莱菔承气汤联合谷氨酰胺治疗脓毒症继发麻痹性肠梗阻的临床研究  

Clinical study on Radish Seed Chengqi Decoction combined with glutamine for treatment of patients with septic secondary paralytic ileus

作　　者：王桐 李望[1] 齐安龙[2] 刘艳存[2] Wang Tong;Li Wang;Qi Anlong;Liu Yancun(National Health Commission(NHC)Key Laboratory of Hormones and Development,Tianjin Key Laboratory of Metabolic Diseases,Tianjin Medical University Chu Hsien-I Memorial Hospital&Tianjin Institute of Endocrinology,Tianjin 300134,China;Department of Emergency Medicine,Tianjin Medical University General Hospital,Tianjin 300052,China)

机构地区：[1]国家卫生健康委员会激素与发育重点实验室,天津市代谢性疾病重点实验室,天津医科大学朱宪彝纪念医院﹠天津市内分泌研究所,300134 [2]天津医科大学总医院急诊医学科,300052

出　　处：《中国中西医结合急救杂志》2019年第5期516-519,共4页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：国家自然科学青年基金(81601714);天津医科大学朱宪彝纪念医院科研基金(2018ZXY02)。

摘　　要：目的观察莱菔承气汤联合谷氨酰胺治疗脓毒症并发麻痹性肠梗阻患者的临床疗效.方法选择天津医科大学总医院急诊重症医学科(EICU)2017年8月至2019年1月收治的脓毒症继发麻痹性肠梗阻患者60例.以采用常规西医综合治疗及谷氨酰胺部分肠外营养等对症治疗的30例患者为单纯西医治疗组;以在常规综合治疗基础上加用莱菔承气汤的30例患者为莱菔承气汤治疗组,莱菔承气汤组成:大黄24 g(后下)、芒硝15 g(冲服)、厚朴15 g、枳壳10 g、木香10 g、怀牛膝10 g、莱菔子15 g,给药剂量每日2剂,每剂加工成药液200 mL,分别鼻饲和灌肠保留,每日2次,每次100 mL,疗程为7 d.观察两组治疗后ICU存活率、临床疗效及降钙素原(PCT)水平的变化.结果莱菔承气汤组治疗后临床总有效率明显高于单纯西医治疗组为〔83.33% (25/30)比66.67%(20/30),P<0.05〕,治疗7 d ICU存活率也明显高于单纯西医治疗组〔90.00%(27/30)比76.67%(23/30),P<0.05〕.两组治疗后PCT(μg/L)水平均较治疗前明显降低(单纯西医治疗组:3.38±1.72比6.43±3.29,莱菔承气汤治疗组:2.39±1.24比6.78±2.31,均P<0.05),且以莱菔承气汤治疗组的降低程度较单纯西医治疗组更显著(μg/L :2.39±1.24比3.38±1.72,P<0.05).结论莱菔承气汤联合谷氨酰胺用于治疗脓毒症并发麻痹性肠梗阻患者能显著改善临床相关症状,降低患者PCT水平,提高存活率.Objective To investigate the therapeutic effect of Radish Seed Chengqi Decoction combined with glutamine for treatment of patients with sepsis complicated with paralytic ileus. Methods Sixty patients with septic ileus admitted to the Department of Emergency Intensive Care Unit (EICU) of Tianjin Medical University General Hospital from August 2017 to January 2019 were enrolled. The Western medicine treatment group (30 cases) received routine Western medical methods including intravenous drip of glutamine, etc. for symptomatic treatment, and the Radish Seed Chengqi Decoction group (30 cases), based on the treatment in the Western medicine group, were additionally given the decoction by nasal feeding and retention enema twice a day, once 100 mL with the course of 7 days in both groups. The herbal prescription of Radish Seed Chengqi Decoction contained rhubarb 24 g (decocted later), sodium sulfate 15 g (mixed with water to take), magnoliae cortex 15 g, orange frui 10 g, aucklandiae 10 g, henan achyranthes root 10 g and radish seed 15 g, constituting one dose, two doses one day given to a patient, making one dose of herbal medicine to 200 mL of decoction for nasal feeding and retention enema, once 100 mL respectively, twice a day for 7 days. After treatment, the changes of survival rate in ICU, the total effective rate and the level of procalcitonin (PCT) were observed in both groups. Results After treatment, the total effective rate in Radish Seed Chengqi Decoction group was significantly higher than that in the Western medicine treatment group [83.33% (25/30) vs. 66.67% (20/30), P < 0.05], and the ICU 7-day survival rate in Radish Seed Chengqi Decoction group was also significantly higher than that in Western medicine treatment group [90.00% (27/30) vs. 76.67% (23/30), P < 0.05]. After treatment, the levels of PCT (μg/L) in both groups were significantly decreased compared with those before the treatment (Western medicine treatment group: 3.38±1.72 vs. 6.43±3.29, and Radish Seed Chengqi Decoction group: 2.39±1.2

关 键 词：莱菔承气汤 谷氨酰胺 脓毒症 肠麻痹 

分 类 号：R25[医药卫生—中医内科学]