The HMGB1、sCD163 And Curative Effect Observation Of Supplementing Qi And Yin And Resolving Phlegm And Blood Stasis On The Treatment Of Hospital Acquired Pneumonia After Severe Stroke

1 Objective Taking the patients with phlegm and blood stasis due to deficiency of both qi and yin syndrome of hospital acquired pneumonia after severe stroke as the research object,taking Supplementing Qi and Yin and resolving phlegm and blood stasis as the treatment principle,choosing Shenmai Injection,Shenxiong Glucose Injection and Kechuanping Granules as the treatment drugs,comparing with the conventional western medicine treatment group,by observing the changes of High mobility group box 1(HMGB1),serum soluble cluster differentiation 163(SCD163)and related indexes,evaluating the clinical efficacy of this treatment method,and exploring new ideas for the treatment of this disease with integrated traditional Chinese and western medicine.2.Methods Sixty-one patients with phlegm and blood stasis due to deficiency of both qi and yin in hospital acquired pneumonia after severe stroke admitted to the Department of Critical Care Medicine(MICU and SICU)in the First Affiliated Hospital of Anhui University of Traditional Chinese Medicine from December 2019 to December 2020 were randomly divided into control group and treatment group.All patients were treated with western medicine(including active treatment of primary diseases;anti infection,expectorant,antispasmodic and antiasthmatic,respiratory support,airway management;nutritional support;maintenance of water,electrolyte,acid-base balance,etc.),the treatment group was added with the method of invigorating qi,yin,resolving phlegm and blood stasis(Shenmai Injection+Shenxiong Glucose Injection+Kechuanping Kranules),and the course of treatment was 7 days.The changes of TCM symptom score,acute physiology and chronic health score(APACHE-Ⅱ score),clinical pulmonary infection score(CPSI score),blood gas analysis index(Pa O2,Pa CO2),oxygenation index(Pa O2 / Fi O2),white blood cell(WBC),high sensitivity C-reactive protein(hs CRP),procalcitonin(PCT),HMGB1 and scd163 were observed before and after treatment in the two groups Statistical analysis was used to determine the therapeutic effect.3 Results:3.1 Scoring indicators and clinical efficacy: TCM symptom score,APACHE-Ⅱ score and CPIS score decreased in both groups,but the decrease in treatment group was more obvious than that in control group,and there was statistical significance between treatment group and control group after treatment(P < 0.05).3.2 Blood gas analysis and oxygenation index: Pa O2 and oxygenation index in both groups were higher than before,but the increase in treatment group was more obvious,and there was significant difference between treatment group and control group after treatment(P < 0.05).Pa CO2＿2 decreased in both groups,but the decrease in treatment group was more obvious than that in control group,and there was a significant difference between treatment group and control group after treatment(P < 0.05).3.3 Laboratory indicators: WBC,hs-CRP and PCT decreased in both groups,but the decrease in treatment group was more obvious than that in control group,and there was statistical significance between treatment group and control group after treatment(P <0.05).3.4 New inflammatory markers: HMGB1 and sCD163 decreased in both groups,but the decrease in treatment group was more obvious than that in control group,and there was significant difference between treatment group and control group after treatment(P <0.05).4.Conclusion Supplementing Qi and Yin and resolving phlegm and blood stasis can effectively improve the clinical symptoms and infection degree of hospital acquired pneumonia after severe stroke,and the clinical effect is remarkable.Supplementing Qi and Yin and resolving phlegm and blood stasis may improve oxygenation index,improve tissue perfusion and reduce inflammatory mediators by regulating immune imbalance,improving circulatory disorder and reducing inflammatory exudation,thus achieving the purpose of treating diseases and contributing to the prognosis of patients.There is no obvious adverse drug reaction in this study,which provides an effective and scientific method for the treatment of hospital-acquired pneumonia after severe stroke with integrated traditional Chinese and western medicine.