从气虚腑实证谈脓毒症的胃肠功能障碍机制  

The Relationship between main Mechanism of Gastrointestinal Dysfunction in sepsis and Qi Deficiency with Fu-viscera Excess

作　　者：张庆[1] 刘清泉[2] 蔡阳平[1] ZHANG Qing;LIU Qingquan;CAI Yangping(Intensive Care Unit,Tongzhou district of Dongzhimen Hopitial,Beijing University of Traditional Chinese Medicine,Beijing 101121,China)

机构地区：[1]北京中医药大学东直门医院通州院区重症监护室,101121 [2]首都医科大学附属北京中医医院

出　　处：《环球中医药》2020年第6期993-997,共5页Global Traditional Chinese Medicine

基　　金：北京市通州区科技计划项目(KJ2019CX008)。

摘　　要：胃肠功能障碍在脓毒症的发生发展中扮演重要角色。“正气虚于一时,邪气突盛而爆发”是脓毒症的病因,内外毒邪交织累及脾胃与肠道,脾胃失升降、肠失传化导致胃肠功能障碍。肠道机械屏障损伤、免疫屏障紊乱、生物屏障失调是脓毒症胃肠功能障碍发生发展的主要机制,三种屏障损伤和肠道炎症反应、氧化应急反应、微循环障碍互为因果形成恶性循环。中医认为脾气充足与否和肠道免疫功能、生物屏障的生理和病理状态相似,机械屏障损伤致脾胃失升降、肠失传化、局部病理产物堆积与脾气虚腑气不通相吻合,同时益气通腑法的疗效,人参和大黄对三种屏障的保护机制是为佐证,再有性苦寒的抗生素和大量液体输注均可损伤脾胃,因此脓毒症胃肠功能障碍的产生机制符合中医气虚腑实的辨证。Gastrointestinal dysfunction plays an important role in the occurrence and development of sepsis.“The righteous qi deficient for a while,the evils bursts out”is the cause of sepsis.Internal and external toxic evils accumulate in the spleen and gastrointestinal tract which cause gastrointestinal dysfunction.The main mechanisms for the development of gastrointestinal dysfunction in sepsis are Intestinal mechanical barrier is damaged,immune barrier and biological barrier are disorder,well,lead to a vicious circle.Traditional chinese medicine believes Spleen-stomach weakness is similar to disordered intestinal immune and biological barrier.The spleen can not send the clear upward and the stomach miss passing the turbid downward,The large intestine loses the funtion of discharging wastes which cause difficult bowel movement and local accumulated Pathological products belong to qi deficiency with fu-viscera excess.Qi-reinforcing and purgation are clinically use generally,ginseng and rhubarb root and rhizome improving intestineal barrier function have been discovered,ginseng stands for Qi-reinforcing durg,rhubarb root and rhizome is representative of purgation durg.Also,antibiotics and large fluid infusions can damage the function of spleen and stomach.Therefore,the mechanism of gastrointestinal dysfunction in sepsis can be explained by the Traditional Chinese medicine Qi Deficiency with Fu-viscera Excess.

关 键 词：脓毒症胃肠功能障碍机制 气虚腑实证 脾失升清 胃失降浊 肠失传导 

分 类 号：R249[医药卫生—中医临床基础]