重症胃肠功能障碍中西医结合集束化防治管理优化方案研究  

Optimized Bundle Therapy Combined with Integrated Traditional Chinese and Western Medicine for Prevention and Treatment of Severe Gastrointestinal Dysfunction

作　　者：赵云燕[1] 吴建鹏[1] 王首红[2] 覃铁和[2] 张慧珠[2] 王中华[2] 曹阳[1] 谭结怡 雷晓兰[1] 戚淑娟[1] 李莉[1] 

机构地区：[1]广州中医药大学附属广州市中医院重症医学科,广东广州510130 [2]广东省人民医院重症医学科,广东广州510080

出　　处：《安徽中医药大学学报》2016年第4期12-18,共7页Journal of Anhui University of Chinese Medicine

基　　金：广州市科技计划攻关项目(201300000144)

摘　　要：目的观察3个不同的集束化防治管理方案对重症胃肠功能障碍(急性胃肠损伤)患者关键预后指标的影响,筛选优化的集束化防治管理方案。方法将180例ICU患者随机分为3组,实施3种不同的治疗方案(方案1是尽早限制性给予肠内营养,以及早期给予肠外营养和中药;方案2是尽早给予合理性肠内营养和中药,3d后肠内营养不足目标热量60%时加肠外营养;方案3是方案2减去中药),疗程为7d,比较3种方案对患者腹腔内压(intra-abdominal pressure,IAP)、腹腔灌注压(abdominal perfusion pressure,APP)、胃肠功能、病情严重程度、ICU住院时间、28d存活率、ICU病死率等的影响。结果治疗后方案2组患者IAP显著降低,APP显著升高,病情严重程度减轻,28d存活率显著增高(P<0.05)。结论方案2能改善重症胃肠功能障碍患者的IAP、APP和病情,提高患者28d存活率,显著优于方案1和方案3。Objective To investigate the effects of three bundle prevention and treatment regimens on key prognostic markers in patients with severe gastrointestinal dysfunction（acute gastrointestinal injury）,and to screen out an optimized bundle prevention and treatment regimen.Methods A total of 180 patients who were admitted to the Intensive Care Unit（ICU）were divided into three groups and received three different therapeutic regimens.The patients in regimen 1group were given limited enteral nutrition as early as possible and parenteral nutrition and traditional Chinese medicine（TCM）in early stage;those in regimen 2group were given reasonable enteral nutrition and TCM as early as possible with the addition of parenteral nutrition if enteral nutrition accounted for less than 60% of target calories 3days later;those in regimen 3group were treated with the same regimen as the regimen 2group except TCM.The course of the treatment was 7days for all groups.The intraabdominal pressure（IAP）,abdominal perfusion pressure（APP）,gastrointestinal function,severity of the patient＇s condition,length of hospital stay in the ICU,28-day survival rate,and mortality rate in the ICU were compared between the three groups.Results After treatment,the regimen 2group showed a significant reduction in IAP,a significant increase in APP,reduced severity of the patient＇s condition,and a significant increase in the 28-day survival rate（P〈0.05）.Conclusion Compared with the regimens 1and 3,regimen 2can significantly improve the IAP,APP,and condition of patients with severe gastrointestinal dysfunction and increase the 28-day survival rate.

关 键 词：急性胃肠损伤 腹腔内压 腹腔灌注压 肠内营养 肠外营养 中西医结合疗法 

分 类 号：R278[医药卫生—中医学] R57