益气通腑逐瘀方灌肠疗法对脓毒症患者肠道黏膜屏障功能的影响  

Effect of Yiqi Tongfu Zhuyu decoction enema therapy on intestinal mucosal barrier function in patients with sepsis

作　　者：鲁召欣[1] 高翠翠[1] 张明[2] 张众慧[2] 姜志明[2] 杨君[2] 徐拥庆[2] 李涛[2] 解建[2] 

机构地区：[1]山东中医药大学临床学院,山东省济南市250014 [2]山东省千佛山医院重症医学科,山东省济南市250014

出　　处：《世界华人消化杂志》2009年第24期2530-2533,共4页World Chinese Journal of Digestology

摘　　要：目的:观察益气通腑逐瘀方灌肠疗法对脓毒症患者肠道黏膜屏障功能的影响.方法:将40例脓毒症患者,随机分为治疗组(20例)与对照组(20例).2组患者均给予敏感抗生素、营养支持等常规治疗,必要时给予机械通气治疗.治疗组在此基础上联合益气通腑逐瘀方灌肠治疗,对照组在此基础上行等量煎药用水灌肠,均每日2次.PCR法测定患者治疗前后外周血细菌DNA片段,分光光度法监测其血清D-乳酸水平,高效液相色谱法监测尿乳果糖/甘露醇(L/M)值,观察脓毒症患者ARDS、MODS的发生.结果:治疗7d与14d后,治疗组较对照组D-乳酸水平均有显著降低(6.04±1.06μg/Lvs8.83±0.73μg/L;3.89±0.86μg/Lvs7.18±0.90μg/L,均P<0.01);治疗14d后,较对照组尿L/M水平有明显降低(0.0499vs0.0709,P<0.05);治疗结束后,与对照组相比治疗组细菌DNA片段转阴率增高、ARDS发生率及MODS发生率均有明显降低(71.4%vs33.3%;17.6%vs50%;0%vs22.2%,均P<0.05).结论:益气通腑逐瘀方灌肠治疗能改善脓毒性患者肠道黏膜屏障功能,降低肠道细菌、内毒素移位,并能降低脓毒症患者ARDS、MODS的发生率.AIM： To observe the effect of Yiqi Tongfu Zhuyu decoction enema therapy on the intestinal mucosal barrier function in patients with sepsis. METHODS： Forty cases of sepsis were randomly divided into two groups： the treatment group （20 cases） and the control group （20 cases）. Sensitive antibiotics, nutritional support, and mechanical ventilation were administered to both groups if necessary. Combined Yiqi Tongfu Zhuyu en- ema treatment was given to the treatment group twice a day while normal saline enema was given to the control group twice a day. Peripheral bacterial DNA fragment was determined before and after treatment with PCR, plasma D-lactic acid level was monitored by spectrophotomen- try, and the urinary lactulose/mannitol （L/M） values were monitored by HPLC. Occurrence of acute respiratory distress syndrome （ARDS） and multiple organ dysfunction symdrome （MODS） was observed in patients with sepsis. RESULTS： The D-lactate levels were signifi- cantly reduced in the treatment group after 7 and 14 d compared with the control group （6.04 ± 1.06 μg/L vs 8.83 ± 0.73μg/L; 3.89 ± 0.86 μg/L vs 7.18 ± 0.90 μg/L, both P 〈 0.01）. Urinary L/M level was significantly lowered 14 d after treat- ment （0.0499 vs 0.0709, P 〈 0.05）. After treatment, the rate of bacterial DNA negative fragment of treatment group was obviously higher than the control group and ARDS and MODS incidence rate were significantly reduced （74.1% vs 33.3%; 17.6% vs 50%; 0% vs 22.2%, all P 〈 0.05）. CONCLUSION： Yiqi Tongfu Zhuyu enema therapy can improve the intestinal mucosa barrier function of the patients with sepsis, and reduce in- testinal bacteria and endotoxin translocation, and ARDS/MODS incidence in patients with sepsis.

关 键 词：益气通腑逐瘀方 灌肠疗法 脓毒症 肠道黏膜屏障功能 

分 类 号：R278[医药卫生—中医学]