CAJ | 학술논문

目的研究大黄通腑法对严重肺挫伤患者炎症因子与肺水代谢的影响.方法采用前瞻性、随机、对照临床病例研究方法,选择本院收治的严重肺挫伤患者60例,按随机原则分为常规治疗对照组和加用中药治疗组,每组30例.对照组在常规治疗基础上加用淀粉胶囊;中药治疗组经胃管注入或口服大黄胶囊4粒(每粒含生药0.4 g),每日3次;两组均连用5 d.于治疗前和治疗5 d监测肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、血管外肺水指数(EVLWI)、白细胞计数(WBC)、血乳酸(Lac)等指标,并比较两组治疗前后的肺挫伤评分.结果两组均实际入选28例.两组治疗前TNF-α(ng/L)、IL-6(ng/L)、WBC(×109/L)、EVLWI (ml/kg)、Lac(mmol/L)、肺挫伤评分(分)比较差异均无统计学意义(均P>0.05),治疗后上述各指标均较治疗前明显下降(均P<0.05),且以中药治疗组下降更显著(TNF-α:1.04±0.33比1.39±0.35,IL-6:81.05±22.35比96.99±28.77,WBC:9.30±1.23比10.66±1.56,EVLWI:6.44±1.23比8.05±2.13,Lac:0.93±0.45比1.68±0.67,肺挫伤评分:5.25±0.84比5.29±0.81,均P<0.05).结论大黄通腑法治疗可明显降低严重肺挫伤患者TNF-α、IL-6、EVLWI的水平,抑制炎症反应程度,控制肺水肿的发展,最终改善肺挫伤患者的预后.
목적연구대황통부법대엄중폐좌상환자염증인자여폐수대사적영향.방법채용전첨성、수궤、대조림상병례연구방법,선택본원수치적엄중폐좌상환자60례,안수궤원칙분위상규치료대조조화가용중약치료조,매조30례.대조조재상규치료기출상가용정분효낭;중약치료조경위관주입혹구복대황효낭4립(매립함생약0.4 g),매일3차;량조균련용5 d.우치료전화치료5 d감측종류배사인자-α(TNF-α)、백세포개소-6(IL-6)、혈관외폐수지수(EVLWI)、백세포계수(WBC)、혈유산(Lac)등지표,병비교량조치료전후적폐좌상평분.결과량조균실제입선28례.량조치료전TNF-α(ng/L)、IL-6(ng/L)、WBC(×109/L)、EVLWI (ml/kg)、Lac(mmol/L)、폐좌상평분(분)비교차이균무통계학의의(균P>0.05),치료후상술각지표균교치료전명현하강(균P<0.05),차이중약치료조하강경현저(TNF-α:1.04±0.33비1.39±0.35,IL-6:81.05±22.35비96.99±28.77,WBC:9.30±1.23비10.66±1.56,EVLWI:6.44±1.23비8.05±2.13,Lac:0.93±0.45비1.68±0.67,폐좌상평분:5.25±0.84비5.29±0.81,균P<0.05).결론대황통부법치료가명현강저엄중폐좌상환자TNF-α、IL-6、EVLWI적수평,억제염증반응정도,공제폐수종적발전,최종개선폐좌상환자적예후.
Objective To explore the effects of Dahuang-tongfu therapy on inflammatory factors and lung fluid metabolism in patients with severe pulmonary contusion. Methods A prospective,randomized,non-blinded clinical trial was conducted. Sixty patients with severe pulmonary contusion were randomly divided into two groups:conventional therapy control group and traditional Chinese medicine(TCM)therapy group(30 cases in each group). In this study,the conventional therapy control group received the routine treatment and placebo(starch capsules)and TCM therapy group received the routine treatment and additionally took 4 rhubarb capsules(each capsule contained crude drug 0.4 g)once orally or intra-gastric administration via a gastric tube,3 times a day,the therapeutic course in the two groups being 5 days. Before therapy and on the 5th day after therapy in both groups,the patients' venous blood samples in both groups were collected to test tumor necrosis factor-α(TNF-α)and interleukin-6 (IL-6),and the extra-vascular lung water index(EVLWI),white blood cell(WBC)count and blood lactic acid(Lac), etc. In the mean time,the pulmonary contusion scores were compared between the two groups before and after the therapy. Results There were 28 patients actually enrolled in each group. Before the treatment in both groups,no statistical significant differences were found in the levels of TNF-α(ng/L),IL-6(ng/L),WBC(×109/L),EVLWI (ml/kg),Lac(mmol/L)and pulmonary contusion scores(all P>0.05). And after the treatment,the above indexes were obviously decreased in both groups(all P<0.05),especially prominent in TCM therapy group(TNF-α:1.04±0.33 vs. 1.39±0.35,IL-6:81.05±22.35 vs. 96.99±28.77,WBC:9.30±1.23 vs. 10.66±1.56,EVLWI:6.44±1.23 vs. 8.05±2.13,Lac:0.93±0.45 vs. 1.68±0.67,pulmonary contusion scores:5.25±0.84 vs. 5.29±0.81, all P<0.05). Conclusion The Dahuang-tongfu therapy can reduce the levels of TNF-α,IL-6 and EVLWI, restrain inflammatory response,control the development of pulmonary edema and improve the prognosis in patients with severe pulmonary contusion.