【摘要】 目的观察清热祛湿法对尿石症(湿热证)患者证候及尿流动力学指标的影响,并探究其改善梗阻性上尿路感染的机制。方法 210例患者以随机数字表法分为观察组、对照组与空白组各70例。所有患者均给予孙氏镜碎石术治疗,术后全部常规头孢呋辛酯片抗感染治疗,观察组给予清热祛湿的中药汤剂,对照组给予宁泌泰胶囊,空白组术后不予利尿排石药物治疗,比较各组患者术后中医证候、急性生理与慢性健康状况量表Ⅱ(APACHEⅡ)评分、肾盂压力、尿流率、尿量、炎症指标[降钙素原(PCT)、C反应蛋白(CRP)、白细胞计数(WBC)]水平。结果观察组证候改善总有效率97.14%(68/70)及对照组的92.86%(65/70)均高于空白组的64.29%(45/70)(P <0.05)。观察组及对照组肾盂压力均低于空白组(均P <0.05),平均尿流率及24 h尿量均高于空白组(均P <0.05)。各组治疗后血WBC、PCT、CRP水平与治疗前比较,均降低(均P <0.05)。各组治疗后第3天、第7天血WBC比较,差别均不大(均P> 0.05);观察组及对照组治疗后第3天、第7天PCT、CRP水平均低于空白组(均P <0.05)。各组治疗前APACHEⅡ评分比较,差别均不大(均P> 0.05)。各组治疗后APACHEⅡ评分与治疗前比较,均降低(均P <0.05)。观察组与对照组治疗后APACHEⅡ评分均低于空白组(均P <0.05)。结论清热祛湿法治疗梗阻性上尿路感染,可通过改善证候,降低肾盂压力,增加尿量,从而改善炎症指标,有清热祛湿、通淋利尿、调理气机、改善微循环的作用。更多还原

【Abstract】 Objective:To investigate the effect of Qingre Qushi Decoction on the symptoms and urodynamics of patients with damp heat type urolithiasis,and to explore the mechanism of improving obstructive upper urinary tract infection.Methods:A total of 210 patients with damp heat type urolithiasis in Zhongshan Hospital of Traditional Chinese Medicine from October 2019 to October 2020 were selected and randomly divided into the observation group,control group and blank group,70 cases in each group.All patients were treated with Sun′s lithotripsy.After operation,all patients were treated with cefuroxime axetil tablets for anti-infection.The observation group was treated with Qingre Qushi Decoction,and the control group was treated with Ningmitai Capsules.The improvement of TCM syndrome,ApacheⅡscore,renal pelvic pressure,urine flow rate,urine volume and inflammatory indexes(PCT,CRP,WBC)were compared among the three groups.Results:The total effective rate of syndrome improvement was 97.14%(68/70)in the observation group and 92.86%(65/70)in the control group,which were higher than 64.29%(45/70)in the blank group(P<0.05).The renal pelvic pressures of the observation group and the control group were lower than those of the blank group(all P<0.05),and the average urine flow rate and 24 hour urine output were higher than those of the blank group(all P<0.05).The white blood cells(WBC),procalcitonin(PCT)and C-reactive protein(CRP)of the three groups before treatment showed little difference(all P>0.05).The levels of WBC,PCT and CRP after treatment in the three groups were all decreased compared with those before treatment(all P<0.05).Comparison of WBC on the 3rd and 7th day after treatment of the three groups showed little difference(all P>0.05);the observation group and control group had lower levels of PCT and CRP on the 3rd and 7th day after treatment than the blank group(all P<0.05).Comparison of APACHEⅡscores before treatment in the three groups showed little difference(all P>0.05).The APACHEⅡscores after treatment in the three groups were all lower than before treatment(all P<0.05).The APACHEⅡscores of the observation group and the control group after treatment were lower than those of the blank group(all P<0.05).The TCM symptoms,APACHE II score,inflammatory indicators of all patients were improved,the improvement of the observation group and the control group were better than the blank group with significant difference(P<0.05);in the aspect of urodynamics,the renal pelvic pressure of the observation group and the control group were significantly lower than the blank group,and the urinary flow rate and 24 hour urine volume were significantly higher than the blank group with significant difference(P<0.05).Conclusion:Qingre Qushi Decoction can improve symptoms,reduce renal pelvis pressure,and increase urine output to improve the inflammation index.It has the functions of clearing heat and eliminating dampness,relieving drenching and diuresis,regulating qi and improving microcirculation.更多还原