加味宣白承气汤治疗重症肺炎合并急性胃肠损伤的临床研究  

Clinical Study on the Treatment of Severe Pneumonia Combined with Acute Gastrointestinal Injury by Supplemented Xuanbai Chengqi Decoction

作　　者：何金波[1] 毛峥嵘[1] 宋鹏阳 HE Jin-bo;MAO Zheng-rong;SONG Peng-yang(The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou 450000, China)

机构地区：[1]河南中医药大学第一附属医院,河南郑州450000

出　　处：《南京中医药大学学报》2022年第2期103-108,共6页Journal of Nanjing University of Traditional Chinese Medicine

基　　金：河南省中医药科学研究专项课题(2018ZY1002)。

摘　　要：目的评价加味宣白承气汤治疗重症肺炎合并急性胃肠损伤(Acute gastrointestinal injury,AGI)的临床疗效。方法采用随机对照研究,将76例重症肺炎合并AGI住院患者随机分成对照组和治疗组各38例,对照组给予西医常规治疗,包括积极治疗原发病和合并疾病、尽早给予肠内营养、胃肠动力药等,治疗组在对照组治疗基础上联用加味宣白承气汤鼻饲给药,疗程均为7 d。治疗前及治疗7 d评估2组患者临床疗效;治疗前及治疗3 d、治疗7 d检测胃肠功能指标变化[胃肠功能衰竭(Gastrointestinal failure,GIF)评分、肠内营养日喂养量和腹内压力(Intraabdominal pressure,IAP)],ELISA法检测患者血清胃动素(Motilin,MTL)水平及二胺氧化酶(Diamine oxidase,DAO)活性;记录患者住院期间机械通气时间、ICU住院时间及28 d病死率。结果治疗后,治疗组总有效率优于对照组(P<0.05);治疗组GIF、肠内营养日喂养量、IAP显著改善(P<0.01),治疗组治疗7 d GIF、肠内营养日喂养量、IAP改善优于对照组(P<0.05);治疗3 d、治疗7 d 2组患者血清MTL水平、DAO活性均显著升高(P<0.01),治疗组治疗3 d、治疗7 d MTL水平显著高于对照组(P<0.05,P<0.01);治疗组机械通气时间、ICU住院天数均明显少于对照组(P<0.01);2组患者28 d病死率比较无显著性差异(P>0.05)。结论加味宣白承气汤能有效改善重症肺炎合并AGI患者的胃肠功能,缩短ICU住院时间,促进患者康复。OBJECTIVE To evaluate the clinical efficacy of Supplemented Xuanbai Chengqi Decoction in the treatment of severe pneumonia combined with acute gastrointestinal injury(AGI).METHODS In a randomized controlled study,76 patients with severe pneumonia combined with AGI were randomly divided into the control group and the treatment group,38 patients in each group.The control group was given conventional western medical treatment,including active treatment of protopathy and complicating disease.In addition,early administration of enteral nutrition and gastrointestinal excitomotor were given in the group.The patients in the treatment group were treated with supplemented Xuanbai Chengqi Decoction intranasally on top of the treatments in the control group.The course of treatment was 7 days and the clinical efficacy of the two groups was evaluated before treatment and 7 days after treatment.The changes of gastrointestinal function indexes[Gastrointestinal failure(GIF)score,enteral nutrition daily feeding amount and intraabdominal pressure(IAP)]were measured before treatment,3 and 7 days after the treatment separately.Motilin(MTL)levels and diamine oxidase(DAO)activity were measured by ELISA.Besides,the duration of mechanical ventilation,ICU stay length and 28-d mortality rate were recorded.RESULTS After treatment,the total effective rate of the treatment group was better than that of the control group(P<0.05).The GIF,enteral nutrition daily feeding amount and IAP of the treatment group significantly improved(P<0.01).However,the GIF,enteral nutrition daily feeding amount and IAP of the treatment group showed better results than those of the control group after 7 days of treatment(P<0.05).In addition,the serum MTL level and DAO activity were significantly increased in both groups after 3 and 7 days of treatment(P<0.01).However,the MTL levels in the treatment group were significantly higher than those in the control group after 3 and 7 days of treatment(P<0.05,P<0.01).The duration of mechanical ventilation and ICU stay length

关 键 词：重症肺炎 急性胃肠损伤 加味宣白承气汤 胃动素 二胺氧化酶 

分 类 号：R256.11[医药卫生—中医内科学]