加味薏苡附子败酱散对脓毒症急性胃肠损伤(湿热内蕴证)的保护作用研究  

Clinical Study on the Protective Effect of Jiawei Yiyi Fuzi Baijiang Powder on Acute Gastrointestinal Injury of Internal Retention of Damp-heat Sepsis with Acute Intestinal Injury

作　　者：王泽田 王丹 吴春荣[1] 徐丹[1] 齐越 孙科远 王余民[1] 唐建国[1] Wang Zetian;Wang Dan;Wu Chunrong;Xu Dan;Qi Yue;Sun Keyuan;Wang Yumin;Tang Jianguo(Shanghai Fifth People'&Hospital Affiliated to Fudan University,Shanghai 200240,China)

机构地区：[1]复旦大学附属上海市第五人民医院,上海200240

出　　处：《中国中医急症》2022年第3期399-402,407,共5页Journal of Emergency in Traditional Chinese Medicine

基　　金：上海市卫计委卫生健康委员会中医药科研项目(ZHYY-ZXYJHZX-201903);复旦大学附属上海市第五人民医院院级重点专科建设(2020WYZDZK06)。

摘　　要：目的探究加味薏苡附子败酱散对湿热内蕴型脓毒症患者急性胃肠损伤的保护作用。方法将脓毒症急性胃肠损伤且中医辨证为湿热内蕴型患者160例分为中西医结合组和西医治疗组各80例,比较两组治疗前、治疗第7日、第14日的急性胃肠损伤分级(AGI)、急性生理学及慢性健康状况评分系统(APACHEⅡ)评分、中医症状评分、胃动素(MTL)、胃泌素(GAS)、D-乳酸、免疫球蛋白G(IgG)、免疫球蛋白A(IgA)、T淋巴细胞亚群(CD3+、CD4+/CD8+)、前白蛋白及中医症状评分。结果治疗前,两组AGI、APACHEⅡ、中医症状评分、MTL、GAS、D-乳酸、IgG、IgA、CD3+、CD4+/CD8+、前白蛋白差异无统计学意义(P>0.05),治疗第7日、第14日,两组GAS、D-乳酸、AGI分级、APACHEⅡ、中医症状评分均明显降低(P<0.05),MTL、IgG、IgA、CD3+、CD4+/CD8+、前白蛋白均明显升高(P<0.05);与西医治疗组比,中西医结合组GAS、D-乳酸、AGI分级、APACHEⅡ评分均明显降低(P<0.05),MTL、IgG、IgA、CD3+、CD4+/CD8+、前白蛋白均明显升高(P<0.05)。中西医结合组的总有效率高于西医治疗组,差异有统计学意义(P<0.05)。治疗期间,两组均无死亡案例,无明显的不良反应。结论在常规西医治疗的基础上给予加味薏苡附子败酱散可明显改善湿热内蕴型脓毒症患者急性肠道损伤的中医症状,可能与加味薏苡附子败酱散降低改善胃肠功能、增强免疫、改善营养状态有关。Objective:To explore the protective effect of Jiawei Yiyi Fuzi Baijiang Powder on acute gastrointestinal injury in internal retention of damp-heat sepsis with acute intestinal injury.Methods:A total of 160 patients with sepsis and acute gastrointestinal injury diagnosed with internal retention of damp-heat in TCM were collected as the research objects and divided into 80 cases of integrated traditional Chinese and western medicine group and80 cases of western medicine treatment group,according to the different treatment methods.The acute gastrointestinal injury classification(AGI),acute physiology and chronic health evaluationⅡ(APACHEⅡ),TCM symptom score,motilin(MTL),gastrin(GAS),D-lactic acid,immunoglobulin G(IgG),immunoglobulin A(IgA),T lymphocyte subgroups(CD3+,CD4+/CD8+),prealbumin before treatment,7 days and 14 days after treatment were compared between the two groups.The TCM effect was compared between the two groups after treatment.Results:Before treatment,the AGI,APACHEⅡ,TCM symptoms scores,MTL,GAS,D-lactate,IgG,IgA,CD3+,CD4+/CD8+,albumin of the two groups were not statistically different(P>0.05).At 7 days and 14 days after treatment,the GAS,D-lactic acid,AGI,APACHEⅡ,TCM symptom scores in the two groups were significantly reduced(P<0.05);the levels of MTL,IgG,IgA,CD3+,CD4+/CD8+,prealbumin in the two groups were all significantly increased(P<0.05).Compared with the western medicine treatment group,the GAS,D-lactic acid,AGI,APACHEⅡand TCM symptom scores were significantly reduced in the integrated traditional Chinese and western medicine group(P<0.05),and the levels of MTL,IgG,IgA,CD3+,CD4+/CD8+,and prealbumin were all significantly increased in the integrated traditional Chinese and western medicine group(P<0.05).The effective rate in the integrated traditional Chinese and western medicine group was higher than that of the western medicine treatmentgroup(P<0.05).During the treatment period,there were no deaths and no obvious adverse reactions in the twogroups.Conclusion:On the basis of convention

关 键 词：脓毒症 急性胃肠损伤 薏苡附子败酱散 湿热内蕴型 

分 类 号：R631[医药卫生—外科学]