青陈合剂治疗脓毒症胃肠功能障碍脾虚气滞证的临床研究  

Clinical research on Qingchen mixture for treatment of patients with sepsis and gastrointestinal dysfunction accompanied by traditional Chinese medicine syndrome of spleen-deficiency and Qi stagnation

作　　者：吴同启[1] 代君[1] 朱维娜[1] 乔丽君[1] 孙明霞[1] 傅元冬[1] 陈畅泉[1] 周媛媛[1] 王克俭[1] 陈华尧[1] 

机构地区：[1]南京中医药大学第三附属医院,江苏南京210001

出　　处：《中国中西医结合急救杂志》2016年第4期348-351,共4页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：汀苏省南京市医学科技发展项目（YKK13099）

摘　　要：目的观察青陈合剂治疗脓毒症胃肠功能障碍脾虚气滞证的疗效。方法选择2013年9月至2015年12月南京中医药大学第三附属医院重症医学科和急诊重症加强治疗病房（EICU）收治的脓毒症合并胃肠功能障碍患者72例，按随机数字表法分为对照组（34例）和青陈合剂组（38例）。两组均给予常规治疗，青陈合剂在常规治疗基础上予青陈合剂（由青皮、陈皮、枳壳、茯苓、六神曲、焦山楂、荷叶组成）20mL口服或鼻饲，每日3次，2周为1个疗程。于治疗前和治疗后7d、14d观察两组胃肠功能障碍积分、腹内压、中医证候积分、急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分；比较两组患者治疗前和治疗后14d血清白细胞介素-6（IL-6）、二胺氧化酶（DAO）、胃动素（MTL），并评价肠功能障碍的疗效。结果两组治疗后胃肠功能障碍积分均较治疗前降低，且青陈合剂组的降低程度较对照组更显著（分：7d为3．8±1．7比4．3±1．5，P〉0．05；14d为2．2±1．4比3．5±1．2，P〈0．05）；两组腹内压、中医证候积分和APACHEⅡ评分随治疗时间延长而逐渐降低，青陈合剂组腹内压和APACHEⅡ评分治疗后7d低于对照组，但差异无统计学意义[腹内压（mmHg，1mmHg=0．133kPa）：10．8±5．5比12．1±6．3；APACHEⅡ评分（分）：13．9±4．8比15．8±4．7，均P〉0．05]，治疗后14d腹内压和APACHEⅡ评分均低于对照组，差异有统计学意义[腹内压（mmHg）：7．5±3．9比10．6±4．2，APACHEⅡ评分（分）：10．9±3．5比13．2±4．6，均P〈0．05]；青陈合剂组治疗后7d、14d中医证候积分（分）均明显低于对照组（7d：12．5±5．1比15．2±4．9，14d：6．2±2．7比10．9±4．5，均P〈0．05）。治疗后14d两组血清IL-6、DAO均较治疗前明显降低，MTL水平较治疗前升高，且青陈合剂上述指标改善程度优于对照组[IL-6（ngL）：54．Objective To observe the clinical therapeutic effect of Qinchen mixture for treatment of sepsis patients with gastrointestinal dysfunction and traditional Chinese medicine （TCM） syndrome of spleen-deficiency and Qi stagnation. Methods Seventy-two patients with sepsis and gastrointestinal dysfunction admitted to emergency intensive care unit （EICU） of the Third Affiliated Hospital of Nanjing University of Chinese Medicine from September 2013 to December 2015 were enrolled in the study, and they were randomly divided into a control group （34 cases） and a Qinchen mixture group （38 cases）. Conventional treatment was given to both groups, and additionally, Qinchen mixture （including ingredients： green tangerine peel, dried tangerine peel, orange fruit, indian bread, massa medicata fermentata, charred fructus crataegi, lotus leaf） was given to Qinchen mixture group, 20 mL once orally taken or fed through nose by a stomach tube, 3 times a day, 2 weeks constituting one therapeutic course. The gastrointestinal dysfunction score （GDS）, intra-abdominal pressure （IAP）, integral score of TCM syndrome and acute physiology and chronic health evaluation 11 （APACHE 1] ） score were observed in two groups before and on the 7th day and 14th day after treatment. Before and 14 days after treatment in the two groups, the serum levels of interleukin-6 （IL-6）, diamine oxidase （DAO） and motilin （MTL） were detected and compared, and the therapeutic effect on gastrointestinal dysfunction was evaluated. Results The GDS after treatment was decreased compared with that before treatment in the two groups, and the degree of decrease in the Qinchen mixture group was more significant than that in the coutrol group （7th day： 3.8 ± 1.7 vs. 4.3 ±1.5, P 〉 0.05; 14th day： 2.2 ± 1.4 vs. 3.5 ± 1.2, P 〈 0.05）. Along with the prolongation of therapeutictime, IAP, integral score of TCM syndrome and APACHE II score were declined gradually in the two groups. Although IAP and APACHE I score were low

关 键 词：脓毒症 胃肠功能障碍 青陈合剂 

分 类 号：R454[医药卫生—治疗学]