CAJ | 학술논문

目的探讨通腑法对重症肺炎实热证临床疗效的影响。方法按随机数字表法将71例重症肺炎实热证患者分为治疗组（35例）和对照组（36例）。两组均给予常规治疗，治疗组在对照组常规治疗基础上鼻饲小承气汤2周。比较两组临床肺部感染评分（CPIS评分）、多器官功能障碍评分（Marshall评分）、中医证候积分和28 d、60 d病死率。结果两组CPIS评分、Marshall评分及中医证候积分均随治疗时间延长而逐渐降低，治疗组CPIS评分和Marshall评分治疗后4 d低于对照组，差异有统计学意义〔CPIS评分（分）：5.8±1.7比6.8±1.9，Marshall评分（分）：5.3±2.3比6.6±2.7，均P＜0.05〕，治疗后7 d、14 d两种评分也低于对照组（7 d CPIS评分：5.3±1.5比5.6±1.4，Marshall评分：5.1±1.9比5.7±1.8；14 d CPIS评分：3.9±1.7比4.4±2.3，Marshall评分：4.2±1.9比4.9±2.5），但差异均无统计学意义（均P＞0.05）。治疗组中医证候积分（分）治疗后4、7、14 d均低于对照组，差异有统计学意义（4 d：7.6±2.3比10.6±2.7，7 d：7.4±2.5比9.2±2.1，14 d：6.1±1.9比8.3±2.4，均P＜0.05）。对照组和治疗组患者28 d和60 d病死率比较差异均无统计学意义（28 d：16.7%比11.4%，60 d：25.0%比20.3%，均P＞0.05）。结论通腑法可以进一步降低重症肺炎实热证患者CPIS评分和Marshall评分，改善重症肺炎患者证候。
목적탐토통부법대중증폐염실열증림상료효적영향。방법안수궤수자표법장71례중증폐염실열증환자분위치료조（35례）화대조조（36례）。량조균급여상규치료，치료조재대조조상규치료기출상비사소승기탕2주。비교량조림상폐부감염평분（CPIS평분）、다기관공능장애평분（Marshall평분）、중의증후적분화28 d、60 d병사솔。결과량조CPIS평분、Marshall평분급중의증후적분균수치료시간연장이축점강저，치료조CPIS평분화Marshall평분치료후4 d저우대조조，차이유통계학의의〔CPIS평분（분）：5.8±1.7비6.8±1.9，Marshall평분（분）：5.3±2.3비6.6±2.7，균P＜0.05〕，치료후7 d、14 d량충평분야저우대조조（7 d CPIS평분：5.3±1.5비5.6±1.4，Marshall평분：5.1±1.9비5.7±1.8；14 d CPIS평분：3.9±1.7비4.4±2.3，Marshall평분：4.2±1.9비4.9±2.5），단차이균무통계학의의（균P＞0.05）。치료조중의증후적분（분）치료후4、7、14 d균저우대조조，차이유통계학의의（4 d：7.6±2.3비10.6±2.7，7 d：7.4±2.5비9.2±2.1，14 d：6.1±1.9비8.3±2.4，균P＜0.05）。대조조화치료조환자28 d화60 d병사솔비교차이균무통계학의의（28 d：16.7%비11.4%，60 d：25.0%비20.3%，균P＞0.05）。결론통부법가이진일보강저중증폐염실열증환자CPIS평분화Marshall평분，개선중증폐염환자증후。
Objective To investigate the clinical efficacy of purging fu-organs traditional Chinese medicine (TCM)therapy for treatment of patients with severe pneumonia and sthenia-heat. Methods According to random number table method,71 patients with sthenia-heat of severe pneumonia were divided into a treatment group (35 cases)and a control group(36 cases). Conventional basic treatment was given to both groups,and additionally, small chengqi decoction was applied nasogastrically for the therapy in treatment group for 2 weeks. The clinical pulmonary infection score(CPIS),Marshall score,integration score of TCM syndromes and the mortalities in 28 days and 60 days were used to compare the clinical efficacy of the two groups. Results With the prolongation of treatment,the CPIS,Marshall score and integration score of syndromes in the two groups were gradually decreased. In treatment group,CPIS and Marshall scores were lower than those of control group on the 4th day ,and there were statistically significant differences(CPIS score:5.8±1.7 vs. 6.8±1.9,Marshall score:5.3±2.3 vs. 6.6±2.7,both P<0.05);the above 2 scores in treatment group were also lower than those of control group on the 7th and 14th day after treatment(7th day CPIS score:5.3±1.5 vs. 5.6±1.4,Marshall score:5.1±1.9 vs. 5.7±1.8;14th day CPIS score:3.9±1.7 vs. 4.4±2.3,Marshall score:4.2±1.9 vs. 4.9±2.5),but there were no statistically significant differences(all P>0.05). In addition,the integration scores of syndromes were significantly decreased on the 4th, 7th and 14th day in the treatment group significantly lower than those in the control group(4th day:7.6±2.3 vs. 10.6±2.7,7th day:7.4±2.5 vs. 9.2±2.1,14th day:6.1±1.9 vs. 8.3±2.4,all P<0.05). However,there were no statistically significant differences in mortality rates in 28 days and 60 days respectively between control group and treatment group(28 days:16.7% vs. 11.4%,60 days:25.0% vs. 20.3%,both P>0.05). Conclusion Purging fu-organs therapy not only can decrease the CPIS and Marshall scores of patients with sthenia-heat of severe pneumonia,but also can improve their syndromes.