宣肺通腑汤辅助治疗中老年重症肺炎合并胃肠功能障碍的临床观察

韩正贵; 陆江涛; 王文静; 王健

doi:10.13422/j.cnki.syfjx.20181630

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宣肺通腑汤辅助治疗中老年重症肺炎合并胃肠功能障碍的临床观察

临床 | 更新时间：2024-01-04

- 宣肺通腑汤辅助治疗中老年重症肺炎合并胃肠功能障碍的临床观察
- Clinical Effect of Xuanfei Tongfu Decoction for Severe Pneumonia Combined with Gastrointestinal Dysfunction in Middle and Old Age
- 中国实验方剂学杂志 2018年24卷第16期页码：188-193
- 作者机构：
- 作者简介：
- 基金信息：
  
  海南省专项科研试制项目（YW1257）
- DOI：10.13422/j.cnki.syfjx.20181630
  中图分类号： R57;R563.1
- 纸质出版日期：2018
- 稿件说明：
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韩正贵, 陆江涛, 王文静, 等. 宣肺通腑汤辅助治疗中老年重症肺炎合并胃肠功能障碍的临床观察[J]. 中国实验方剂学杂志, 2018,24(16):188-193.

HAN Zheng-gui, LU Jiang-tao, WANG Wen-jing, et al. Clinical Effect of Xuanfei Tongfu Decoction for Severe Pneumonia Combined with Gastrointestinal Dysfunction in Middle and Old Age[J]. Chinese journal of experimental traditional medical formulae, 2018, 24(16): 188-193.
韩正贵, 陆江涛, 王文静, 等. 宣肺通腑汤辅助治疗中老年重症肺炎合并胃肠功能障碍的临床观察[J]. 中国实验方剂学杂志, 2018,24(16):188-193. DOI： 10.13422/j.cnki.syfjx.20181630.

HAN Zheng-gui, LU Jiang-tao, WANG Wen-jing, et al. Clinical Effect of Xuanfei Tongfu Decoction for Severe Pneumonia Combined with Gastrointestinal Dysfunction in Middle and Old Age[J]. Chinese journal of experimental traditional medical formulae, 2018, 24(16): 188-193. DOI： 10.13422/j.cnki.syfjx.20181630.

摘要

目的：观察宣肺通腑汤治疗中老年重症肺炎合并胃肠功能障碍的疗效及对胃肠功能的保护作用及对炎症因子的影响。方法：将104例符合要求的患者随机分为对照组和观察组各52例。对照组给予抗感染治疗、抗炎治疗、对症治疗及支持治疗，给予枸橼酸莫沙必利口服溶液，10 mL/次，3次/d，口服；双歧杆菌三联活菌散，2 g/次，3次/d，口服。观察组在对照组治疗的基础上给予宣肺通腑汤，1剂/d。两组疗程均连续治疗14 d。记录治疗前后CURB65，SMART-COP，临床肺部感染评分（CPIS），中医证候评分、胃肠功能障碍（GIDF），急性病生理和长期健康Ⅱ评分（APACHEⅡ）和多器官功能障碍综合征（MODS）评分，检测治疗前后血清胃动素（MTL），胃泌素（GAS），D-乳酸，二胺氧化酶（DAO），降钙素原（PCT），白细胞介素-6（IL-6），IL-8，肿瘤坏死因子-α（TNF-α）水平；记录ICU病死率（2周内），ICU住院日、机械通气时间。结果：观察组患者临床疗效愈显率为59.62%，高于对照组愈显率38.46%（χ2=4.6564，P<0.05）；观察组机械通气时间和ICU住院日均短于对照组（P<0.01），观察组ICU病死率11.54%，低于对照组病死率15.38%，组间比较差异无统计学意义；观察组患者CURB65，SMART-COP，CPIS，中医证候，GIDF，APACHEⅡ和MODS评分均低于对照组（P<0.01）；观察组血清GAS，D-乳酸和DAO水平均低于对照组，MTL水平高于对照组（P<0.01）；观察组患者血清PCT，TNF-α，IL-6和IL-8水平均低于对照组（P<0.01）。结论：在西医常规治疗的基础上，宣肺通腑汤辅助治疗重症肺炎合并GIDF患者，可控制临床症状，调节胃肠激素，促进肠黏膜屏障修复和胃肠功能恢复，抑制炎症反应，减轻病情程度，缩短了疾病的愈合时间。

Abstract

Objective: To observe the effect of Xuanfei Tongfu decoction on severe pneumonia combined with gastrointestinal dysfunction in middle and old age

and investigate its protection effect on gastrointestinal function and inflammatory factors. Method: One hundred and four eligible patients were randomly divided into control group (52 cases) and observation group (52 cases) by random number table. Patients in control group got anti-infection treatment

anti-inflammation treatment

symptomatic treatment and supportive treatment

and they got mosapride citrate oral solution

10 mL/time

3 times/days

lactobacillus and enterococcus powder

2 g/time

3 times/days. Based on the treatment in control group

the patients in observation group additionally got Jiawei Xuanfei Tongfu decoction

1 dose/day. The treatment course was 14 days in both groups. Before and after treatment

CURB65

SMART-COP and clinical pulmonary infection score (CPIS)

scores of traditional Chinese medicine(TCM)

gastrointestinal dysfunction (GIDF)

acute physiology and chronic health evaluationⅡ score (APACHEⅡ) and scores of multiple organ dysfunction syndrome (MODS) were graded

and levels of serum motilin (MTL)

gastrin (GAS)

D-lactic acid

diamine oxidase (DAO)

procalcitonin (PCT)

interleukins-6 (IL-6)

IL-8 and tumor necrosis factor-α (TNF-α) were detected. In addition

the fatality rate in ICU (within 2 weeks)

duration of hospitalization in ICU and time of mechanical ventilation were recorded. Result: The markedly effective rate was 59.62% in observation group

higher than 38.46% in control group (χ2=4.656 4

P<0.05). The duration of hospitalization in ICU and time of mechanical ventilation in observation group were shorter than those in control group (P<0.01). The fatality rate in ICU was 11.54% in observation group

lower than 15.38% in control group

with no statistically significant differences between two groups. The scores of CURB65

SMART-COP

CPIS

TCM

GIDF

APACHEⅡ

and MODS in observation group were lower than those in control group (P<0.01). The serum GAS

D-lactic acid and DAO levels were lower while level of MTL was higher than those in control group (P<0.01). The serum PCT

TNF-α

IL-6 and IL-8 levels in observation group were lower than those in control group (P<0.01). Conclusion: Adjuvant therapy of Jiawei Xuanfei Tongfu decoction based on routine western treatment can control clinical symptoms

regulate gastrointestinal hormones

promote repair of intestinal mucosal barrier and recovery of gastrointestinal function

inhibit inflammatory reaction

relieve degree of disease and can shorten healing time in treatment for patients with severe pneumonia combined with GIDF.

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