凉膈散对机械通气患者血清瓜氨酸和肠型脂肪酸结合蛋白的影响  

Effects of Lianggesan on serum citrulline and intestinal fatty acid binding protein levels in patients with mechanical ventilation and gastrointestinal injury

作　　者：骆宁[1] 高红梅[1] 李寅[1] 李红洁[1] 范文[1] Luo Ning;Gao Hongrnei;Li Yin;Li Hongjie;Fan Wen(Department of Intensive Care Unit,Institute of Emergency Medicine,the First Center Hospital of Tianjin,Tianjin 300192,China)

机构地区：[1]天津市第一中心医院急救医学研究所ICU,300192

出　　处：《中国中西医结合急救杂志》2019年第1期58-61,共4页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：天津市中医药管理局中医中西医结合科研专项课题(13117).

摘　　要：目的观察凉膈散对机械通气合并急性胃肠功能损伤(AGI)患者血清瓜氨酸和肠型脂肪酸结合蛋白(IFABP)的影响.方法选择天津市第一中心医院2017年5月至12月收治的机械通气合并AGI患者80例,按治疗方法不同分为常规治疗组和中药治疗组,每组40例;选取机械通气未合并AGI患者10例作为对照组.所有患者入院后均给予有创机械通气,并根据AGI分级治疗流程进行胃肠道干预;中药治疗组在常规治疗组基础上加用凉膈散(组成:连翘30 g、黄芩10 g、栀子10 g、竹叶10 g、大黄10 g、薄荷6 g、芒硝6 g、甘草15 g,所用中药为江阴天江药业有限公司生产的单味中药颗粒剂,将各单味中药颗粒按比例溶于80~100℃开水200 mL中,每次100 mL、每日2次鼻饲).观察3组治疗前后血清瓜氨酸以及IFABP水平的变化.结果治疗前,常规治疗组和中药治疗组血清瓜氨酸均显著低于对照组(μmol/L:19.84±4.74、20.84±4.65比28.89±2.18,均P<0.05),IFABP均显著高于对照组(ng/L:571.89±42.98、552.49±44.78比155.68±22.95,均P<0.05),常规治疗组和中药治疗组比较差异无统计学意义(P>0.05);随着治疗时间的延长,常规治疗组和中药治疗组瓜氨酸水平呈先降低后逐渐升高的趋势,于治疗1 d达谷值〔两组分别为(16.12±4.44)、(18.49±4.59)μmol/L〕,以后逐渐升高,治疗7 d达峰值,且中药治疗组的升高程度较常规治疗组更明显(μmol/L:26.77±4.18比22.75±3.07,P<0.05),治疗5 d、7 d中药治疗组瓜氨酸已接近对照组水平;常规治疗组和中药治疗组IFABP呈先升高后逐渐降低的趋势,于治疗1 d达峰值〔两组分别为(654.23±63.24)、(630.32±49.11)ng/L〕,以后逐渐降低,治疗7 d达谷值,且中药治疗组的降低程度较常规治疗组更明显(ng/L:262.21±30.89比375.43±44.43,P<0.05),但中药治疗组IFABP水平仍明显高于对照组(ng/L:262.21±30.89比158.95±29.34,P<0.05).结论凉膈散能有效提升机械通气合并AGI患者的血清瓜氨�Objective To observe the effects of Lian ggesa n on serum citrulline and in testinal fatty acid Hindi ng protein(IFABP)levels in patients with mechanical ventilation and acute gastrointestinal injuiy(AGI).Methods Eighty patients with mechanical ventilation and AGI admitted to Tianjin First Center Hospital from May to December 2017 were divided into a conventional treatment group and a traditional Chinese medicine(TCM)treatment group according to different treatment methods,40 cases in each group;10 patients with mechanical ventilation but without AGI were selected as a control group.All patients were given invasive mechanical ventilation after admission,and the gastrointestinal tract intervention was carried out according to AGI grading treatment process;Lianggesan(compositions:forsythia suspensa 30 g,Scutellaria 10 g,gardenia 10 g.ham boo leaf 10 g,rhubarb 10 g,mint 6 g,mirabilite 6 g,licorice 15 g)was added to the TCM treatment group on the Basis of the conventional treatment.The above TCM drug used was a single Chinese medicine granule produced by Jiangyin Tianjiang Pharmaceutical Co.,Ltd.Each single Chinese herbal granule was proportionally poured into 200 mL boiling water at 80-100℃,100 mL each time,twice daily nasal feeding for one week.The changes of senim citmlline and IFABP levels were observed before and 1,3.5 anH 7 days after treatment in the three groups.Results Before treatment,senim citmlline levels in the conventional treatment group and the TCM treatment group were significantly lower than those in the control group(|imol/L:19.84±4.74,20.84±4.65 vs.28.89±2.18,both P<0.05),and IFABP levels were significantly higher than those in the control group(ng/L:571.89±42.89,552.49±44.78 vs.155.68±22.95,both P<0.05).there were no significant differences Between the conventional treatment group and the TCM treatment group(P>0.05);with the extension of treatment time,the levels of citmlline in the conventional and TCM treatment groups were decreased first and then increased gradually,reaching the valley

关 键 词：凉膈散 机械通气 急性胃肠功能损伤 瓜氨酸 肠型脂肪酸结合蛋白 

分 类 号：R472.9[医药卫生—护理学]