| 1.Purpose:The main purpose of this study was to observe the soluble leukocyte differentiation antigen 14 subtypes in patients with post-stroke hospital acquired pneumonia before and after treatment by using the method of supplementing qi,activating blood circulation,and removing stasis(Shenmai Injection,Danshen Polyphenolate,and Kechuanping Instant Granules)(Presepsin,sCD14-ST),procalcitonin(PCT),C-reactive protein(CRP),WBC,blood gas analysis,mechanical ventilation time,acute physiology and chronic health status assessment system(APACHE-II),National Institutes of Health National Institutes of Health Stroke Scale(NIHSS),Clinical Pulmonary Infection Scale(CPIS),TCM symptom scores,and comparison with conventional western medicine treatment groups,to verify benefits from clinical symptoms,signs,laboratory indicators,etc.The therapeutic effect of qi,blood circulation and stasis treatment on hospital-acquired pneumonia after stroke was explored,and its possible mechanism was explored.It was an effective treatment for the treatment of hospital-acquired pneumonia after stroke.2 methods:We selected 60 patients with qi-deficiency and blood-stagnation of post-stroke hospital acquired pneumonia in MICU(Intensive Care Unit)and SICU from March 2017 to December 2017 and were randomly divided into two groups.Control group 30 Cases,treatment group 30 cases.The patients in the control group were treated with conventional western medicine(anti-infection,corrected electrolyte imbalance,nutritional support,oxygen deficiency in apparent oxygen deficiency,treatment of primary disease,etc.),and the treatment group was treated with supplementing Qi,promoting blood circulation,and removing blood stasis based on conventional western medicine treatment(Shenmai Injection+Danshen Polyphenolate +Kechuan Pingchong),treatment for 7 days.Observe the soluble leukocyte differentiation antigen 14 subtype(Presepsin,sCD14-ST),procalcitonin(PCT),C-reactive protein(CRP),WBC,bloodgas analysis,mechanical ventilation time,acute physiology and chronicity before and after treatment in the two groups of patients Health status assessment system(APACHE-II),National Institutes of Health stroke scale(NIHSS),Clinical Pulmonary Infection Score(CPIS),TCM symptom score changes,and two groups of patients The clinical prognosis is compared.3 results:3.1 General Information Analysis The control group included 30 males,15 males and 15 females,aged 42-82 years,mean age(63.10±12.89)years,average course of disease(15.70±8.32);primary disease: 4cases of cerebral hemorrhage,large area There were 6 cases of cerebral infarction,5cases of lacunar infarction,7 cases of cerebral hemorrhage,and 8 cases of cerebral hemorrhage.The observation group included 30 males,14 males and 16 females,aged41-83 years,mean age(69.77±11.03)years,average disease duration(17.67±9.14),and primary disease category: brain stem bleeding in 5 cases.There were 4 cases of large-area cerebral infarction,6 cases of lacunar infarction,6 cases of cerebral hemorrhage,and 7 cases of intracerebral hemorrhage.There was no significant difference in gender,age,duration,and disease status between the two groups(sex:?2=0.00,P=0.83;age: ?2=2.00,P=0.50;course of disease: t=0.87,P=0.39;illness : ?2 =0.35,P = 0.50).3.2 Clinical efficacy analysis of two groups of patients After treatment,the total effective rate in the observation group was 86.67%,which was30% higher than that in the control group.The observation group's effective rate was26.67%,which was also significantly higher than the control group(13.33%).The ineffective rate in the observation group was 13.33%,while the inefficiency in the control group was as high as 43.33%.It is indicated that the Chinese medicine combined group has better efficacy than the conventional western medicine treatment group in hospital-acquired pneumonia after stroke.3.3 The improvement of patients' symptoms and signsThere was no significant difference between the two groups in the scores of TCM symptoms before treatment(t=-0.03,P=0.98);both groups of patients had significantly improved TCM symptom scores before treatment(observation group: z=-23.00,P= 0.00;control group: z=-20.49,P=0.00),but the improvement of symptoms and signs of the Chinese medicine combined group group was more advantageous than the control group(t=-2.23,P=0.03).3.4 Improvement of APACHE-II score in patients There was no significant difference in the APACHE-II score between the two groups before treatment(t=0.13,P=0.89);the efficacy of APACHE-II score after treatment was also significant in both groups(observation group: z=-19.49,P=0.00 Control group:z=-17.05,P=0.00),but the Chinese medicine combined group showed better efficacy than the control group(t=-3.07,P=0.003).3.5 Improvement of NIHSS score of patients There was no significant difference in NIHSS scores between the two groups before treatment(t=0.12,P=0.90);both groups had significant reductions in NIHSS scores after treatment(observation group: z=-19.49,P=0.00;Control group: z=-17.05,P=0.00),but the efficacy of the Chinese medicine combined group was more prominent(t=-4.91,P=0.00).3.6 Effect on CPIS score of patients There was no significant difference in CPIS scores between the two groups before treatment(t=0.48,P=0.63);both treatments had significant down-regulation of CPIS scores(observation group: z=-4.80,P=0.00;Group:z=-4.79,P=0.00),but the effect of the Chinese medicine combined group was more prominent(t=-3.18,P=0.002).3.7 Effect on oxygen partial pressure in patients There was no significant difference in the oxygen partial pressure between the two groups before treatment(t=0.25,P=0.81);both therapies had a significant up-regulation of oxygen partial pressure in patients(observation group: t=-13.16,P=0.00;Group:t=-8.34,P=0.00);between the two groups of patients after treatment oxygen partialpressure group comparison,t=7.89,P=0.004,indicating that the Chinese medicine combined group of oxygen partial pressure after treatment was significantly higher than the antibiotic treatment group.3.8 Influence on partial pressure of carbon dioxide in patients There was no significant difference in the partial pressure of carbon dioxide before treatment(t=0.10,P=0.92);the partial pressure of carbon dioxide after treatment was significantly lower than before(observation group: t=18.95,P=0.00;control group:t=15.58,P=0.00);However,the reduction of carbon dioxide partial pressure in the combined Chinese medicine group was superior to the conventional treatment group(t= 7.89,P=0.00).Effect of 3.9 on oxygenation index in patients The levels of oxygenation index before treatment were comparable between the two groups(t=-0.49,P=0.63);both treatments were effective in increasing the oxygenation index(observed group: t=-34.58,P=0.00;Group: t=-25.70,P=0.00),but the observation group had more advantages in the treatment of oxygenation index(t=11.39,P=0.004).3.9 Effect on serum procalcitonin in patients There was no significant difference in serum procalcitonin levels before treatment(t=0.04,P=0.97);serum procalcitonin levels were significantly lower in the two groups after treatment(observation group: t=10.68,P=0.00;control group: t=7.63,P=0.00);However,the combination of Chinese herbs combined with serum procalcitonin was superior to conventional treatment(t=-2.56,P=0.01).3.10 Effect on serum C-reactive protein in patients CRP was comparable before treatment in the two groups(t=1.90,P=0.062);both treatments significantly reduced the serum CRP concentration(observed group: t=17.05,P=0.00;control group: t=8.42,P=0.00),but the decrease in serum CRP was more pronounced in the combined Chinese medicine group than in the western medicine group(t=-2.57,P=0.013).3.11 Effect on white blood cell count in patients' bloodThere was no significant difference in the leukocyte count between the two groups before treatment(t=-1.81,P=0.75);both therapies were able to improve the leukocyte concentration in the patient's blood(observed group t=19.39,P=0.00;control group):t=12.32,P=0.00),but the combined Chinese medicine group can more significantly correct blood counts(t=-2.19,P=0.032).3.12 Comparison of sCD14-ST Levels in Two Groups There was no significant difference in serum sCD14-ST concentrations between the two groups before treatment(t=0.49,P=0.62);both therapies were able to improve the blood leukocyte concentration well in the patients(observation group z=-100.20,P = 0.00;control group: z=-86.05,P = 0.00);but the combination of traditional Chinese medicine combined to reduce the serum level of sCD14-ST is more obvious than the control group(t=-2.19,P = 0.032).4 Conclusion:Yiqi Huoxue Huayu method can significantly reduce the APACHE-II score and TCM symptom scores in hospital acquired pneumonia patients with qi deficiency and blood stasis type,improve the body condition,and have obvious clinical effect.The mechanism may be related to qi-invigorating,blood-activating and phlegm-removing therapy,which can better regulate post-stroke immunosuppression in patients,improve microcirculatory disturbances,reduce the level of inflammation in patients,increase systemic oxygenation for the purpose of treating diseases,and improve the prognosis of patients.And improve the patient's condition.There was no obvious adverse drug reaction in this study.This treatment provided an objective indicator and basis for the treatment of hospital-acquired pneumonia after stroke with Chinese and Western medicine,which demonstrated the hospital acquired pneumonia after stroke treatment.The unique effect. |
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