张文珊　张用华

摘要：目的 观察清瘟败毒饮联合常规治疗对重症肺炎（SP）行机械通气患者的临床疗效。方法 选取重症肺炎的患者共58例，采用随机数字表法分为观察组和对照组，每组各29例。对照组给予抗感染、祛痰解痉平喘、补液、维持酸碱和电解质平衡、进行肠内或肠外营养支持等基础治疗，观察组在对照组治疗基础上加用清瘟败毒饮加减1剂/日，鼻饲，7 d 1个疗程，共2个疗程。观察比较2组的中医证候疗效、病情危重程度评分、氧合指数、呼吸机参数、呼吸机使用时长、住院时间以及感染指标。结果 治疗后观察组中医症候总有效率高于对照组，差异有统计学意义（P<0.05）;治疗后观察组急性生理与慢性健康状況评分Ⅱ（APACHE Ⅱ）及临床肺部感染评分系统（CPIS）与治疗前相比均有下降，且下降比对照组更显著，差异有统计学意义（P<0.05）;治疗后观察组的潮气量（VT）、吸氧浓度（FiO2）、支持压力（PS）、呼吸末正压（PEEP）及氧合指数（OI）均有改善，且改善程度比对照组明显，差异有统计学意义（P<0.05）;观察组的呼吸机使用时长以及住院时间在治疗后相比对照组较短，差异有统计学意义（P<0.05）;白细胞计数（WBC）、降钙素原（PCT）、C反应蛋白（CRP）水平在治疗后2组均有下降，但观察组下降更明显，差异有统计学意义（P<0.05）。结论 清瘟败毒饮联合常规治疗对SP行机械通气患者的临床疗效明显优于单纯的常规治疗，可以降低APACHE Ⅱ评分和CPIS评分，改善呼吸功能、感染情况和降低对呼机的依赖程度，提高临床疗效，有助于增加SP患者的脱机率，缩短住院时长。

关键词：重症肺炎;机械通气;清瘟败毒饮;脱机率

中图分类号：R563.1   文献标志码：B   文章编号：1007-2349（2021）10-0052-06

【Abstract】Objective： To observe the clinical effect of Qingwen Baidu Decoction combined with conventional treatment on severe pneumonia （SP） patients undergoing mechanical ventilation. Methods： 58 SP patients were selected and divided into an observation group and a control group by random number table， 29 cases each group. The control group was given basic treatments such as anti-infection， spasm and asthma expectorant， fluid infusion， maintenance of acid-base and electrolyte balance， and enteral or parenteral nutrition support. The observation group was given Qingwen Baidu Decoction， modified one dose daily on the basis treatment of the control group， with nasal feeding， 7 days 1 course and 2 courses in total. The effect of TCM syndromes， critical illness score， oxygenation index， ventilator parameters， ventilator use time， hospital stay and infection indicators in the two groups were observed and compared. Results： After treatment， the total effective rate of TCM symptoms in the observation group was higher than that in the control group， and the difference was statistically significant （P<0.05）. After treatment， the acute physiology and chronic health score Ⅱ （APACHE Ⅱ） and clinical lung infection scoring system （CPIS） of the observation group were decreased compared with those of the prior treatment， and the decrease of the treatment group was more significant than that of the control group， and the difference was statistically significant （P<0.05）. After treatment， the tidal volume （VT）， oxygen concentration （FiO2） and support pressure （PS）， positive end-expiratory pressure （PEEP） and oxygenation index （OI） of the observation group were improved， and the degree of improvement was more obvious than that of the control group， the difference was statistically significant （P<0.05）. The duration of ventilator use and the length of hospital stay after treatment was shorter than that of the control group， and the difference was statistically significant （P<0.05）. The white blood cell count （WBC）， procalcitonin （PCT）， and C-reactive protein （CRP） levels were decreased after treatment both in the two groups， but the decrease in the observation group was more obvious， and the difference was statistically significant （P<0.05）. Conclusion： The clinical effect of Qingwen Baidu Decoction combined with conventional treatment on SP patients undergoing mechanical ventilation was significantly better than that of single conventional treatment. The treatment can reduce APACHE Ⅱ score and CPIS score， improve respiratory function and infection and reduce dependence on the ventilator， improve clinical effect and help increase the weaning rate of SP patients and shorten the length of hospital stay.

【Key words】Severe Pneumonia; Mechanical Ventilation; Qingwen Baidu Decoction; Weaning Rate

重症肺炎是（Severe pneumonia，SP）是重症监护病房（ICU）常见的危重症之一，该病发病急促，病情进展快，如若治疗不及时则会快速发展为多器官功能障碍综合征甚至死亡[1]。SP患者在抗感染和使用机械通气治疗后，可在一定程度上降低SP患者的死亡率，但SP的整体疗效仍有待提高[2-3]。目前的研究表明，对SP患者机械通气治疗时，若在西医规范治疗的基础上联合中医药干预，能够进一步改善患者的肺通气和氧合功能，更好地控制肺部感染，缩短患者的住院时间，且安全性方面较理想[4]。在中医学中，痰热壅肺证是SP最常见的证型，病甚可见明显热毒入血的症状。清瘟败毒饮出自《疫疹一得》，具有清热解毒，凉血泻火的功效，是治疗热毒入血证的常用方剂。……