清营汤加味对老年脓毒症患者胃肠道功能保护作用的临床观察  

The clinical observation for protective effiects of modified Qingying decoction on gastrointestinal functionon in elderly patients with sepsis

作　　者：张艳[1] 蔡莉娟[1] 刘文兵[1] 丁学军[1] 

机构地区：[1]浙江中医药大学附属第三医院重症监护科,浙江杭州310005

出　　处：《上海中医药杂志》2016年第7期53-55,共3页Shanghai Journal of Traditional Chinese Medicine

基　　金：浙江省中山医院(浙江中医药大学附属第三医院)院级课题项目(2014ZS07)

摘　　要：目的观察清营汤加味对老年脓毒症患者胃肠道功能的保护作用。方法将62例患者随机分成治疗组与对照组,每组31例。两组均采用西医常规治疗,治疗组加用清营汤加味方内服。两组疗程均为7天,观察急性生理学及慢性健康状况评分(APACHEⅡ)、血红素加氧酶-1(HO-1)、降钙素原(PCT)水平以及腹内压(IAP)、胃肠减压量、胃肠黏膜pH值(pHi)的变化情况,并记录胃肠道开通时间、MODS的发生率及随访28天死亡率。结果①组间治疗后比较,APACHEⅡ评分、HO-1及PCT水平下降幅度治疗组明显大于对照组(P<0.05)。②组间治疗后比较,IAP、胃肠减压量及pHi水平下降程度治疗组明显大于对照组(P<0.05)。③两组胃肠道开通时间、MODS发生率及28天死亡率比较,差异均有统计学意义,治疗组预后明显优于对照组(P<0.05)。结论清营汤加味联合西医常规疗法治疗老年脓毒症患者,可较好抑制炎症反应,并能启动机体胃肠道保护系统,从而缩短开通胃肠道的时间,进而减少MODS的发生。Objective To observe the protective effiects of modified Qingying decoction on gastrointestinal functionon in elderly patients with sepsis. Methods 62 patients were randomly divided into treatment group and control group, 31 in each group. Two groups were both treated with routine western medicine. Additionally treatment group was given modified Qingying decoction orally. Course of treatment for both groups was 7 days. The change of score of acute physiology and chronic health situation （ APACHE ll）, the level of heine oxygenase- 1 （ HO- 1 ） and procaleitonin （PCT） , the intra-abdomina] pressure （ lAP）, the gastrointestinal decompression amount, the pH of gastrointestinal mucosa（pHi） were observed. The opening time of gastrointestinal tract, the incidence of MODS and mortality within follow-up 28 days were recorded. Results ①Compared with the control group after treatment, the APACHE Ⅱ score and the level of HO- 1 and PCT in treatment group decreased more significantly（P 〈 0.05 ）. ②Compared with the control group after treatment, the lAP, the gastrointestinal decompression amount and the pHi in treatment group decreased more significantly（ P 〈 0.05 ）. ③The difference of the opening time of gastrointestinal tract, the incidence of MODS, and mortality within follow-up 28 days between two groups was statistically significant. The prognosis of the treatment group was significantly better than that of the control group. Conclusion The modified Qingying decoction combined with conventional western medicine therapy could be used for elderly patients with sepsis, which suppress the inflammatory reaction and start the body gastrointestinal protection system so as to shorten the opening time of the gastrointestinal tract and ~duce the incidence of MODS.

关 键 词：脓毒症 老年人 胃肠道功能 清营汤 大黄 厚朴 温病学 

分 类 号：R459.7[医药卫生—急诊医学]