目的 观察温阳败毒饮对脓毒症(阳虚浊毒证)患者早期微循环指标的影响，分析其具体疗效，为临床治疗脓毒症微循环障碍提供新视角。方法 选取2022年1月至2023年7月山西省中西医结合医院重症监护病房(ICU)收治的64例脓毒症(阳虚浊毒证)患者，按随机数字表法分为对照组和观察组，每组32例。对照组给予西医常规治疗;观察组在西医常规治疗基础上给予温阳败毒饮200 mL/d(每次100 mL，间隔12 h)口服或鼻饲，连用3 d。检测两组治疗前及治疗6、12、24和48 h的中心静脉血氧饱和度(ScvO2)、中心静脉-动脉血二氧化碳分压差(Pcv-aCO2)、动脉血乳酸(Lac)、脉搏灌注指数(PI)、毛细血管再充盈时间(CRT)和皮肤花斑评分(SMS);同时记录患者治疗前和治疗72 h的中医证候积分，以及治疗前及治疗24 h和72 h的序贯器官衰竭评分(SOFA)和急性生理学与慢性健康状况评分Ⅱ(APACHE Ⅱ)。结果 两组患者性别、年龄及治疗前各项微循环指标比较差异均无统计学意义，均衡性一致。与治疗前比较，两组治疗后微循环指标ScvO2、Pcv-aCO2、Lac、PI、CRT、SMS均有显著改善;且观察组治疗24 h和48 h时Lac和PI均较对照组改善更显著[Lac(mmol/L):24 h 为 2。45±0。92 比 3。07±1。07，48 h 为 2。06±0。87 比 2。59±1。01;PI:24 h 为 3。45±0。89 比 2。92±0。98，48 h为 3。56±0。99 比 3。01±0。87，均P＜0。05]，治疗 48 h 时 CRT 和 SMS 较对照组改善更显著[CRT(s):2。04±1。08比 2。62±0。99，SMS(分):0。5(0。0，1。0)比 1。0(1。0，1。0)，均 P＜0。05]，而 ScvO2、Pcv-aCO2 在两组间各时间点比较差异均无统计学意义。两组治疗后APACHE Ⅱ评分、SOFA评分及中医证候积分均较治疗前明显改善，且观察组各评分改善程度均较对照组显著[72 h APACHE Ⅱ(分):15。0(12。2，16。0)比17。0(13。5，20。0)，72 h SOFA(分):6。0(6。0，8。0)比 10。0(8。0，13。0)，72 h 中医证候积分(分):10。13±3。73 比 14。63±5。55，均 P＜0。05]。结论 在西医常规治疗基础上联合温阳败毒饮在一定程度上能显著改善脓毒症(阳虚浊毒证)患者的微循环障碍，从而改善患者预后。
Effect of Wenyang Baidu Yin on early microcirculation disturbance in patients with sepsis(syndrome of Yang deficiency and turbid toxin):a randomized controlled trial
Objective To observe the effect of Wenyang Baidu Yin on early microcirculation indicators in patients with sepsis(syndrome of Yang deficiency and turbid toxin),analyze the specific therapeutic effect,and provide a new perspective for clinical treatment of microcirculation disorders in sepsis.Methods Sixty-four patients with sepsis admitted to the intensive care unit(ICU)of Shanxi Province Hospital of Integrated Traditional Chinese and Western Medicine from January 2022 to July 2023 were enrolled.Patients were divided into control group and observation group by randomly number table method,with 32 cases in each group.The control group received conventional Western medicine treatment.On the basis of conventional Western medicine treatment,the observation group was given Wenyang Baidu Yin 200 mL/d(100 mL each time,with an interval of 12 hours)orally or by nasal feeding for 3 consecutive days.The central venous oxygen saturation(ScvO2),difference of central venous-to-arterial partial pressure of carbon dioxide(Pcv-aC02),arterial lactic acid(Lac),pulse perfusion index(PI),capillary refill time(CRT),and skin mottling score(SMS)of two groups were detected before treatment and at 6,12,24,and 48 hours of treatment;simultaneously record the traditional Chinese medicine(TCM)syndrome score before treatment and at 72 hours of treatment,as well as the sequential organ failure assessment(SOFA)and acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)before treatment and at 24 hours and 72 hours of treatment.Results There were no statistically significant differences in gender,age,and various microcirculation indicators before treatment between the two groups,indicating consistent baseline characteristics.Compared with before treatment,the microcirculation indicators ScvO2,Pcv-aCO2,Lac,PI,CRT,and SMS in both groups showed significant improvement after treatment.Moreover,the observation group showed more significant improvements in Lac and PI compared to the control group at 24 hours and 48 hours of treatment[Lac(mmol/L):2.45±0.92 vs.3.07±1.07 at 24 hours,2.06±0.87 vs.2.59±1.01 at 48 hours;PI:3.45±0.89 vs.2.92±0.98 at 24 hours,3.56±0.99 vs.3.01±0.87 at 48 hours,all P＜0.05].CRT and SMS showed more significant improvements compared to the control group at 48 hours of treatment[CRT(s):2.04±1.08 vs.2.62±0.99,SMS:0.5(0.0,1.0)vs.1.0(1.0,1.0),both P＜0.05],while there were no statistically significant differences in ScvO2 and Pcv-aCO2 at each time point between the two groups.After treatment,the APACHE Ⅱ score,SOFA score,and TCM syndrome score improved in both groups compared to before treatment,and the improvement degree of each score in the observation group was significantly higher than that in the control group[72 hours APACHE Ⅱ score:15.0(12.2,16.0)vs.17.0(13.5,20.0),72 hours SOFA score:6.0(6.0,8.0)vs.10.0(8.0,13.0),72 hours TCM syndrome score:10.13±3.73 vs.14.63±5.55,all P＜0.05].Conclusion On the basis of conventional Western medicine treatment,the combination of Wenyang Baidu Yin can significantly improve microcirculation disorders in patients with sepsis(syndrome of Yang deficiency and turbid toxin)to a certain extent,thereby improving patient prognosis.
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