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目的:观察清肺承气汤辅助治疗重症肺炎痰热壅肺证的临床疗效以及对血清晚期糖基化终末产物受体(RAGE),肿瘤坏死因子-α(TNF-α)和白细胞介素-6(IL-6)水平的影响。方法:本组研究共96例,均为ICU病房收治重症肺炎患者,参照数字表法随机分为治疗组和对照组各48例;对照组采取常规治疗,在早期抗感染采取利奈唑胺注射液,静脉滴注治疗,1次/12 h,600 mg/次;治疗组在对照组治疗的基础上给予清肺承气汤内服,1剂/d,常规水煎煮2次。两组患者疗程均为2周。比较两组治疗前后中医主证积分、动脉血气变化以及急性生理和慢性健康状况评分Ⅱ(APACHEⅡ);评价两组治疗后的临床效果;检测两组治疗前后血清RAGE,TNF-α和IL-6水平。结果:治疗组治疗后中医主证积分发热、咳嗽、痰壅和气促分均明显低于对照组(P<0.01);治疗组总有效率为95.83%,对照组为79.17%,治疗组优于对照组(P<0.05);治疗组治疗后二氧化碳分压(Pa CO2)和APACHEⅡ均明显低于对照组,而血氧饱和度(Sa O2)和血氧分压(Pa O2)明显高于对照组(P<0.01);治疗后治疗组RAGE,TNF-α和IL-6水平均明显低于对照组,比较差异均有统计学意义(P<0.01)。结论:在西医临床治疗的基础上,加用清肺承气汤辅助治疗重症肺炎痰热壅肺证可明显改善患者中医主证积分,APACHEⅡ评分以及动脉血气,提高临床治疗效果,降低血清RAGE,TNF-α和IL-6水平可能是其发挥治疗作用的机制之一。
Objective: To observe the clinical efficacy of Qingfei Chengqi Decoction in adjuvant treatment of severe pneumonia and phlegm-heat lungs syndrome and to evaluate the clinical effect of serum advanced glycation end-products receptor (RAGE), tumor necrosis factor-α (TNF-α) and interleukin -6 (IL-6) levels. Methods: A total of 96 cases were studied in this study. All patients were admitted to ICU ward for severe pneumonia. According to the digital meter method, 48 cases were randomly divided into treatment group and control group. In the control group, routine treatment was given to linezolid injection , Intravenous drip treatment, once / 12 h, 600 mg / time; the treatment group in the control group on the basis of treatment given Qingfei Chengqi Decoction, 1 / d, conventional boiling water twice. Two groups of patients were treated for 2 weeks. The scores of main TCM syndromes, arterial blood gas, and acute physiology and chronic health status Ⅱ (APACHEⅡ) were compared between the two groups before and after treatment. The clinical effects of the two groups were evaluated before and after treatment. The levels of serum RAGE, TNF-α and IL-6 Level. Results: The scores of fever, cough, phlegm and blood pressure were significantly lower in the treatment group than those in the control group (P <0.01). The total effective rate was 95.83% in the treatment group and 79.17% in the control group. The treatment group was superior to the control group (P <0.05). The PaCO 2 and APACHEⅡ in the treatment group were significantly lower than those in the control group, while the values of Sa O2 and Pa O2 in the treatment group were significantly higher than those in the control group (P <0.01). After treatment, the levels of RAGE, TNF-α and IL-6 in the treatment group were significantly lower than those in the control group (P <0.01). Conclusion: Based on the clinical treatment of Western medicine, adding Qingfei Chengqi Decoction to adjuvant treatment of severe pneumonia and phlegm-heat lungs can significantly improve the main TCM syndrome score, APACHEⅡscore and arterial blood gas, improve the clinical therapeutic effect, lower the serum RAGE, TNF-α and IL-6 levels may be one of its mechanisms of action.