通腑理肺汤结肠透析联合肺泡灌洗对重症肺炎合并脓毒症TNF-α、IL-6的影响

摘要

目的:探讨通腑理肺汤结肠透析联合纤维支气管镜肺泡灌洗对重症肺炎合并脓毒症患者TNF-α、IL-6水平的影响.方法:按照随机数字表达法将患者90例分为3组,第1组为通腑理肺汤结肠透析并纤支镜肺泡灌洗组(治疗组A),第2组为温水结肠透析并纤支镜肺泡灌洗组(治疗组B),第3组为温水结肠透析组(对照组),每组各30例病人,治疗组A在常规治疗基础上给予通腑理肺汤结肠透析联合纤维支气管镜肺泡灌洗治疗;治疗组B在常规治疗基础上给予等量温水结肠透析联合纤维支气管镜肺泡灌洗治疗;对照组在常规治疗基础上每日给予温水结肠透析治疗,观察3组患者治疗前、治疗后1周末、2周末留取肺泡灌洗液检测IL -6、TNF-α水平;同时记录3组患者治疗前及治疗后2周末中医证候学积分、临床肺部感染积分(CPIS),呼吸机机械通气时间、ICU住院时间.应用SPSS 22.0统计软件进行统计学分析.结果:治疗组A总有效率90％,治疗组B总有效率80％,对照组总有效率63.3％, 3组比较,差异有统计学意义(P ＜0.05);3组患者治疗前IL -6、TNF -α水平无统计学差异(P＞ 0.05), 治疗1周末、2周末治疗组AIL-6、TNF-α水平明显低于治疗组B及对照组,且治疗组A降低最为显著,差异有统计学意义(P＜0.05).3组患者治疗后中医证候学积分、CPIS评分均有所降低,呼吸机使用时间、ICU住院时间明显缩短,治疗后2周末治疗组A显著低于治疗组B及对照组,差异有统计学意义(P＜0.05).结论:通腑理肺汤结肠透析联合纤维支气管镜肺泡灌洗能降低患者肺泡灌洗液中TNF -α、IL -6水平,显著降低中医证候学积分、CPIS评分,减少呼吸机使用时间、ICU住院时间,提高患者临床疗效,改善患者预后,其机制可能与其改善患者的胃肠功能、降低TNF -α、IL -6的水平,阻止肠源性感染与多器官功能障碍之间的恶性循环,抑制过度的炎症反应,减轻组织损伤及炎症反应有关.%To explore the effects of the colonic dialysis with Tongfu Lifei decoction combined wtih alveolus lavage by branchofiberoscope on the levels of TNF - a and IL -6 in patients with severe pneumonia with sepsis. Methods: 90 patients were randomly divided into three groups, group A (colonic dialysis with Tongfu Lifei decoction + alveolus lavage), group B (colonic dialysis with warm water + alveolus lavage), and group C (colonic dialysis with warm water), with 30 cases in each group. The levels of IL - 6 and TNF - a in the alveolus lavage were observed before treatment, one week and two weeks after the treatment in the three groups. At the same time, scores of TCM syndromes, clinical pulmonary infection scores(CPIS), mechanical ventilation use time, and ICU staying time were recorded in the three groups. SPSS 22.0 statistical software was used for statistical analysis. Results: The total effective rates were 90％, 80％, and 63.3％ respectively in group A, group B and group C, and their differences were statistically significant(P ＜0.05). There was no statistical difference in terms of the levels of IL - 6 and TNF - a among the three groups before the treatment (P ＞0.05); however, the levels of IL -6 and TNF -α in group A were significantly lower than those of group B and group C one week and two weeks after the treatment (P ＜ 0.05 ). Scores of TCM syndromes and CPIS were decreased, breathing machine use time and ICU staying time were shortened after the treatment in the three groups, of which group A was significantly lower than group B and group C two weeks after the treatment, and the differences were statistically significant(P ＜ 0.05 ). Conclusion: The therapy of colonic dialysis with Tongfu Lifei decoction combined with alveolus lavage by branchofiberoscope can reduce the levels of IL - 6 and TNF - α, decrease scores of TCM syndromes and CPIS, shorten the respirator use time and ICU stay, increase the clinical curative effect, and improve the prognosis of the disease; its mechanism may be related to improving gastrointestinal function, reducing the levels of TNF - a and IL - 6, preventing enteric infection and multiple organ dysfunction, inhibiting excessive inflammation, and reducing tissue injury and inflammation.