

＜0.05）； Pplat level on the 5th and 7th day were lower in treatment group（

＜0.01）. The CPIS score on the 7th day was lower in the treatment group （

＜0.05）， while the 28-day ventilation-free time was prolonged （

＜0.01）， and the length of ICU stay was shortened （

＜0.05）.

Conclusion

Compared to western medicine alone， the adjuvant treatment with Modified

Xuanbai Chengqi Decoction

can extend the 28-day ventilation-free time and shorten the length of ICU stay when treating severe traumatic VAP with phlegm-heat obstructing the lung pattern. This may be related to the improvement of CPIS， oxygenation index and the respiratory mechanics indicators.

关键词

Keywords

references

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Thirty Cases of Severe Traumatic Ventilator-associated Pneumonia with Phlegm-heat Obstructing the Lung Pattern Treated by Modified Xuanbai Chengqi Decoction （加味宣白承气汤）

DOI：10.13288/j.11-2166/r.2023.03.010

摘要

Abstract

关键词

Keywords

references