通腑降浊方联合常规治疗对脓毒症患者消化道症状、营养状况、胃肠动力学的影响  

Effect of Tongfu Jiangzhuo Prescription Combined with Conventional Treatment on Gastrointestinal Symptoms,Nutritional Status,and Gastrointestinal Dynamics in Septic Patients

作　　者：施保柱 杨明华 董妍 许梅 董旭[1] 王雷[1] 刘源 李岩涛[1] SHI Baozhu;YANG Minghua;DONG Yan;XU Mei;DONG Xu;WANG Lei;LIU Yuan;LI Yantao(Department of Critical Care Medicine,Chinese Medicine Hospital of Hebei Province,Shijiazhuang 050011 Hebei,China)

机构地区：[1]中医院重症医学科,河北省中医院,河北省石家庄050011

出　　处：《中药新药与临床药理》2021年第5期727-732,共6页Traditional Chinese Drug Research and Clinical Pharmacology

基　　金：河北省中医药管理局科研计划项目(2019048)。

摘　　要：目的观察通腑降浊方联合常规治疗对脓毒症患者消化道症状、营养状况、胃肠动力学的影响。方法选取河北省中医院2017年4月至2020年4月收治的脓毒症105例患者按随机数字表法分为对照组(52例)和观察组(53例)。对照组给予抗感染、血管活性药物等常规治疗,观察组在常规治疗的基础上联用通腑降浊方治疗,疗程为7 d。观察2组患者治疗前后消化道症状改善情况[急性生理与慢性健康评价系统Ⅱ(APACHEⅡ)评分、全身炎症反应综合征(SIRS)评分]、营养状况[血红蛋白(Hb)、白蛋白(ALB)、前白蛋白(PA)]、胃肠动力学[胃泌素(GAS)、生长抑素(SS)、胃动素(MOT)]水平、炎症反应指标[高敏C反应蛋白(hs-CRP)、肿瘤坏死因子α(TNF-α)、降钙素原(PCT)]、免疫功能指标[免疫球蛋白A(IgA)、IgM、IgG]水平变化及不良反应发生情况。结果(1)治疗后观察组反流呕吐消失时间、肠鸣音恢复时间少于对照组(P<0.05),每天排便次数多于对照组(P<0.05);(2)2组患者治疗3 d、7 d后APACHEⅡ评分和SIRS评分均较治疗前明显降低(P<0.05),且观察组对消化道症状改善效果优于对照组(P<0.05);(3)2组患者治疗7 d后血清Hb、ALB、PA水平高于治疗前(P<0.05),且观察组营养状况优于对照组(P<0.05);(4)2组患者治疗3 d、7 d后血清GAS水平低于治疗前(P<0.05),SS、MOT水平高于治疗前(P<0.05),且观察组对各胃动力学指标的改善效果优于对照组(P<0.05);(5)2组患者治疗3 d、7 d后的血清hs-CRP、TNF-α、PCT水平低于治疗前(P<0.05),且观察组降低hs-CRP、TNF-α、PCT水平明显优于对照组(P<0.05);(6)2组患者治疗3 d、7 d后的血清IgA、IgM水平高于治疗前(P<0.05),且观察组的血清IgA、IgM水平高于对照组(P<0.05);(7)2组患者在治疗过程中均无不良反应发生。结论通腑降浊方联合常规治疗能进一步改善脓毒症患者的消化道症状、营养状况、胃肠动力学,安全性高。Objective To observe the effect of Tongfu Jiangzhuo prescription combined with conventional treatment on the gastrointestinal symptoms,nutritional status and gastrointestinal dynamics in septic patients.Methods105 patients with sepsis admitted to Chinese Medicine Hospital of Hebei Province from April 2017 to April 2020 were selected and divided into control group(52 cases)and observation group(53 cases)according to random number table method.The control group was given conventional treatment,such as anti-infection and vasoactive drugs,and the observation group was given Tongfu Jiangzhuo prescription on the basis of conventional treatment.The treatment was continued for 7 d.The improvement of gastrointestinal symptoms[Acute Physiology and Chronic Health Evaluation SystemⅡ(APACHEⅡ)score,Systemic Inflammatory Response Syndrome(SIRS)score],nutritional status[hemoglobin(Hb),albumin(ALB),prealbumin(PA)],gastrointestinal dynamics[gastrin(GAS),somatostatin(SS),motilin(MOT)]levels,inflammatory response indexes[high-sensitivity C-reactive protein(hs-CRP),tumor necrosis factor-α(TNF-α),procalcitonin(PCT)],immune function indexes[immunoglobulin A(IgA),IgM,IgG]levels before and after treatment,and the occurrence of adverse reactions were observed between the two groups.Results(1)After treatment,the disappearance time of reflux vomiting and recovery time of intestinal sounds in the observation group were less than those in the control group(P<0.05),and the frequency of defecation per day was more than that in the control group(P<0.05).(2)At 3 d,7 d after treatment,APACHEⅡscore and SIRS score of 2 patient groups decreased significantly compared with that before treatment(P<0.05),and the improvement of gastrointestinal symptoms in observation group was better than that of control group(P<0.05).(3)After 7 days of treatment,serum Hb,ALB and PA levels in 2 groups were higher than those before treatment(P<0.05),and nutritional status in observation group was better than that in control group(P<0.05).(4)After 3 and 7 days of

关 键 词：脓毒症 通腑降浊方 病情程度 炎症 营养 免疫功能 胃肠动力 

分 类 号：R285.6[医药卫生—中药学]