电针上巨虚联合通腑益气汤敷脐对脓毒症患者肠屏障功能的影响  

The effect of electroacupuncture on Shangjuxu combined with Tongfu Yiqi Decoction on the intestinal barrier function of the patients with sepsis

作　　者：庞丽莎 孟建标[1] 季春莲[1] 张微[1] 徐敏荣 胡马洪[1] PANG Lisha;MENG Jianbiao;JI Chunlian;ZHANG Wei;XU Minrong;HU Mahong(ICU,Tongde Hospital of Zhejiang Province,Hangzhou 310010,China)

机构地区：[1]浙江省立同德医院ICU,浙江杭州310010

出　　处：《中国现代医生》2020年第34期9-13,共5页China Modern Doctor

基　　金：浙江省中医药科技计划项目(2018ZB034)。

摘　　要：目的探讨电针上巨虚联合通腑益气汤敷脐对脓毒症患者在调节肠道功能、保护肠黏膜屏障功能以及改善预后等方面的影响。方法选择2015年9月~2019年6月入住浙江省立同德医院重症医学科的60例脓毒症肠功能障碍患者,将其随机分为治疗组与对照组,每组各30例。对照组采用常规抗感染、促进胃肠动力、调节肠道菌群等治疗,而治疗组在对照组的基础上加用电针上巨虚联合通腑益气汤敷脐治疗7 d。观察两组治疗前后第1、3、7天的PCT、IL-6、D-乳酸、DAO以及肠鸣音、IAP的变化,同时记录两组患者机械通气时间、ICU停留时间及28 d死亡率,并对炎症因子及肠屏障血清标志物水平进行相关性分析。结果与治疗前相比,两组患者治疗后第1天炎症因子水平及肠屏障功能血清标志物水平比较,差异无统计学意义(P>0.05);而治疗第3、7天后,治疗组患者炎症因子及肠屏障功能血清标志物水平明显下降(P<0.05),肠鸣音及IAP水平较治疗前改善(P<0.05)。治疗组患者ICU停留时间及机械通气时间明显缩短(P<0.05);与本组治疗前比较,治疗后两组第3、7天患者炎症因子及肠屏障功能血清标志物水平明显下降(P<0.05),肠鸣音及IAP较治疗前改善(P<0.05)。患者血清炎症因子水平与D-乳酸、DAO、IAP及肠鸣音水平呈正相关(P<0.05),D-乳酸、DAO、IAP及肠鸣音水平与机械通气时间、ICU停留时间呈正相关(P<0.05)。结论电针上巨虚联合通腑益气汤敷脐可能通过抑制脓毒症患者炎症反应,改善肠黏膜屏障损伤情况,从而改善肠功能,促进脓毒症肠功能障碍患者早期恢复。Objective To explore the effect of electroacupuncture on Shangjuxu(ST37)combined with Tongfu Yiqi decoction applied to umbilicus on the regulation of the intestinal function,the protection of the intestine mucosal barrier function and the improvement of the prognosis of the patients with sepsis.Methods A total of 60 patients with the sepsis and intestinal dysfunction hospitalized in ICU of Tongde Hospital of Zhejiang Province from September 2015 to June 2019 were selected and randomly divided into the treatment group and the control group,with 30 patients in each group.The control group was treated with conventional anti-infection,promotion of gastrointestinal motility and regulation of intestinal flora,etc.,while the treatment group was treated with electroacupuncture on Shangjuxu combined with Tongfu Yiqi Decoction applied to umbilicus for 7 d on the basis of the control group.The changes of PCT,IL-6,D-lactic acid,DAO,intestinal sound and IAP on the 1st,3rd and 7th d before and after treatment in the two groups were observed.Meanwhile,the mechanical ventilation time and ICU hospitalization time and the death rate of 28 d between the two groups of patients were recorded,and the correlation analysis of the levels of inflammatory factors and serum markers of intestinal barriers was carried out.Results When a comparison was made with the control group,there was no significant statistical difference in the levels of inflammatory factors and serum markers of the intestinal barrier function between the two groups on the 1st d after treatment(P>0.05),while on the 3rd and 7th d after treatment,the levels of inflammatory factors and serum markers of the intestinal barrier function in the treatment group significantly decreased(P<0.05),and the levels of intestinal sound and IAP were improved when compared with those before treatment(P<0.05).The duration of ICU stay and the mechanical ventilation time in the treatment group were shorter(P<0.05);within the same group,compared with those before treatment,the levels of inflam

关 键 词：上巨虚 通腑益气汤 脓毒症 肠屏障功能 

分 类 号：R459.7[医药卫生—急诊医学]