大黄附子汤加味治疗老年脓毒症急性胃肠损伤的随机对照研究  

Efficacy of modified Dahuang Fuzi Decoction on sepsis-associated acute gastrointestinal injury in elderly patients:A randomized controlled trial

作　　者：刘锦[1] 方晓磊[2] 孙琛琛 潘惠惠 刘陟[2] 孙磊[2] 刘福生[2] LIU Jin;FANG Xiao-lei;SUN Chen-chen;PAN Hui-hui;LIU Zhi;SUN Lei;LIU Fu-sheng(Dongzhimen Hospital,Beijing University of Chinese Medicine,Beijing 100700,China;Dongfang Hospital,Beijing University of Chinese Medicine,Beijing 100078,China)

机构地区：[1]北京中医药大学东直门医院,北京100700 [2]北京中医药大学东方医院,北京100078

出　　处：《中华中医药杂志》2022年第11期6868-6872,共5页China Journal of Traditional Chinese Medicine and Pharmacy

基　　金：中央高校基本科研业务费专项(No.2016-JYB-JSPY-047,No.2017-JYB-JS-101,No.2018-JYBZZ-JS075,No.2019-JYB-JSPYGD-011);国家中医临床研究基地业务建设专项(No.JDZX2015289)。

摘　　要：目的:评价大黄附子汤加味治疗老年脓毒症急性胃肠损伤的疗效。方法:采用单中心、随机、安慰剂对照的研究方法将来自北京中医药大学东方医院急诊及急诊重症监护室符合纳入标准的64例老年脓毒症急性胃肠损伤患者随机分为试验组、对照组。试验组采用西医常规治疗+大黄附子汤加人参口服或鼻饲,对照组采用西医常规治疗+大黄附子汤加人参的安慰剂口服或鼻饲,均治疗6 d。治疗前后评价主要疗效指标[急性胃肠损伤(AGI)评分及分级]及次要疗效指标[急性生理与慢性健康评分(APACHEⅡ)、序贯脓毒症相关的器官功能衰竭评估(SOFA)评分及28 d生存率];测定两组患者胃肠激素(胃动素、胃泌素)、D-乳酸及内毒素;同时观察不良事件。结果:60例患者完成试验,与对照组比较,试验组显著改善老年脓毒症急性胃肠损伤患者AGI评分及分级、降低SOFA评分和APACHEⅡ评分(P<0.05),但未改变28 d生存率,且试验组显著提高了血清胃动素的水平,降低了血清胃泌素、D-乳酸及内毒素水平(P<0.05)。结论:大黄附子汤加人参有助于改善老年脓毒症急性胃肠损伤患者的胃肠功能,可能与调节胃肠激素、降低肠道通透性及缓解炎症水平有关。Objective:To assess the evaluate curative efficacy of modified Dahuang Fuzi Decoction(mDHFZD)on sepsis-associated acute gastrointestinal injury in elderly patients.Methods:A single-center,randomized and placebo-controlled method was adopted.A total of 64 elderly sepsis patients with acute gastrointestinal injury(AGI)from Dongfang Hospital,Beijing University of Chinese Medicine who met the criteria were randomly assigned into the mDHFZD group and control group.Patients in the mDHFZD group were treated with the standard western medicine treatment and mDHFZD while patients in control group with the standard western medicine treatment and the placebo for 6 days.The primary efficacy indexes were AGI score and grading,and the secondary efficacy indexes were APACHE II score,SOFA score and 28-day survival rate.Gastrointestinal hormones(motilin,gastrin),D-lactic acid and Endotoxin were evaluated at 2 time points:pre-treatment and after 6 days posttreatment,and adverse events were observed.Results:The final completion of 60 patients.Compared with the control group,the treatment group could improve AGI score and grading,decrease SOFA score and APACHE II score(P<0.05),but did not improve 28-day survival rate.What’s more,the treatment group could significantly increase the level of serum motilin,decrease the level of serum gastrin,D-lactic acid and endotoxin levels(P<0.05).Conclusion:mDHFZD can improve the gastrointestinal function of sepsis in elderly patients,which may be related to the regulation of gastrointestinal hormones,reduction of intestinal permeability and alleviation of inflammation.

关 键 词：大黄附子汤 老年患者 脓毒症 急性胃肠损伤 随机对照试验 机制 疗效 

分 类 号：R278[医药卫生—中医学]