胃肠道是脓毒症首先累及的器官,同时胃肠道功能损伤也可加重或诱发脓毒症.探讨脓毒症急性胃肠功能损伤(AGI)的临床症状与中医六经病的关系,认为AGI疾病分级符合六经传变规律,临床上可采用六经辨证理论进行治疗.按六经病提纲,脓毒症AGIⅠ级辨少阳阳明同病;AGIⅡ级辨太阴阳明同病;AGIⅢ级辨太阴病;AGIⅣ级辨少阴病、厥阴病.总结此类患者的临床治疗经验,认为AGIⅠ级患者常给予通腑泻热治疗;AGIⅡ级患者则寒温并用;AGIⅢ级患者在温脾汤基础上,佐以宣肺、行气、泄水利尿药物;AGIⅣ级患者可在温脾汤基础上合用乌梅丸加减治疗.同时附验案3则,对患者均采用了六经辨证疗法,获得较好疗效.

目的 观察在标准治疗基础上使用破格救心汤治疗脓毒性心肌病的临床疗效.方法 选取脓毒性心肌病患者60例随机分为对照组和观察组,对照组给予常规基础治疗,观察组在对照组基础上使用破格救心汤治疗.治疗后比较两组中医疗效,急性生理和慢性健康状况评分(APACHEⅡ),全身感染相关器官功能衰竭评分(SOFA),心功能指标[平均动脉压(MAP)、心脏指数(CI)、左室射血分数(LVEF)],血乳酸(Lac)及乳酸清除率,炎症因子[肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)],心肌损伤标志物[N端脑利钠肽前体(NT-proBNP)、心肌肌钙蛋白Ⅰ(cTnⅠ)],统计机械通气、肾脏替代治疗时间和28 d病死率.结果 观察组的中医疗效优于对照组(P＜0.05);两组治疗后APACHEⅡ评分、SOFA评分比较差异有统计学意义(P＜0.05);两组治疗后MAP、CI、LVEF均升高,但观察组改善更明显(P＜0.05);观察组7d后TNF-α、IL-6、NT-proBNP、cTnⅠ水平及乳酸清除率均显著优于对照组(P＜0.05);观察组机械通气及肾脏替代治疗时间短于对照组(P＜0.05),但28 d病死率差异无统计学意义(P＞0.05).结论 破格救心汤可以提高脓毒性心肌病患者的中医证候疗效,能抑制炎症反应,保护心肌,改善脓毒性心肌病患者预后.

目的 观察破格救心汤治疗脓毒性休克的临床疗效.方法 脓毒性休克患者92例随机分为对照组与观察组各46例.两组均给予常规治疗,观察组加用破格救心汤治疗.分析两组中医证候疗效,检测两组患者治疗前后的急性生理和慢性健康状况评分(APACHEⅡ)、全身感染相关器官功能衰竭评分(SOFA)、平均动脉压(MAP)、中心静脉血氧饱和度(SCvO2)、血乳酸(Lac)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、超敏C反应蛋白(hs-CRP)、降钙素原(PCT),并计算乳酸清除率,记录机械通气时间、血管活性药物使用时间、28 d病死率.结果 观察组的中医疗效总有效率为84.78％,高于对照组的71.74％ (P＜ 0.05).与治疗前比较,两组APACHEⅡ、SOFA评分及血清TNF-α、IL-6、hs-CRP、PCT均明显降低,且观察组降低更明显(P＜0.05);与治疗前比较,两组MAP、ScvO2均明显升高,且观察组升高更明显(P＜0.05);观察组12、24、48 h血Lac浓度及乳酸清除率均显著低于对照组(P＜0.05);两组机械通气时间、血管活性药物使用时间、28 d病死率差异无统计学意义(P＞0.05).结论 破格救心汤可以提高脓毒性休克患者的中医证候疗效,改善病情,显著减轻炎症反应.

目的 观察大黄附子汤治疗脓毒症肺损伤患者的临床疗效.方法 选择2018年6月至2020年6月北京中医药大学深圳医院(龙岗)重症监护病房(ICU)收治的60例脓毒症肺损伤患者,采用随机数字表法分为对照组和治疗组,每组30例.所有患者均给予常规治疗.对照组在常规治疗基础上加用枸橼酸莫沙必利片和双歧杆菌三联活性胶囊治疗;治疗组在常规治疗基础上加用大黄附子汤(组成:大黄12?g,制附子15?g,细辛6?g)治疗,每剂煎煮成200?mL,每日1剂,分3次服用;两组疗程均为8?d.观察两组患者治疗前后序贯器官衰竭评分(SOFA)、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)、胃肠功能障碍评分、肺部超声B线评分、动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)、氧合指数(PaO2/FiO2)变化;记录两组患者28?d病死率、机械通气时间、ICU住院时间和总住院时间.结果 两组患者治疗3?d肺部超声B线评分较治疗前略降低,治疗5?d和8?d肺部超声B线评分均较治疗前明显降低,以治疗组降低更明显(分:治疗5?d为12.78±2.13比14.32±2.40,治疗8?d为8.59±1.16比9.43±1.35,均P<0.05).随治疗时间延长,治疗组患者治疗3、5、8?d?APACHEⅡ评分、SOFA评分、胃肠功能障碍评分均呈明显降低趋势,PaO2、PaO2/FiO2均呈明显升高趋势,且上述指标与对照组同时间点比较差异均有统计学意义,以治疗8?d变化最明显〔APACHEⅡ评分(分):15.74±3.62比18.21±3.82,SOFA评分(分):3.43±1.22比4.32±1.43,胃肠功能障碍评分(分):6.44±1.49比7.37±1.51,PaO2(mmHg,1?mmHg≈0.133?kPa):86.81±9.87比81.76±9.45,PaO2/FiO2(mmHg):295.88±57.47比265.89±51.64,均P<0.05〕.治疗组患者机械通气时间、ICU住院时间和总住院时间均较对照组明显缩短〔机械通气时间(d):7.35±2.52比9.32±3.31,ICU住院时间(d):9.46±4.23比12.24±5.18,总住院时间(d):14.39±6.72比18.46±7.22,均P<0.05〕;两组患者28?d病死率比较差异无统计学意义〔20.00％(6/30)比33.33％(10/30),P>0.05〕.结论 大黄附子汤能促进脓毒症肺损伤患者胃肠功能恢复,减轻肺水肿,改善呼吸功能,缩短住院时间,缓解病情.

目的:从辅助性T细胞17(Th17)/调节性T细胞(Treg)免疫失衡角度研究茯苓四逆汤对脓毒性心肌病患者免疫调节的影响.方法:选取北京中医药大学深圳医院(龙岗)2018年3月至2021年2月期间重症加强护理病房(ICU)收治的脓毒症合并脓毒性心肌病患者56例,使用随机数字表法随机分为对照组和观察组,各28例.对照组采用常规治疗,观察组在对照组基础上给予茯苓四逆汤口服,疗程7d.比较两组患者治疗前后的急性生理和慢性健康状况评分(APACHE-Ⅱ)、全身感染相关器官功能衰竭评分(SOFA)、中医症候积分以及治疗前后白细胞介素-6(IL-6)、IL-10、肌钙蛋白Ⅰ(cTnⅠ)、氨基末端脑钠肽前体(NT-proBNP)、CD4+/CD8+、Th17/Treg,统计ICU停留时间及28 d病死率以及治疗总有效率.结果:观察组患者治疗总有效率为82.14％,高于对照组的71.14％,差异具有统计学意义(P＜0.05);治疗前两组患者IL-10、IL-6、CD4+/CD8+、Th17/Treg水平比较,差异无统计学意义(P＞0.05);治疗后两组患者的IL-10、CD4+/CD8+均不同程度升高,IL-6、Th17/Treg不同程度下降,且观察组患者IL-10、CD4+/CD8+高于对照组,IL-6、Th17/Treg低于对照组,差异具有统计学意义(P＜0.05).治疗前两组患者的cTnⅠ、NT-proBNP水平比较,差异无统计学意义(P＞0.05);治疗后两组患者的cTnⅠ、NT-proBNP水平均不同程度下降,且观察组低于对照组,差异具有统计学意义(P＜0.05).观察组患者28 d病死率为5例(17.86％),与对照组的6例(21.43％)比较,差异无统计学意义(P＞0.05).观察组患者ICU住院时间为(6.84±1.53)d,短于对照组的(8.25±1.69)d,差异具有统计学意义(P＜0.05).结论:茯苓四逆汤能通过免疫调节,改善脓毒性心肌病患者的免疫失衡,抑制炎症反应,保护心肌,改善短期预后.

目的 观察茯苓四逆汤对老年脓毒症大鼠心肌损伤的保护作用并探讨其机制.方法 采用盲肠结扎穿孔术制备老年脓毒症大鼠模型.115只老年雄性SD大鼠随机分为正常组、假手术组、模型组、中药低、中、高剂量组共6组,其中正常组15只,余组各20只.造模后给药3 d,观察大鼠一般情况,术后24 h、48 h、72 h检测各组血清肿瘤坏死因子-α、白细胞介素-6浓度,同时采用Western印迹法检测各组心肌细胞心型脂肪酸结合蛋白、核转录因子-κB蛋白表达水平.结果 中药各组一般情况均好于模型组,高剂量组感染症状最轻,中药各组总死亡率低于模型组(P<0.05);与正常组同时间点比较,模型组血清肿瘤坏死因子-α、白细胞介素-6浓度及心肌细胞心型脂肪酸结合蛋白、核转录因子-κB蛋白表达水平明显升高(P<0.01);中药各组血清肿瘤坏死因子-α、白细胞介素-6及心肌细胞心型脂肪酸结合蛋白、核转录因子-κB蛋白表达等指标的改善优于模型组(P<0.05,P<0.01),其中高剂量组改善最明显.结论 茯苓四逆汤能显著减轻老年脓毒症大鼠心肌损伤,其作用机制与抑制炎症反应有关.

目的:观察温脾汤对脓毒症心肌损伤患者疗效及对核转录因子-κB (NF-κ B)的影响.方法:80例脓毒症心肌损伤患者随机分为2组,每组40例,对照组采用西医常规治疗,治疗组配合温脾汤治疗,两组疗程均为8d.观察2组治疗前及治疗第4d、8d血清肌酸激酶同工酶-Mb(CK-Mb)、肌钙蛋白Ⅰ(cTnI)、N-末端脑钠肽前体(NT-proBNP)、NF-κB、白细胞介素-6(IL-6)、肿瘤坏死因子--α(TNF-α)含量变化;记录2组急性生理及慢性健康评分(APACHEII评分)、序贯性脏器衰竭评分(SOFA评分)变化,同时比较2组ICU住院时间、死亡患者的存活时间、28 d死亡率.结果:两组治疗后第4d、8 d CK-Mb、NT-proBNP、cTnI、NF-κ B、IL-6、TNF-α水平均较前治疗前下降,治疗组较对照组下降更明显(P＜0.05,P＜0.01);治疗组在下调APACHEII评分、SOFA评分方面优于对照组(P＜0.05,P＜0.01);治疗组ICU住院时间(10.35±7.52)d,短于对照组(19.64± 11.57)d (P＜0.01);治疗组死亡患者的存活时间(14.25±6.32)d,对照组(8.25±3.32)d,两组对比有显著差异(P＜0.01);治疗组28d死亡率低于对照组,但无统计学差异(P＞0.05).结论:温脾汤能减轻脓毒症心肌损伤患者NF-κ B信号通路激活所致的炎症反应、改善心功能及临床症状、缩短住院时间,远期预后无改善.

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BACKGROUND:H-type hypertension is a kind of cardiovascular disease that threatens human life and health seriously. Banxia Baizhu Tianma Tang (BBTT) has been used widely for H-type hypertension while its effective evidence is not clear. Hence, we provide a systematic review protocol to evaluate the efficacy and safety of BBTT in the treatment of H-type hypertension. METHODS:Nine databases including Cochrane Library, PubMed, EMBASE, WOS, Medline, CNKI, WangFang, CBM, and VIP will be searched from their inception to October 2019. All randomized controlled trials (RCTs) of BBTT for H-type hypertension will be included. The language is limited to Chinese and English. The primary outcome measure will be the major adverse cardiac and cerebral events (MACCE). The entire process will include study selection, data extraction, assessment of bias risk, data synthesis. Data analysis will be performed using RevMan V.5.3.5 (The Cochrane Collaboration, Oxford, UK). RESULTS:This study will evaluate the efficacy and safety of BBTT in the treatment of H-type hypertension from several aspects, including MACCE, blood pressure (BP), blood lipids, inflammation indicators and homocysteine (Hcy). CONCLUSION:This systematic review will provide evidence for determining whether or not BBTT is an effective and safe intervention for H-type hypertension. PROSPERO REGISTRATION NUMBER:PROSPERO CRD 42019131491.

BACKGROUND:Sepsis is the most common critical illness in the clinic, with a high incidence and mortality. Qingwen Baidu decoction (QWBDD) has been widely applied in the treatment of sepsis, however, there is no systematic review or meta-analysis of QWBDD in the treatment of sepsis. Hence, we provide a protocol of systematic review and meta-analysis to evaluate the efficacy and safety of QWBDD in the treatment of sepsis. METHODS:The databases including Cochrane Library, PubMed, Embase, Web of Science, Cochrane Clinical Trial Database, World Health Organization International Clinical Trial Registration Platform, CNKI, CBM, VIP, and WanFang Database will be searched from the time when the respective databases were established to January 2019. All randomized controlled trials (RTCs) published in Chinese and English assessing QWBDD for sepsis will be included. Continuity data are expressed as mean difference (MD) or standard mean difference (SMD), and dichotomous data is expressed as relative risk. Analyses will be performed by using RevMan V.5.3.5 software. RESULTS:This study will provide high-quality synthesis of current evidence of QWBDD in the treatment of sepsis from the following aspects, including 28-day mortality, mean arterial pressure (MAP), blood lactate, procalcitonin (PCT), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), hypersensitive C-reactive protein (hs-CRP), acute physiology and chronic health score (APACHE-II), intensive care unit stay, mean hospital stay, mechanical ventilation time, etc. CONCLUSION:: Our systematic review will provide evidence for judging whether QWBDD is an effective intervention for sepsis. PROSPERO REGISTRATION NUMBER:PROSPERO CRD 42019123078.

目的 研究茯苓四逆汤对脓毒症大鼠心肌抑制的保护作用机制.方法 取SPF级SD雄性大鼠100只,随机分成5组:假手术组、脓毒症组,茯苓四逆汤低剂、中、高剂量组(1.3 g/d、2.6 g,/d、3.9 g/d).假手术组、脓毒症组给予等容量0.9％氯化钠注射液,茯苓四逆汤各剂量组给予相应药物,均为灌胃给药;盲肠结扎穿孔法制作脓毒症模型,假手术组仅是暴露盲肠,造模后6h开始给药,每日剂量分2次给药,直至造模后第3日,记录其生存状态,并在术前、术后24 h、48 h、72h 3个时间点各选5只大鼠尾静脉取血并处死,取心肌组织后超低温保存备用,测定肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、心型脂肪酸结合蛋白(H-FABP)水平.结果 脓毒症组及中药各剂量组的大鼠TNF-α、IL-6、H-FABP明显升高,与假手术组差异有统计学意义(P＜0.01);与脓毒症组同时间点比较,中药各剂量组的大鼠TNF-α、IL-6水平明显下降(P＜ 0.01),H-FABP水平也明显下降(P＜0.05);而中药各剂量组同时间比较发现,剂量越高,其TNF-α、IL-6水平下降越明显(P＜ 0.01或P＜0.05);不同剂量治疗组中比较发现,随着时间的延长,剂量越高的茯苓四逆汤对于改善H-FABP水平越好(P＜0.05).结论 茯苓四逆汤对脓毒症大鼠心肌抑制具有良好保护作用,其机制可能与减少炎症释放有关.

This study establishes the loop-mediated isothermal amplification (LAMP) assay for detection of the toxin genes tcdA and tcdB in Clostridioides difficile (C. difficile). Genomic DNA was extracted based on magnetic nanoparticles and amplified by LAMP using the primers designed by us. The specificity and sensitivity of the primers were also determined by agarose gel electrophoresis and fluorescence intensity detection. A total of 11 pathogenic bacterial strains from different species were found to be negative for tcdA and tcdB, whereas only one positive result was obtained for C. difficile. The limit of detection for tcdA and tcdB was determined to be 1 pg/mu L and 10 pg/mu L, respectively. The primers were found to be highly specific and sensitive. The LAMP assay was then applied for the detection of tcdA and tcdB in the feces of critically ill patients and to perform C. difficile typing. In conclusion, the LAMP assay is a reliable tool for the identification of C. difficile toxin genes tcdA and tcdB as well as for direct detection of the toxin genes in feces of critically ill patients with high sensitivity and specificity. This method established by us shows immense potential for clinical application in the future and can greatly reduce the challenges in the detection of C. difficile toxin genes through an expedited process.

Background: Essential hypertension is one of the most common chronic diseases worldwide, as well as a leading risk factor for cardiocerebrovascular diseases. Zhengan Xifeng Decoction (ZGXFD) has been widely used to treat essential hypertension, but there is no systematic review by assessing efficacy and safety of ZGXFD on essential hypertension. Therefore, we aim to perform systematic review and meta-analysis to evaluate the efficacy and safety of ZGXFD in the treatment of essential hypertension. Methods: This systematic review and meta-analysis will be performed by means of electronic databases, including EMBASE, Cochrane Center Registration Controlled trials (Cochrane Library), Web of Science (WOS), World Health Organization International Clinical Trials Registry Platform, PubMed, China Biomedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), Chinese Scientific Journal Database (VIP), and Wan-fang database. The electronic databases will be searched from their inception to October 2018. This systemic review will include only published English and Chinese articles randomized controlled trials (RTCs) of ZGXFD on essential hypertension. The primary outcome is Efficacy and blood pressure (BP), blood lipid and adverse reactions will be accepted as secondary outcomes. All statistical analyses will be conducted using RevMan V.5.3.5 software. Results: This systematic review and meta-analysis will provide high-quality evidence from several aspects, including for efficacy, blood pressure, blood lipid and adverse effects to evaluate the efficacy and safety of ZGXFD on EHTN. Conclusion: This systematic review will determine whether or not ZGXFD is an effective intervention for essential hypertension.

AbstractBackground:Sepsis is the most common critical illness in the clinic, with a high incidence and mortality. Qingwen Baidu decoction (QWBDD) has been widely applied in the treatment of sepsis, however, there is no systematic review or meta-analysis of QWBDD in the treatment of sepsis. Hence, we provide a protocol of systematic review and meta-analysis to evaluate the efficacy and safety of QWBDD in the treatment of sepsis.Methods:The databases including Cochrane Library, PubMed, Embase, Web of Science, Cochrane Clinical Trial Database, World Health Organization International Clinical Trial Registration Platform, CNKI, CBM, VIP, and WanFang Database will be searched from the time when the respective databases were established to January 2019. All randomized controlled trials (RTCs) published in Chinese and English assessing QWBDD for sepsis will be included. Continuity data are expressed as mean difference (MD) or standard mean difference (SMD), and dichotomous data is expressed as relative risk. Analyses will be performed by using RevMan V.5.3.5 software.Results:This study will provide high-quality synthesis of current evidence of QWBDD in the treatment of sepsis from the following aspects, including 28-day mortality, mean arterial pressure (MAP), blood lactate, procalcitonin (PCT), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), hypersensitive C-reactive protein (hs-CRP), acute physiology and chronic health score (APACHE-II), intensive care unit stay, mean hospital stay, mechanical ventilation time, etc.Conclusion:Our systematic review will provide evidence for judging whether QWBDD is an effective intervention for sepsis.PROSPERO registration number:PROSPERO CRD 42019123078.