牛黄承气汤治疗重型颅脑损伤患者急性胃肠损伤的疗效及对血清MTL、DAO、NSE水平影响  

Clinical Efficacy of Niuhuang Chengqitang in Treatment of Acute Gastrointestinal Injury in Patients with Severe Traumatic Brain Injury and Its Effect on MTL,DAO,and NSE

作　　者：何金波[1] 毛峥嵘[1] 艾莘 HE Jinbo;MAO Zhengrong;AI Shen(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,郑州450000

出　　处：《中国实验方剂学杂志》2022年第24期131-137,共7页Chinese Journal of Experimental Traditional Medical Formulae

基　　金：河南省中医药科学研究专项(2018ZY1002)。

摘　　要：目的:评价牛黄承气汤治疗重型颅脑损伤(sTBI)患者急性胃肠损伤(AGI)的临床疗效,并观察对血清胃动素(MTL)、二胺氧化酶(DAO)、神经元特异性烯醇化酶(NSE)的影响。方法:采用前瞻性随机对照研究,将86例重型颅脑损伤合并急性胃肠损伤住院患者随机分成对照组和观察组(每组各43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,观察组在对照组基础上联用牛黄承气汤鼻饲给药,疗程均为7 d。治疗前及治疗7 d后对比评估2组患者临床疗效;治疗前、治疗3 d及治疗7 d,记录患者胃肠功能衰竭(GIF)评分、腹腔压力(IAP),检测血清MTL、DAO及NSE水平;记录患者28 d格拉斯哥昏迷量表(GCS)评分、机械通气时间、ICU住院时间及28 d病死率。结果:86例患者在治疗观察过程中有4例脱落,最终入组82例,观察组和对照组各41例。治疗后,观察组总有效率80.49%(33/41),对照组的总有效率56.10%(23/41),观察组优于对照组,差异有统计学意义(χ^(2)=9.137,P<0.05);与本组治疗前比较,观察组患者治疗3 d、治疗7 d GIF、IAP均显著改善(P<0.01),与对照组治疗后比较,观察组患者治疗7 d GIF、IAP改善优于对照组(P<0.05)。与本组治疗前比较,2组患者治疗3 d、治疗7 d血清MTL、DAO及NSE水平均明显改善(P<0.05,P<0.01),与对照组治疗后比较,观察组患者治疗3 d MTL、NSE水平明显优于对照组(P<0.05,P<0.01),观察组患者治疗7 d MTL、DAO及NSE水平明显优于对照组(P<0.05,P<0.01)。与对照组比较,观察组28 d GCS评分高于对照组(P<0.01),机械通气时间、ICU住院天数均明显少于对照组(P<0.05);2组患者28 d病死率比较差异无统计学意义。观察组患者无牛黄承气汤相关不良反应发生。结论:牛黄承气汤能有效改善重型颅脑损伤患者急性胃肠损伤的胃肠功能,调节血清MTL、DAO、NSE水平,缩短ICU住院时间,促进患者康复。Objective:To evaluate the clinical efficacy of Niuhuang Chengqitang in the treatment of acute gastrointestinal injury(AGI)in patients with severe traumatic brain injury(sTBI)and observe the effect on serum motilin(MTL),diamine oxidase(DAO),and neuron-specific enolase(NSE).Method:By the prospective randomized controlled trial(RCT)method,86 sTBI inpatients with AGI were randomly divided into an observation group(43 cases)and a control group(43 cases).All patients were given conventional western medicine treatment,including actively targeting the primary diseases and combined diseases,supply of enteral nutrition as soon as possible,and gastrointestinal agents,while those in the observation group received additional Niuhuang Chengqitang by nasal administration.The treatment course of both groups was 7 days.The clinical efficacy of the two groups was compared before treatment and 7 days after treatment.Gastrointestinal failure(GIF)score and intra-abdominal pressure(IAP)of the two groups were recorded,and serum MTL,DAO and NSE levels were detected before treatment,3 days and 7 days after treatment.The Glasgow Coma Scale(GCS)score,duration of mechanical ventilation,length of ICU stay,and 28-day mortality were recorded.Result:During the treatment and observation,4 cases fell off and 82 cases were finally enrolled,including 41 in the observation group and 41 in the control group.After treatment,the total effective rate in the observation group was 80.49%(33/41),higher than 56.10%(23/41)in the control group(χ^(2)=9.137,P<0.05).GIF and IAP scores in the observation group were significantly improved after 3 and 7 days of treatment(P<0.01),and the observation group was superior to the control group after 7 days of treatment(P<0.05).The serum levels of MTL,DAO,and NSE in the two groups were improved after 3 and 7 days of treatment(P<0.05,P<0.01).The levels of MTL and NSE in the observation group were better than those in the control group after 3 days of treatment(P<0.05,P<0.01),and the levels of MTL,DAO,and NSE in the observ

关 键 词：重型颅脑损伤 急性胃肠损伤 牛黄承气汤 胃动素 二胺氧化酶 

分 类 号：R22[医药卫生—中医基础理论] R242[医药卫生—中医学] R2-031R287R651.15R57