子午流注择时应用清瘟败毒饮合凉膈散加减通腑治疗脓毒症胃肠功能障碍(热毒炽盛证)的临床研究  

Clinical Study of Qingwen Baidu Decoction and Liange San Freeing the Bowels according to Midnightnoon Ebb-flow on Gastrointestinal Dysfunction in Sepsis with Syndrome of Heat-toxicity

作　　者：李明雁[1] 沈云霞[1] 万青[1] 李春娥[1] 张晓琳[1] Li Mingyan;Shen Yunxia;Wan Qing;Li Chun′e;Zhang Xiaolin(Kunming Municipal Hospital of Traditional Chinese medicine,Yunnan,Kunming 650011,China)

机构地区：[1]云南省昆明市中医医院,云南昆明650011

出　　处：《中国中医急症》2020年第8期1407-1410,共4页Journal of Emergency in Traditional Chinese Medicine

基　　金：昆明市科技局科技计划重点项目(2019-1-S-25318000001369)。

摘　　要：目的探讨子午流注择时应用清瘟败毒饮合凉膈散加减通腑对脓毒症胃肠功能障碍(热毒炽盛证)的临床疗效。方法选取脓毒症患者共116例按随机数字表法分为对照组和观察组各58例。两组患者按指南予西医常规治疗;对照组加予清瘟败毒饮合凉膈散加减通腑,时间不固定,每日1剂;观察组依子午流注择时通腑(卯时灌肠、未时灌胃)。两组疗程均为2周。比较两组胃肠功能障碍评分、急性生理和慢性健康状况评分(APACHEⅡ)、序贯器官衰竭评估(SOFA)、肠鸣音评分、腹腔压力、临床疗效以及血清超敏反应蛋白(hs-CRP)和降钙素原(PCT)水平。结果治疗后,观察组患者的胃肠功能障碍、APACHEⅡ评分、SOFA评分、肠鸣音评分以及腹腔压力显著低于对照组(P<0.01);观察组的总有效率显著高于对照组(P<0.05);治疗后,观察组患者血清hs-CRP和PCT水平显著低于对照组(P<0.01)。结论子午流注择时应用清瘟败毒饮合凉膈散加减通腑能改善脓毒症(热毒炽盛证)患者的胃肠功能障碍,提高临床疗效。其机制可能与治疗抑制炎症反应有关。Objective:To investigate the efficacy of Qingwen Baidu Decoction and Liange San freeing the bowels according to midnight-noon ebb-flow on gastrointestinal dysfunction in sepsis with syndrome of heat-toxicity.Methods:116 patients were randomly divided into the control group and the observation group,58 cases in each.Both groups received routine Western medicine treatment according to the guidelines.The control group was treated by Qingwen Baidu Decoction and Liange San freeing the bowels with unfixed time.The observation group was treated according to midnight-noon ebb-flow(enema at Chen Time,gavage at Wei Time).Both groups were treated for 2 weeks.Scores of gastrointestinal dysfunction,APACHEⅡ,SOFA,bowel sounds,abdominal pressure,the clinical curative effect and serum levels of hs-CRP and PCT were compared in two groups.Results:After treatment,scores of gastrointestinal dysfunction,APACHEⅡ,SOFA,bowel sounds and abdominal pressure in the observation group were significantly lower than those of the control group(P<0.01).The total effective rate of the observation group was significantly higher than that of the control group(P<0.05).After treatment,serum levels of hsCRP and PCT in the observation group were significantly lower than those in the control group(P<0.01).Conclusion:Qingwen Baidu Decoction and Liange San freeing the bowels according to midnight-noon ebb-flow can improve the gastrointestinal dysfunction of sepsis patients with syndrome of heat-toxicity,increase the efficacy,and its inhibition of inflammatory response may be related to the efficacy.

关 键 词：脓毒症 子午流注 清瘟败毒饮 凉膈散 热毒炽盛证 胃肠功能 

分 类 号：R459.7[医药卫生—急诊医学]