了解抗感染、糖皮质激素、血必净等综合治疗基础上中药方剂治疗对改善重症肺炎早期疗效及改善的临床症状及安全性，分析重症肺炎中西医结合治疗优选组方，以改善重症肺炎疗效及预后。

选取符合纳入标准的89例重症肺炎患者，根据中药服用意愿分为对照组46例(抗生素激素血必净组)和观察组43例(抗生素激素血必净中医组)。对照组给予左氧氟沙星、氢化可的松、血必净治疗。观察组在对照组治疗基础上辨证加用中药方剂。比较两组血清感染标志[白细胞计数(white blood cell count, WBC)、超敏C-反应蛋白(high-sensitivity C-reactive protein, hs-CRP)、降钙素原(procalcitonin, PCT)、淀粉样蛋白A (serum amyloid A, SAA)、白介素-6 ( interleukin-6, IL-6)]水平、氧合指标、疗效及不良反应发生率。

两组治疗14天后比较治疗前血清感染标志物水平(WBC、hs-CRP、PCT、SAA、IL-6)得到改善；观察组WBC(9.78 ± 0.85)×10⁹/L、hs-CRP(7.23±0.15) mg/L、PCT (0.09±0.00)pg/ml、SAA (10.27±0.25)mg/L、IL-6 9.35 (7.48，13.32) pg/ml低于对照组(11.15±0.76)×10⁹/L、(12.73±0.89) mg/L、(0.15±0.00) pg/ml、(24.20±1.32) mg/L、18.34 (13.54，21.51)pg/ml，观察组在降低血清炎症标志物方面优于对照组(P<0.05)，IL-6水平降低明显，接近正常参考值范围；两组治疗后，动脉血气氧合指标(PaO₂、SaO₂、氧合指数PaO₂/FiO₂)得到提升，观察组PaO₂(95.64±18.25) mmHg、SaO₂(98.58±14.41)%、PaO₂/FiO₂(333.27±20.89)mmHg分别高于对照组(84.74±5.90) mmHg、(94.63±17.39)%、(240.50±22.01) mmHg，观察组改善动脉氧合指标方面优于对照组(P<0.05)；观察组治疗后发热消退时间2.38 d、咳嗽咳痰缓解时间6.32 d、机械通气时间75.38 h、胸部CT显示炎症吸收时间8.46 d及平均住院天数10.74 d低于对照组5.31 d、11.88 d、128.53 h、13.25 d、13.34 d(P<0.05)。两组治疗后，CPIS评分有所降低，观察组CPIS评分4.15低于对照组6.57(P<0.05)；观察组治疗有效34例(79.07%)高于对照组34例(76.40%)；观察组死亡7例(16.28%)低于对照组死亡8例(17.39%)(P>0.05)；观察组的不良反应总发生率27.91%低于对照组28.26%(P>0.05)，多为轻微的皮疹、轻度的头晕、胃肠道反应(恶心呕吐、腹胀)等，未出现严重心肌损害及肝肾功能损害。

中西医结合联合治疗(抗感染＋氢化可的松＋血必净＋中药方剂)能显著改善炎症指标，改善氧合、缩短病程，不良反应轻微，安全性好，可作为重症肺炎治疗优选方案。中药方剂对重症肺炎有辅助疗效。

To evaluate the clinical efficacy and safety of traditional Chinese medicine (TCM) prescriptions in improving the early outcomes and prognosis of severe pneumonia when used in combination with comprehensive treatments such as anti-infection therapy, glucocorticoids, and Xuebijing, and to explore the optimal TCM prescription for early integrated TCM-Western medicine therapy in severe pneumonia to enhance treatment efficacy and prognosis.

A total of 89 patients with early-stage severe pneumonia who met the inclusion criteria were selected and divided into a control group (antibiotic, glucocorticoid, and Xuebijing group, 46 cases) and an observation group (antibiotic, glucocorticoid, Xuebijing, and TCM group, 43 cases) based on their willingness to take TCM. The control group received treatment with levofloxacin, hydrocortisone, and Xuebijing. The observation group received additional TCM prescriptions tailored to their syndrome differentiation on the basis of the control group′s treatment. The serum infection markers [white blood cell count (WBC), high-sensitivity C-reactive protein (hs-CRP), procalcitonin (PCT), amyloid A (SAA), interleukin-6 (IL-6)], oxygenation indicators, treatment efficacy, and incidence of adverse reactions were compared between the two groups.

After treatment, serum infection markers (WBC, hs-CRP, PCT, SAA, IL-6) in both groups showed significant improvement compared to pre-treatment levels. The observation group exhibited lower levels of WBC(9.78±0.85)×10⁹/L、hs-CRP(7.23±0.15) mg/L、PCT (0.09±0.00)pg/ml、SAA (10.27±0.25)mg/L、IL-6 9.35 (7.48, 13.32) pg/ml than those of the control group(11.15±0.76)×10⁹/L, (12.73 ± 0.89) mg/L, (0.15±0.00) pg/ml, (24.20±1.32) mg/L, 18.34 (13.54, 21.51) pg/ml. The observation group significantly outperformed the control group in reducing serum inflammatory markers, with statistically significant differences (P<0.05). Notably, IL-6 levels decreased markedly, approaching the normal reference range. After, arterial blood gas oxygenation indicators (PaO₂, SaO₂, oxygenation index PaO₂/FiO₂) in both groups improved significantly compared to pre-treatment levels. The observation group showed higher PaO₂(95.64±8.25) mmHg, SaO₂(98.58±4.41)%、PaO₂/FiO₂(333.27±10.89)mmHg than those of the control group(84.74±5.90) mmHg, (94.63±7.39)%, (240.50±12.01) mmHg. The observation group significantly outperformed the control group in improving arterial oxygenation indicators, with statistically significant differences (P<0.05). The observation group had shorter durations for fever resolution (2.38 days), cough and sputum relief (6.32 days), mechanical ventilation (75.38 hours), chest CT inflammation absorption (8.46 days), and average hospitalization (10.74 days) compared to the control group (5.31 days, 11.88 days, 128.53 hours, 13.25 days, 13.34 days, respectively). The observation group significantly outperformed the control group in reducing these indicators, with statistically significant differences (P<0.05). Both groups showed reduced CPIS scores at D14 compared. The observation group achieved a CPIS score of 4.15, which was significantly lower than the control group′s 6.57. The effective rate in the observation group (79.07%) was slightly higher than that in the control group (76.40%), but the difference was not statistically significant; The mortality rate in the observation group (16.28%) was comparable to that in the control group (17.39%), with no statistically significant difference. The overall incidence of adverse reactions in the observation group (27.91%) was similar to that in the control group (28.26%), showing no statistically significant difference between the two groups. Most adverse reactions were mild, including rashes, slight dizziness, and gastrointestinal symptoms (nausea, vomiting, bloating), with no severe myocardial damage or liver and kidney function impairment observed.

The combined treatment of traditional Chinese and Western medicine (anti infection+ hydrocortisone+ Xuebijing+ Chinese herbal formula) can significantly improve various inflammatory indicators, improve oxygenation, shorten the course of disease, achieve ideal therapeutic effects, and have mild adverse reactions and good safety. It can be used as the preferred early treatment plan for severe pneumonia. (2) Traditional Chinese medicine formulas have certain adjuvant therapeutic value for severe pneumonia, but there is no definite advantage in improving overall efficacy and reducing mortality.