【目的】 探讨加减白虎汤对气虚毒滞型脓毒症相关性脑病（SAE）患者的干预作用。【方法】 采用临床随机对照试验，选 取2024年3月至2025年2月广州中医药大学附属广州中西医结合医院重症医学科收治的72例气虚毒滞型SAE患者为研究对 象，采用随机数字表法将患者随机分为治疗组和对照组，每组各36例。对照组给予常规西医治疗，治疗组在对照组常规西 医治疗的基础上加用加减白虎汤治疗，2组疗程均为5 d。观察2组患者治疗前后中医证候积分、格拉斯哥昏迷评分（GCS）及 血清降钙素原（PCT）、白细胞介素6（IL-6）、N末端B型利钠肽原（NT-proBNP）水平的变化情况，并评定2组患者的意识状态 改善疗效和中医证候改善疗效。【结果】（1）脱落情况方面，治疗过程中，2组患者各有6例脱落，最终共有60例患者纳入统 计分析，其中治疗组和对照组各30例。（2）意识状态改善疗效方面，治疗5 d后，治疗组的总有效率为80.00%（24/30），对照 组为 63.33%（19/30），组间比较（χ2检验），治疗组的意识状态改善疗效明显优于对照组（P＜0.05）。（3）中医证候改善疗效方 面，治疗5 d后，治疗组的总有效率为60.00%（18/30），对照组为26.67%（8/30），组间比较（χ2 检验），治疗组的中医证候改善 疗效明显优于对照组（P＜0.05）。（4）实验室指标方面，治疗后，2组患者的血清PCT、IL-6、NT-proBNP水平均较治疗前明显 下降（P＜0.05 或 P＜0.01），且治疗组对血清 PCT、IL-6、NT-proBNP 水平的下降幅度均明显优于对照组（P＜0.05 或 P＜ 0.01）。（5）相关量表评分方面，治疗后，2组患者的意识状态GCS评分均较治疗前升高（P＜0.05或P＜0.01），中医证候积分均 较治疗前下降（P＜0.05或 P＜0.01），且治疗组对意识状态 GCS评分的升高幅度及对中医证候积分的下降幅度均明显优于对 照组（P＜0.01）。【结论】 加减白虎汤可以有效降低气虚毒滞型SAE患者的炎症反应并改善患者意识状态和中医临床症状。

Objective To investigate the therapeutic effects of Modified Baihu Decoction for sepsis-associated encephalopathy （SAE） patients with qi deficiency and toxin stagnation syndrome. Methods A randomized controlled trial was conducted in 72 SAE patients diagnosed with qi deficiency and toxin stagnation syndrome admitted to the Intensive Care Unit of Guangzhou Hospital of Intergrated Traditonal and West Medicine （affiliated to Guangzhou University of Chinese Medicine） between March 2024 and February 2025. Patients were randomly assigned to treatment group （n=36） and control group （n=36） using a random number table. The control group received conventional western therapy，while the treatment group additionally received Modified Baihu Decoction for 5 days. Changes in traditional Chinese medicine （TCM） syndrome scores，Glasgow Coma Scale （GCS） scores， and serum levels of procalcitonin （PCT），interleukin-6（IL-6），and N-terminal pro-brain natriuretic peptide （NT-proBNP） were observed. Improvement in consciousness and TCM syndrome efficacy were evaluated. Results （1） During the treatment period， 6 patients from each group dropped out. A total of 60 patients were ultimately included in the statistical analysis，with 30 patients in each group.（2） After 5 days of treatment，the total effective rate for improving consciousness was 80.00% （24/30） in the treatment group and 63.33% （19/30） in the control group. Intergroup comparison （by chi-square test） showed that the consciousness improvement efficacy was significantly superior in the treatment group compared to the control group （P＜0.05）.（3） After 5 days of treatment，the total effective rate for improving TCM syndrome was 60.00% （18/30） in the treatment group and 26.67% （8/30） in the control group. Intergroup comparison （by chi-square test） demonstrated significantly superior TCM syndrome improvement in the treatment group （P＜0.05）.（4） After treatment，serum levels of PCT， IL-6，and NT-proBNP significantly decreased in both groups compared to baseline levels （P＜0.05 or P＜0.01）. The treatment group showed significantly greater reductions in serum PCT，IL-6，and NT-proBNP levels than the control group （P＜0.05 or P＜0.01）.（5） After treatment，GCS scores increased significantly from baseline levels in both groups （P＜0.05 or P＜0.01），while TCM syndrome scores significantly decreased （P＜0.05 or P＜0.01）. The treatment group demonstrated significantly greater improvement in GCS score elevation and TCM syndrome score reduction than the control group （P＜0.01）. Conclusion Modified Baihu Decoction effectively reduces inflammatory response and improves consciousness and TCM clinical symptoms in SAE patients with qi deficiency and toxin stagnation syndrome.

R259.153

国家中医药管理局资助项目—杨沛群全国基层名老中医药专家传承工作室项目（国中医药人教函[2024]256号）；广东省中医药局 科研项目（编号：20231252）；广州市花都区基础与应用基础研究区院联合资助项目（编号：24HDQYLH26）