世界中医药

作者	单位
程永华1，彭书玲2，王元元3，杨自生4	1 河南省郑州市第九人民医院老年科，郑州，450000； 2 河南省郑州人民医院中医科，郑州，450000； 3 河南中医药大学第一附属医院呼吸科，郑州，450000； 4 河南省人民医院CCU，郑州，450000

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中文摘要:

目的：分析麻杏石甘汤化裁辨治对重症肺炎患者肺功能、微观指标、病情进展影响性，为重症肺炎治疗方案选择提供参考。方法：选取2015年2月至2017年1月郑州市第九人民医院收治的重症肺炎患者112例，按照入组顺序编号，单号为对照组，双号为观察组，每组56例。对照组采用常规西药治疗，观察组患者在常规西药治疗的基础上加用麻杏石甘汤化裁辨治。2组均连续治疗2周(1个疗程)。比较2组治疗前、治疗后肺功能指标：呼吸频率（RR）、用力肺活量（FVC）、第1秒用力呼吸容积（FEV1）、动脉血氧分压（PaO2）、动脉血二氧化碳（PaCO2）、最大呼气中段流量(maMMF）、氧合指数（IO）。微观指标：红细胞分布宽度(RWD)、血小板分布宽度（PWD）、高迁移率族蛋白B1（HMGB1）、肿瘤坏死因子-α（TNF-α）、降钙素原（PCT）、白细胞介素-6（IL-6）。病情变化指标：APACHEⅡ评分、CPIS评分、PIS评分情况。比较2组治疗过程中药物不良反应和预后结果。结果:2组治疗后APACHEⅡ评分、CPIS评分、PIS评分均较治疗前明显下降,且观察组明显低于对照组（P<0.05）；2组治疗后RR、FVC、FEV1、maMMF、IO较治疗前均升高，且观察组高于对照组（P<0.05）；2组治疗后，观察组RWD、PWD、HMGB1、TNF-α、PCT、IL-6均较治疗前明显下降，且观察组低于对照组（P<0.05）；2组治疗过程中药物不良反应率比较，差异无统计学意义（P>0.05）；观察组患者30 d内死亡4例，死亡率7.14%，对照组死亡7例，死亡率12.50%，观察组死亡率明显低于对照组（P<0.05）。结论：麻杏石甘汤辅助西药化裁治疗重症肺炎能降低患者炎性反应、呼吸功能，减缓病情进展，更具优势，可有效提升患者预后，且安全性高，具有较高临床价值。

English Summary:

To analyze the effects of Maxing Shigan Decoction on pulmonary function，microscopic indexes and disease progression in patients with severe pneumonia，and to provide reference for the choice of treatment scheme for severe pneumonia. Methods:A total of 112 cases of severe pneumonia treated in Ninth People's Hospital of Zhengzhou from February 2015 to January 2017 were numbered according to the order of entry，and the odd number was the control group and the even number was the observation group，with 56 cases in each group. The control group was treated with routine therapy of Western medicine，on the basis of which the observation group was treated with Maxing Shigan Decoction. Two groups of patients were treated continuously for 2 weeks as a course of treatment. The pulmonary function indexes before and after treatment were compared between the two groups，including respiratory rate (RR)，forced vital capacity (FVC)，forced breathing volume (FEV1)，arterial oxygen partial pressure (PaO2)，arterial blood carbon dioxide (PaCO2)，maximum exhalation middle segment flow (maMMF)，oxygen index (IO); microscopic indexes，including red blood cell distribution width (RWD)，platelet distribution width (PWD)，high mobility group protein B1 (HMGB1)，tumor necrosis factor-alpha (TNF-alpha)，calcitonin (PCT)，interleukins-6 (IL-6); and condition change index，including APACHE II score，CPIS score，and PIS score. The adverse drug reactions during treatment were compared between the two groups. The outcome of the two groups was compared. Results:1) The APACHE II score，CPIS score and PIS score of the two groups were significantly decreased after the treatment，and the scores of patients in the observation group were significantly lower than those of the control group (P<0.05); 2) RR，FVC，FEV1，maMMF and IO of the two groups were increased after the treatment，and those of the observation group were higher than those of the control group (P<0.05); 3) after the treatment，the RWD，PWD，HMGB1，TNF-α，PCT and IL-6 in the observation group were significantly decreased and were lower than those of the control group (P<0.05); 4) there was no significant difference in the rate of adverse drug reactions in the two groups (P>0.05); 5) The mortality rate in the observation group was 7.14% with 4 cases. The mortality rate in the control group was 12.50% with 7 cases. The mortality in the observation group was significantly lower than that in the control group (P<0.05). Conclusion:Maxing Shigan Decoction in the treatment of severe pneumonia patients combined with Western medicine can reduce the inflammatory state of the patients，improve the immune function，respiratory function，slow down the disease progression，and improve the prognosis of the patients effectively，with high safety and high clinical value.

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