CAJ | 학술논문

　　目的研究涤痰醒脑承气汤对脓毒症脑功能障碍患者的临床疗效。方法将62例脓毒症脑功能障碍患者按随机数字表法分为治疗组（32例）和对照组（30例）。对照组给予临床常规治疗；治疗组在西医常规治疗的基础上加用中药涤痰醒脑承气汤鼻饲，观察治疗前及治疗后12、24、48、72 h和1周两组患者C-反应蛋白（CRP）的变化；治疗前后评定两组患者的格拉斯哥预后评分（GOS），并判断临床疗效；同时观察两组患者的住院费用、住院时间、总有效率，并进行成本-效益分析。结果随着治疗时间延长，两组治疗后CRP （mg/L）水平均较治疗前明显降低，且治疗组下降更明显，24 h开始两组比较差异有统计学意义（106.5±22.3比201.6±25.4，P＜0.05）。两组治疗后GOS评分（分）均较治疗前明显升高，且治疗组升高更显著（72 h：10.34±0.76比7.34±0.48，1周：13.16±0.86比9.56±0.64，均P＜0.05）。治疗组重症监护病房（ICU）住院费用（元）明显低于对照组（43276.16±1844.23比51347.75±2011.06，P＜0.05），ICU住院时间（d）明显短于对照组（15.11±2.25比20.30±2.97，P＜0.05）。治疗组总有效率高于对照组，但差异无统计学意义（87.5%比60.0%，P＞0.05），但治疗组的成本-效益比明显小于对照组（497.42比855.80，P＜0.05）。结论涤痰醒脑承气汤对拮抗炎症因子、抑制过度炎症反应、改善意识障碍有较好的疗效，早期干预可以控制脓毒症脑功能障碍患者的病情，改善预后、减少住院费用。
　　목적연구조담성뇌승기탕대농독증뇌공능장애환자적림상료효。방법장62례농독증뇌공능장애환자안수궤수자표법분위치료조（32례）화대조조（30례）。대조조급여림상상규치료；치료조재서의상규치료적기출상가용중약조담성뇌승기탕비사，관찰치료전급치료후12、24、48、72 h화1주량조환자C-반응단백（CRP）적변화；치료전후평정량조환자적격랍사가예후평분（GOS），병판단림상료효；동시관찰량조환자적주원비용、주원시간、총유효솔，병진행성본-효익분석。결과수착치료시간연장，량조치료후CRP （mg/L）수평균교치료전명현강저，차치료조하강경명현，24 h개시량조비교차이유통계학의의（106.5±22.3비201.6±25.4，P＜0.05）。량조치료후GOS평분（분）균교치료전명현승고，차치료조승고경현저（72 h：10.34±0.76비7.34±0.48，1주：13.16±0.86비9.56±0.64，균P＜0.05）。치료조중증감호병방（ICU）주원비용（원）명현저우대조조（43276.16±1844.23비51347.75±2011.06，P＜0.05），ICU주원시간（d）명현단우대조조（15.11±2.25비20.30±2.97，P＜0.05）。치료조총유효솔고우대조조，단차이무통계학의의（87.5%비60.0%，P＞0.05），단치료조적성본-효익비명현소우대조조（497.42비855.80，P＜0.05）。결론조담성뇌승기탕대길항염증인자、억제과도염증반응、개선의식장애유교호적료효，조기간예가이공제농독증뇌공능장애환자적병정，개선예후、감소주원비용。
Objective To study the clinical effects of Ditan Xingnao Chengqi soup for treatment of patients with sepsis brain dysfunction. Methods Sixty-two cases of sepsis brain dysfunction were divided into treatment group(32 cases)and control group(30 cases)according to random digits table. Both groups received general clinical treatment,while the treatment group additionally accepted Ditan Xingnao Chengqi soup through nasal feeding. The changes of C-reactive protein(CRP)of two groups before treatment and after treatment for 12,24,48,72 hours and 1 week were observed. Besides,the Glasgow Outcome Scale(GOS)was used to assess the curative effect of two groups, and its clinical significance was judged. Meanwhile,the hospitalization costs,the times staying in hospital and total effective rates of the two groups after treatment were observed. In addition,cost-effectiveness analysis was carried out. Results With the extension of therapeutic time,the levels of CRP(mg/L)in the two groups were reduced effectively in comparison with those before treatment,and the change was more obvious in the treatment group;after treatment for 24 hours,the difference in the level of CRP between the two groups began to be statistically significant(106.5±22.3 vs. 201.6±25.4,P<0.05). The GOS of two groups after treatment had been increased markedly in comparison to that before treatment,and the change was more obvious in treatment group(72 hours:10.34±0.76 vs. 7.34±0.48,1 week:13.16±0.86 vs. 9.56±0.64,both P<0.05). Hospitalization costs(yuan)of treatment group in intensive care unit (ICU)was lower than that in control group(43276.16±1844.23 vs. 51347.75±2011.06,P<0.05),and the duration of staying(day)in ICU of treatment group was shorter than that in control group(15.11±2.25 vs. 20.30±2.97,P<0.05). The total effective rate of treatment group was higher than that of control group,but the difference had no statistical significance(87.5%vs. 60.0%,P>0.05).The ratio of cose effectiveness analysis in treatment group was smaller than that of control group(497.42 vs. 855.80,P<0.05). Conclusions Ditan Xingnao Chengqi soup has a relatively good effect on antagonizing inflammatory factors,controlling excessive inflammatory response and improving disturbance of consciousness. The early intervention with this agent for a patient with sepsis cognitive impairment can control the disease situation,improve the patient's prognosis and reduce his or her hospitalization costs.