清瘟败毒饮合凉隔散加减辅助血必净注射液治疗脓毒症热毒炽盛证的多靶点效应

任钰鑫; 刘小军; 连永红; 何延忠

doi:10.13422/j.cnki.syfjx.2017100189

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清瘟败毒饮合凉隔散加减辅助血必净注射液治疗脓毒症热毒炽盛证的多靶点效应

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- 清瘟败毒饮合凉隔散加减辅助血必净注射液治疗脓毒症热毒炽盛证的多靶点效应
- Multi-target Effect of Xuebijing Injection Combined with Dialectical Therapy of Qingwen Baiduyin and Lianggesan in Treating Sepsis with Severe Heat Poisoning Syndrome
- 中国实验方剂学杂志 2017年23卷第10期页码：189-194
- 作者机构：
- 作者简介：
- 基金信息：
  
  河南省教育厅科研项目（2012Y065）
- DOI：10.13422/j.cnki.syfjx.2017100189
  中图分类号： R459.7
- 纸质出版日期：2017
- 稿件说明：
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任钰鑫, 刘小军, 连永红, 等. 清瘟败毒饮合凉隔散加减辅助血必净注射液治疗脓毒症热毒炽盛证的多靶点效应[J]. 中国实验方剂学杂志, 2017,23(10):189-194.

REN Yu-xin, LIU Xiao-jun, LIAN Yong-hong, et al. Multi-target Effect of Xuebijing Injection Combined with Dialectical Therapy of Qingwen Baiduyin and Lianggesan in Treating Sepsis with Severe Heat Poisoning Syndrome[J]. Chinese journal of experimental traditional medical formulae, 2017, 23(10): 189-194.
任钰鑫, 刘小军, 连永红, 等. 清瘟败毒饮合凉隔散加减辅助血必净注射液治疗脓毒症热毒炽盛证的多靶点效应[J]. 中国实验方剂学杂志, 2017,23(10):189-194. DOI： 10.13422/j.cnki.syfjx.2017100189.

REN Yu-xin, LIU Xiao-jun, LIAN Yong-hong, et al. Multi-target Effect of Xuebijing Injection Combined with Dialectical Therapy of Qingwen Baiduyin and Lianggesan in Treating Sepsis with Severe Heat Poisoning Syndrome[J]. Chinese journal of experimental traditional medical formulae, 2017, 23(10): 189-194. DOI： 10.13422/j.cnki.syfjx.2017100189.

摘要

目的：观察清瘟败毒饮合凉隔散辨证内服辅助治疗对脓毒症热毒炽盛证患者炎症反应、肠屏障功能、凝血功能和血液流变学的影响，以探讨中药对脓毒症患者预后的作用。方法：将118例患者采用区组、分层随机分为对照组和观察组。对照组采用早期目标导向的液体复苏，抗感染，机械通气，营养支持治疗，控制血糖，预防应激性溃疡，抑制毛细血管微栓形成、纠正电解质紊乱、酸碱失衡等综合干预措施。观察组在对照组治疗的基础上采用血必净注射液，100 mg/次，溶于5%的葡萄糖注射液250 mL，静脉滴注，2次/d；和清瘟败毒饮合凉隔散辨证，1剂/d，内服或胃管给药；两组疗程均为7 d。预后评估指标采用急性生理及慢性健康评分（APACHEⅡ），感染相关器官功能衰竭估计（SOFA）和血清降钙素原（PCT）3个指标；检测治疗前后肿瘤坏死因子-α（TNF-α），白细胞介素-6（IL-6），白细胞介素-10（IL-10），白细胞介素-1β（IL-1β）炎症因子；检测治疗前后凝血酶原时间（PT），血浆凝血酶时间（TT），部分凝血酶原时间（APTT），D-二聚体（D-D），血小板（PLT），纤维蛋白（FIB）和血液流变学指标；肠屏障功能指标采用包括血清D-乳酸和内毒素；进行治疗前后热毒炽盛证评分。结果：观察组中医证候疗效总有效率为77.97%，高于对照组的42.37%（χ2=15.594，P<0.01）；两组在治疗后APACHEⅡ和SOFA评分呈下降趋势（F对照=6.73，F观察=7.412，P<0.05），经配对t检验，观察组在治疗第3天和第7天的APACHEⅡ和SOFA评分均低于对照组（P<0.01）；在第7天，观察组血清TNF-α，IL-1β，IL-6水平均低于对照组，IL-10水平高于对照组（P<0.01）；观察组血清D-乳酸、内毒素和PCT水平均低于对照组（P<0.01）；观察组全血高切黏度、全血低切黏度、血浆黏度、红细胞聚集指数、红细胞变性指数改善均优于对照组（P<0.01）；观察组患者FIB，D-D和PLT水平均低于对照组（P<0.01）。结论：在西医综合干预措施的基础上，加用血必净注射液静脉滴注、清瘟败毒饮合凉隔散辨证治疗脓毒症热毒炽盛证患者，能抑制早期炎症反应，控制细菌和毒素移位，能改善凝血功能紊乱状态和机体微循环，降低APACHEⅡ，SOFA评分和血清PCT水平，减轻了病情，起到改善预后的作用。

Abstract

Objective: To observe the effect of Xuebijing injection combined with dialectical therapy of Qingwen Baiduyin and Lianggesan on inflammatory response

intestinal barrier function

coagulation and blood rheology of patients with severe heat poisoning syndrome of sepsis

in order to discuss the effect of traditional Chinese medicine on prognosis of patients with symptoms of heat poisoning. Method: Altogether one hundred and eighteen patients were randomly divided into control group and observation group. Control group took early goal-directed fluid resuscitation

anti-infection

mechanical ventilation

nutritional support therapy

blood sugar control

prevention of stress ulcers

inhibition of capillary thrombosis

correction of electrolyte imbalance and acid-base imbalance and other comprehensive intervention measures. In addition to the therapy of control group

observation group was also given Xuebijing injection dissolved in 250 mL of 5% dextrose injection

intravenous drip

100 mg/time

2 times/day. And Qingwen Baiduyin and Lianggesan for oral or via gastric tube

1 dose/day. The course of treatment for both of the groups is 7 d. Acute physiology and chronic health scoring (APACHEII)

infection related organ failure estimation (SOFA) and serum procalcitonin (PCT) were adopted as prognostic indicators. And levels of tumor necrosis factor-α (TNF-α)

interleukin-6 (IL-6)

interleukin-1β (IL-1β)

interleukin-10 (IL-10)

inflammatory factor

prothrombin time (PT)

plasma thrombin time (TT)

partial prothrombin time (APTT)

D-dimer (D-D)

platelets (PLT)

Fibrin (FIB) and hemorheology index were detected. Endotoxin and serum D-lactic acid were taken as intestinal barrier function indexes. Mortality rate within 14 days were recorded. And scores of severe heat poisoning syndrome of sepsis before and after treatment were graded. Result: The total effective rate of traditional Chinese medicine syndrome was 77.97%

which was higher than 42.37% in control group (χ2=15.594

P<0.01). After treatment

scores of APACHEⅡ and SOFA decreased (Fcontrol=6.73

Fobservation=7.412

P<0.05). According to the paired T-test

at the 3th and 7th day after treatment

scores of APACHEⅡ and SOFA were lower than those in control group (P<0.01). At the 7th day

levels of TNF-α

IL-1β and IL-6 and D-lactic acid

endotoxin and PCT in observation group were lower than those in control group

and level of IL-10 in observation group was higher than that in control group (P<0.01). The amelioration of whole blood high shear viscosity

whole blood low shear viscosity

plasma viscosity

erythrocyte aggregation index and erythrocyte degeneration index in observation group were better than those in control group (P<0.01). And levels of FIB

D-D and PLT in observation group were lower than those in control group (P<0.01). Conclusion: In addition to integrated western intervention measures

Xuebijing injection combined with dialectical oral and adjuvant therapy of Qingwen Baiduyin and Lianggesan can inhibit early inflammatory response

control bacterial and toxin translocation

ameliorate coagulation disorders and body microcirculation

decrease APACHEII and SOFA scores and serum PCT levels

reduce the disease and improve prognosis.

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