Study On The Clinical Efficacy Of Xinjia Xuanbai Chengqi Decoction On Patients With Severe Pneumonia Based On The Principle Of "lung And Large Intestine Are Exterior And Interior".

Object:Severe pneumonia is a common respiratory disease in clinical critical illness,which develops rapidly and often inflects multiple organs with high mortality and poor prognosis.Due to the irrational application of some broad-spectrum antibiotics,the proliferation of opportunistic pathogens,and the increase of drug-resistant bacteria,especially multi-drugresistant bacteria,the clinical treatment effect of severe pneumonia has been affected to a certain extent.The multi-target intervention of TCM has become a unique advantage in the treatment of some complex diseases.Combined with the conventional modern treatment of Western medicine,it can improve the clinical efficacy of patients with moderate and severe diseases.This clinical study is to explore the clinical efficacy of using Xinjia Xuanbai Chengqi Tang in patients with severe pneumonia based on the principle "interior and exterior between the lung and the large intestine",to further explore the clinical advantages of combining Chinese and Western medicine in the treatment of severe pneumonia.This paper also wishes that the combination of Chinese and Western medicine can better solve patients’problems and serve the clinic more effectively.Method:In this clinical study,80 inpatients who were admitted to the Department of Intensive Care Medicine of Beijing Sino-Japanese friendship hospital from October 2020 to February 2022 were selected for the research.All patients met the diagnostic criteria of severe pneumonia in Western medicine and the heat-phlegm and sthenic-fu syndrome in TCM According to the random,controlled,and single-blind principle,they were admitted to the control group and the treatment group respectively,40 cases in each group.The control group was treated with conventional Western medicine treatment,while the treatment group was treated with Xinjia Xuanbai Chengqi Decoction based on conventional Western medicine treatment.The treatment period of both groups was 7 days,and the information required by the patient’s study was recorded before treatment and on the 7th day after treatment.The clinical efficacy,TCM symptom efficacy,CPIS,APACHE-Ⅱ,TCM symptom score,inflammatory infection indexes(WBC,CRP,PCT,TNF-α,IL-6,IL-10),immune function indexes(CD3+,CD4+,CD4+/CD8+),blood gas analysis indexes(PaO2,PaCO2,OI),ventilator-related indexes(duration of mechanical ventilation,decompression efficiency),and hemodynamic indexes(CI,EVLWI,ITBVI)were recorded in the treatment and control groups and put in statistical comparisons.Statistical analysis of clinical data was performed using SPSS 20.0 software.X2 test was used for counting data or composition ratio;the Standard deviation of mean addition and subtraction(X ± S)was used for measurement data.Independent sample t-test and paired sample t-test were applied for data processing if the data accorded with normal distribution;a non-parametric test was used for non-normal distribution.If P<0.05,there was a statistical difference.Results:1.Clinical efficacy and TCM symptom efficacy:(1)After comparing the clinical efficacy of the treatment group with that of the control group after treatment,it was concluded that P=0.20>0.05,and there was no statistical significance in the difference.However,the total effective rate of the treatment group was 78.95,which is higher than the total effective rate of the control group,65.79.(2)After comparing the TCM symptom efficacy of the treatment group with that of the control group after treatment,it was concluded that P=0.04<0.05,the difference was statistically significant.2.Remission of disease degree:In the comparison before and after treatment within the same group,CPIS,APACHE-Ⅱ,and TCM symptom scores were reduced in the treatment and control groups,with all P<0.05,and the difference was statistically significant;comparing the APACHE-Ⅱ scores between the two groups after treatment,P=0.04<0.05,and the difference was statistically significant;comparing the TCM symptom scores between the two groups after treatment,P=0.046<0.05,the difference was statistically significant;comparing CPIS scores after treatment in the two groups,P=0.33>0.05,the difference was not statistically significant.3.Inflammatory infection indexes:(1)In the comparison before and after treatment within the same group,the values of WBC,CRP,and PCT were reduced in the treatment group and the control group,with P<0.05,and the difference was statistically significant;comparing the WBC after treatment between the two groups,with P=0.02<0.05,and the difference was statistically significant;comparing the CRP after treatment between the two groups,with P=0.01<0.05,the difference was statistically significant;comparing PCT between the two groups after treatment,P=0.52>0.05,the difference was not statistically significant;(2)In the comparison before and after treatment within the same group,TNF-α and IL-6 values decreased and IL-10 values increased in both the treatment and control groups,with P<0.05,and the difference was statistically significant.Comparing the TNF-α after treatment between the two groups,P=0.80>0.05,the difference was not statistically significant;comparing the IL-6 after treatment between the two groups,P<0.01,and the difference was statistically significant;comparing the IL-10 after treatment between the two groups,P<0.01,and the difference was statistically significant.4.Immune function indexes:In the comparison before and after treatment within the same group,the CD3+,CD4+and CD4+/CD8+values in the treatment group and the control group all increased,all P<0.05,and the difference was statistically significant;comparing the CD3+between the two groups after treatment,P=0.24>0.05,and the difference was not statistically significant;comparing the CD4+between the two groups after treatment,P=0.04<0.05,and the difference was statistically significant.comparing the CD4+/CD8+ between the two groups after treatment,P=0.03<0.05,and the difference was statistically significant;5.In terms of coagulation function indicators:compared before and after the treatment group in the same group,the levels of PT,APTT,D-D,PLT,and Fib in the treatment group and the control group were improved,all P<0.05,and the difference was statistically significant.Comparison between groups,P=0.03<0.05,the difference was statistically significant;APTT between the two groups after treatment,P=0.02<0.05,the difference was statistically significant;D-D after treatment between the two groups was compared,P=0.39>0.05,the difference was not statistically significant;Fib between the two groups after treatment was compared,P=0.54>0.05,the difference was not statistically significant;PLT was compared between the two groups after treatment,P=0.77>0.05,there was no difference Statistical significance.6.Blood gas analysis and ventilator-related aspects:(1)In the comparison before and after treatment within the treatment group,PaO2 and OI values increased and PaCO2 values decreased in both treatment and control groups,all P<0.05,and the difference was statistically significant;PaO2 was compared between the two groups after treatment,P=0.02<0.05,and the difference was statistically significant;PaCO2 was compared between the two groups after treatment,P=0.10>0.05,the difference was not statistically significant;the OI after treatment was compared between the two groups,P=0.04<0.05,and the difference was statistically significant;(2)the mechanical ventilation time values in the treatment and control groups were compared,and the value decreased after treatment,P=0.03<0.05,and the difference was statistically significant.At the same time,comparing the offline efficiency of the two groups,it was concluded that P=0.27>0.05,and the difference was not statistically significant;however,the offline efficiency of the treatment group was 77.78%,which was higher than the offline efficiency of the control group,64.29%.8.Hemodynamic aspects:In the comparison before and after treatment within the treatment group,the CI values in the treatment group and the control group increased,and the EVLWI and ITBVI values all decreased,P<0.05,and the difference was statistically significant;comparing the CI between the two groups after treatment,P=0.02<0.05,and the difference was statistically significant;comparing the EVLWI between the two groups after treatment,P=0.04<0.05,the difference was statistically significant;comparing the ITBVI between the two groups after treatment,P=0.67>0.05,the difference was not statistically significant.10.In terms of bedside lung ultrasound score:compared before and after the treatment group in the same group,the LUS of the treatment group and the control group decreased,P<0.05,the difference was statistically significant;the LUS of the two groups after treatment was compared between the groups,P=0.02<0.05,The difference was statistically significant.Meanwhile,the Pearson correlation analysis showed that the correlation between LUS and CPIS was r=0.572,P=0.03,and the difference was statistically significant;the correlation between LUS and APACHE-Ⅱ was r=0.614,P=0.01,and the difference was statistically significant.Conclusion:Compared with the conventional Western medicine treatment group,the adjuvant treatment of severe pneumonia with Xinjia Xuanbai Chengqi Tang can more effectively reduce the patient’s inflammatory response,improve immune function,as well as stabilize the patient’s hemodynamics(circulatory function),improve oxygenation,shorten the duration of mechanical ventilation,and increase the efficiency of deconditioning.Therefore,this treatment is more beneficial to the improvement of the patient’s TCM symptoms and the remission of the disease degree.