MODS胃肠功能障碍腹胀满病中医诊疗方案的临床研究  

Clinical Effects of TCM Diagnosis and Treatment Project on Patients with MODS Gastrointestinal Dysfunction of Abdominal Distension and Fullness Disease

作　　者：周江[1] 陈明祺[1] 耿艳霞[1] 裴颖皓 鲁俊[1] 戴林峰[1] 吕海[1] 王醒[1] 

机构地区：[1]南京中医药大学附属医院,江苏南京210029

出　　处：《南京中医药大学学报》2017年第6期560-564,共5页Journal of Nanjing University of Traditional Chinese Medicine

基　　金：国家中医药管理局"十二五"重点专科重点专病协作组研究项目(ZP1001ZZ011);国家中医临床研究基地和中国中医科学院江苏分院开放课题资助;江苏省中医药局科技计划项目(JD201501)

摘　　要：目的探讨多器官功能障碍综合征(MODS)胃肠功能障碍腹胀满病中医诊疗方案的临床疗效。方法纳入自2012年7月至2016年12月于南京中医药大学附属医院重症监护病房(ICU)收治的腹胀满病患者共78例,随机分为对照组(n=35)和试验组(n=43)。2组均采用积极抗感染、脏器功能支持、营养免疫调理等基础治疗,试验组经中医辨证为热毒中阻证者予大黄黄连泻心化裁方消导化积,清热解毒;气滞血瘀证者予血府逐瘀化裁方理气通腑,活血祛瘀;肺脾气虚证者予自拟益气通腑方益气健脾,通腑泄浊。各证型均配以针灸、穴位贴敷等治疗。记录并比较2组患者治疗前和治疗后第7、14天腹部症状、体征、腹内压等胃肠道功能相关指标的变化、ICU住院天数及住院期间病死率。结果治疗后2组患者中医症状评分、腹部体征评分、腹内压水平均呈下降趋势,但在试验组治疗第7、14天各指标较对照组下降更为明显,具有显著统计学差异(P<0.05),且治疗第14天以中医症状评分及腹部体征评分下降更明显(P<0.01)。2组28d死亡率相比无明显统计学差异,但试验组患者平均ICU住院时间明显低于对照组(P<0.05)。试验组分析显示,以热毒中阻证患者占比最高,且痊愈率明显高于气滞血瘀证和脾肺气虚证患者,而无效率明显低于气滞血瘀证和脾肺气虚证患者(P<0.05)。结论在MODS腹胀满病住院患者中应用诊疗方案进行诊疗可显著提高第14天的临床疗效,缩短ICU住院时间。ABSTRUCT:OBJECTIVE To evaluate the clinical effects of TCM diagnosis and treatment project for patients with MODS gastrointestinal dysfunction of abdominal distension and fullness disease.METHODS TCM diagnosis and treatment project(draft protocol)for abdominal distention and fullness disease was decided according to MODS diagnosis criteria which was formulated in the 3 rd CSCCM.Seventy-eight patients with abdominal distension and fullness disease included in ICU of the affiliated hospital of Nanjing University of Chinese Medicine from July,2012 to December,2016 were enrolled in this study,and were randomly divided into the control group(n=35)and the treatment group(n=43).Basic treatments such as active antiinfection,functional support of organs,immuno-nutrition supplement were performed for both groups.For the treatment group,patients who were diagnosed as the syndrome of middle-heat obstruction were treated with the modified Dahuang Huanglian Xiexin decoction to eliminate stagnation,clear away heat and detoxify.patients who were diagnosed as the syndrome of qi stagnation and blood stasis were treated with the modified Xuefu Zhuyu decoction to regulate qi and dredge fu-organs,activate blood circulation and remove blood stasis,and patients who were diagnosed as the qi deficiency of lung and spleen were treated with the self-formulated Yiqi Tongfu decoction to supplement qi,invigorate spleen and purge fu-organs.In addition,all syndromes were also treated with acupuncture and moxibustion and acupoints application.gastrointestinal function related indexes such as abdominal symptoms,signs,intra-abdominal pressure,ICU stays and mortality during hospitalization in both groups were recoded and compared on the 7 th and 14 th day before and after the treatment.RESULTS TCM Symptom score,abdominal signs score,intra-abdominal pressure level in both groups showed a downward trend after the treatment,but all indexes in the treatment group decreased more significantly on the 7 th and 14 th day compared with those of the control

关 键 词：MODS胃肠功能障碍 腹胀满病 中医诊疗方案 临床疗效分析 

分 类 号：R278[医药卫生—中医学]