胃肠复元法治疗脓毒症胃肠功能障碍的临床研究  

Weichang Fuyuan Therapy for the Treatment of Gastrointestinal Dysfunction in Sepsis Patients: a Clinical Study

作　　者：曹迎[1] 刘琳[1] 石嘉恒 赵丹[3] 彭伟[1] 张红升[1] 范圣凯[1] 裴晓璐[1] 吴彦青[1] 曲志成[1] 姚卫海[1] CAO Ying;LIU Lin;SHI Jia-heng;ZHAO Dan;PENG Wei;ZHANG Hong-sheng;FAN Sheng-kai;PEI Xiao-lu;WU Yan-qing;QU Zhi-cheng;YAO Wei-hai(Department of Emergency,Beijing Hospital of Traditional Chinese Medicine,Capital Medical University,Beijing,100010;Department of ICU,Guangfan men Hospital,China Academy of Chinese Medical Sciences,Beijing,100053;Department of ICU,Xiyuan Hospital,China Academy of Chinese Medical Sciences,Beijing,100091)

机构地区：[1]首都医科大学附属北京中医医院急诊科,北京100010 [2]中国中医科学院广安门医院ICU,北京100053 [3]中国中医科学院西苑医院ICU,北京100091

出　　处：《中国中西医结合杂志》2019年第8期943-948,共6页Chinese Journal of Integrated Traditional and Western Medicine

基　　金：北京市中医药科技项目(No.JJ2014-24)

摘　　要：目的评价胃肠复元法治疗脓毒症胃肠功能障碍的临床疗效。方法将60例脓毒症胃肠功能障碍评分≤2分患者随机分为试验组和对照组,每组30例。对照组给予脓毒症常规治疗,试验组在脓毒症常规治疗方案基础上,加用胃肠复元法治疗(胃肠复元汤口服或鼻饲,每次100 mL,每日3次,以及中药直肠滴注每日1次)。两组疗程均为14日。观察两组终点事件(死亡、麻痹性肠梗阻或应激溃疡出血)发生率及相对危险度(RR);比较两组治疗前后脓毒症胃肠功能障碍评分、序贯器官衰竭评估评分(SOFA)、急性生理与慢性健康评分Ⅱ(APACHEⅡ),血浆瓜氨酸(CIT)、血清二胺氧化酶(DAO)、D-乳酸(DLA)、和肽素(CPP)、纤维母细胞生长因子-23(FGF-23)、Toll样受体4(TLR4)水平变化。结果试验组11例(36.7%)患者在试验期间发生终点事件,对照组20例(66.7%)患者在试验期间发生终点事件。终点事件的RR为1.900(95%CI 1.070~3.375),死亡的RR为1.042(95%CI 0.819~1.324),麻痹性肠梗阻或应激性溃疡出血的RR为1.500(95%CI 1.026~2.192)。与本组治疗前比较,试验组治疗后脓毒症胃肠功能障碍评分降低,CIT水平升高(P<0.05),两组SOFA评分、APACHEⅡ评分、DAO、DLA、CPP、TLR4水平均降低(P<0.05);治疗后与对照组比较,试验组脓毒症胃肠功能障碍评分降低(P<0.05),CIT水平升高(P<0.05),DAO、DLA、TLR4水平亦降低(P<0.05)。结论胃肠复元法可降低脓毒症患者胃肠功能障碍评分,减少患者出现麻痹性肠梗阻或应激性溃疡出血的风险,其机制可能与升高CIT,降低DAO、DLA、TLR4水平有关。Objective To evaluate the clinical efficacy of Weichang Fuyuan Therapy(WFT)in the treatment of gastrointestinal dysfunction in sepsis patients.Methods Totally 60 sepsis patients with gastrointestinal dysfunction were randomly assigned to experimental group and control group,30 in each group.The gastrointestinal dysfunction score of the included patients was less than or equal to two.Patients in the control group received routine therapy.Those in the experimental group received routine therapy and WFT,Weichang Fuyuan Decoction was taken through oral or nasal feeding,100 mL each time and three times a day,and received rectal drip-irrigation of Chinese medicine once a day.All treatment lasted for 14 days.The incidences of endpoint events(including death,paralytic ileus or stress ulcer bleeding)and relative risk(RR)were observed in both groups.Gastrointestinal dysfunction score,Sepsis Related Organ Failure Assessment(SOFA),acute physiology and chronic health evaluationⅡ(APACHEⅡ),citrulline(CIT),diamine oxidase(DAO),D-lactic acid(DLA),Copeptin(CPP),fibroblast growth factor-23(FGF-23),and Toll-like receptor 4(TLR4)were compared before and after treatment.Results Endpoint events occurred in 11 patients of experimental group(36.7%)and 20 patients of control group(66.7%)during the trial.RR of endpoint was 1.900(95%CI 1.070-3.375),RR of death was 1.042(95%CI 0.819-1.324),RR of paralytic ileus or stress ulcer bleeding was 1.500(95%CI 1.026-2.192).Compared with the same group before treatment,the gastrointestinal dysfunction score decreased(P<0.05)and CIT increased(P<0.05)in the experimental group.SOFA score,APACHEⅡscore,and the content of DAO,DLA,CPP and TLR4 all decreased in both groups(P<0.05).Compared with the control group,gastrointestinal dysfunction score decreased(P<0.05),CIT increased(P<0.05),the content of DAO,DLA,TLR4 decreased(all P<0.05)in the experiment group.ConclusionsWFT reduces gastrointestinal dysfunction score and decreases risk of paralytic ileus and stress ulcer bleeding in sepsis patients with ga

关 键 词：胃肠复元法 脓毒症 胃肠功能障碍 

分 类 号：R47[医药卫生—护理学]