中国中西医结合急救杂志2025，Vol.32Issue(2)：149-154,6.DOI:10.3969/j.issn.1008-9691.2025.02.005
清肺化瘀通腑方对脓毒症相关ARDS机械通气患者呼吸力学和炎症指标及免疫功能的影响
The impact of Qingfeihuayutongfu prescription on respiratory mechanics,inflammatory markers,and immune function in mechanically ventilated patients with sepsis-associated acute respiratory distress syndrome
摘要
Abstract
Objective To observe the effects of the traditional Chinese medicine Qingfeihuayutongfu prescription on oxygenation index,respiratory mechanics,inflammatory markers,and immune function in mechanically ventilated patients with sepsis-associated acute respiratory distress syndrome(ARDS).Methods A prospective randomized controlled trial was conducted.Sixty-eight patients with sepsis-associated ARDS,who met the TCM syndrome pattern of lung-heat transferring to intestines syndrome,admitted to the department of intensive care unit(ICU)of the Affiliated Hospital of Nanjing University of Chinese Medicine between January 2023 and January 2024,were enrolled as study subjects.Patients were randomly divided into an experimental group and a control group using a random number table,with 34 patients in each group.Four patients dropped out from each group,resulting in 30 patients being analyzed in each group.Both groups received conventional Western medical treatment after admission.The experimental group additionally received Qingfeihuayutongfu prescription[composition:Scutellaria baicalensis 10 g,Mori Cortex 10 g,Descurainiae Semen 15 g,Trichosanthis Fructus 10 g,Lumbricus 10 g,Persicae Semen 10 g,Salviae Miltiorrhizae Radix 10 g,Curcumae Rhizoma 6 g,Rheum palmatum 3 g(decocted later),Aurantii Fructus Immaturus 10 g,Magnoliae Officinalis Cortex 10 g,Glycyrrhizae Radix praeparata 3 g].The decoction was concentrated to 100 mL per bag.One dose was administered daily,divided into 2 nasogastric feedings.The control group received an equivalent volume of warm water twice daily via nasogastric tube in addition to conventional Western treatment.Treatment continued for 7 days in both groups.Differences in oxygenation index,respiratory mechanics parameters,inflammatory cytokines,and immune cell levels before and after treatment were compared between the two groups.Results Prior to treatment,no statistically significant differences were observed between the two groups in oxygenation index,respiratory mechanics parameters,levels of inflammatory cytokines or immune cell counts.Following treatment,both groups exhibited a significant increase in oxygenation index and natural killer cell(NK cell),alongside significant decreases in plateau pressure(Pplat),driving pressure(ΔP),hypersensitive C-reactive protein(hs-CRP),procalcitonin(PCT),interleukins(IL-6,IL-8,IL-1β),tumour necrosis factor-α(TNF-α),and CD4+/CD8+ratio compared to baseline.Post-treatment comparison between groups revealed that the experimental group had a significantly higher oxygenation index and NK cell than the control group[oxygenation index(mmHg,1 mmHg≈0.133 kPa):331.32±90.89 vs.238.64±83.26,NK cell:0.20(0.12,0.25)vs.0.10(0.08,0.19),both P<0.05].Conversely,the experimental group demonstrated significantly lower values than the control group for Pplat,ΔP,hs-CRP,PCT,IL-6,IL-8,TNF-α,CD4+/CD8+[Pplat(cmH2O,1 cmH2O≈0.098 kPa):16(15,19)vs.22(19,24),ΔP(cmH2O):11±2 vs.14±3,hs-CRP(mg/L):21.32(11.63,31.84)vs.41.36(17.41,89.02),PCT(μg/L):0.13(0.08,0.21)vs.0.45(0.14,1.35),IL-6(ng/L):16.25(10.72,49.96)vs.66.70(25.82,195.64),IL-8(ng/L):5.48(0.84,12.60)vs.26.23(23.10,50.16),TNF-α(ng/L):0.77(0.72,1.20)vs.1.10(0.92,1.48),CD4+/CD8+:1.76(1.43,2.00)vs.2.12(1.77,4.03),all P<0.05].Conclusion The Qingfeihuayutongfu prescription can effectively improves the oxygenation index,reduces Pplat and ΔP,mitigates inflammation,and modulates immune function in mechanically ventilated patients with sepsis-associated ARDS.关键词
脓毒症/急性呼吸窘迫综合征/清肺化瘀通腑方/氧合指数/呼吸力学/炎症因子/免疫细胞Key words
Sepsis/Acute respiratory distress syndrome/Qingfeihuayutongfu prescription/Oxygenation index/Respiratory mechanics/Inflammatory factor/Immune cell引用本文复制引用
程璐,原佳雯,陆沁云,杭宇豪,鲁俊,王德祥..清肺化瘀通腑方对脓毒症相关ARDS机械通气患者呼吸力学和炎症指标及免疫功能的影响[J].中国中西医结合急救杂志,2025,32(2):149-154,6.基金项目
国家自然科学基金(82074379) （82074379）
江苏省中医药科技发展计划(QN202004) （QN202004）
南京中医药大学自然科学基金(XZR2021008) National Natural Science Foundation of China(82074379) （XZR2021008）
Jiangsu Province Traditional Chinese Medicine Science and Technology Development Program(QN202004) （QN202004）
Natural Science Foundation of Nanjing University of Chinese Medicine(XZR2021008) （XZR2021008）
