马书娟　毛峥嵘河南中医学院第一附属医院ICU，河南郑州　450003

宣白承气汤鼻饲灌肠治疗重症肺炎临床观察

马书娟毛峥嵘
河南中医学院第一附属医院ICU，河南郑州450003

目的 探讨宣白承气汤鼻饲灌肠治疗重症肺炎疗效及其对炎症指标的影响。方法 选取我科2013年1月～2015年12月收治重症肺炎患者40例，随机分为观察组和对照组各20例，对照组患者给予西医常规治疗，观察组患者在西医常规治疗基础上加用宣白承气汤，均治疗7 d。结果 治疗后，总有效率为90%，高于对照组的55%（P＜0.05）。观察组患者主要症状、体征和影像学情况均较对照组明显改善。且在整个治疗过程中，两组患者均未发生严重不良反应。结论 宣白承气汤鼻饲灌肠治疗重症肺炎临床疗效良好，能显著改善患者症状、体征、影像学及呼吸机撤离时间，降低炎症反应，安全性高。

宣白承气汤；重症肺炎；鼻饲；灌肠；炎症反应

［Abstract］Objective To explore the curative effects of nasal feeding and enema of Xuanbai Chengqi Decoction in the treatment of severe pneumonia and its effects on inflammatory indicators.Methods 40 patients with severe pneumonia who were admitted to our department from January 2013 to December 2015 were selected.They were randomly assigned to the observation group and the control group，with 20 patients in each group.The control group was given regular treatment with Western medicine，and the observation group was further given Xuanbai Chengqi Decoction on the basis of the regular treatment with Western medicine.The treatment was 7 days for both groups.Results After the treatment，the total effective rate in the observation group was 90%，higher than that of 55%in the control group（P＜0.05）.The main symptoms，physical signs and imaging results in both groups were significantly improved compared with those before the treatment.In the whole course of treatment，no severe adverse reactions were observed in both groups.Conclusion Nasal feeding and enema of Xuanbai Chengqi Decoction in the treatment of severe pneumonia has favorable clinical curative effects，which is able to improve patients'symptoms，physical signs，imaging results and withdrawal time of respirator as well as reduce inflammatory reactions，and its safety is high.

［Key words］Xuanbai Chengqi decoction；Severe pneumonia；Nasal feeding；Enema；Inflammatory reactions

重症肺炎是近年来提出的一个概念，是为了区别于普通肺炎，是在普通肺炎基础上并发呼吸急促，发绀，尿少，汗出肢冷，神志异常等症的急诊常见危重症。属中医“风温”、“肺热病”、“肺炎喘嗽”等病症发展到严重阶段的重症，病机主要为痰热互结，肺气壅塞［1，2］。诊断标准如下：①意识障碍；②呼吸频率＞30次/min；③PaO2＜60 mmHg，氧合指数（PaO2/FiO2）＜300，需行机械治疗；④血压＜90/60 mmHg；⑤胸片显示双侧或多肺叶受累，或入院48 h内病变扩大＞50%；⑥少尿：尿量＜20 mL/h，或80 mL/4 h，或急性肾功能衰竭需要透析治疗强调了患者病情的严重性以及积极治疗的迫切性，目前多数学者将其定义为：因病情严重而需要进入重症医学科监护，治疗的肺炎［3］。……