床旁超声测量胃窦横截面积评估大承气汤治疗脓毒症胃肠功能障碍的临床研究  

Clinical study of evaluating the clinical effect of Dachengqi decoction in the treatment of sepsis complication with gastrointestinal dysfunction via gastric antrum cross-sectional area measured by bedside ultrasound

作　　者：李探 张潇月 刘克琴 蒋晨露 曾浩 邵龙刚 Li Tan;Zhang Xiaoyue;Liu Keqin;Jiang Chenlu;Zeng Hao;Shao Longgang(Department of Emergency,the Second Affiliated Hospital of Nanjing University of Chinese Medicine(the Second Chinese Medicine Hospital of Jiangsu Province),Nanjing 210017,Jiangsu,China;Graduate School,Nanjing University of Chinese Medicine,Nanjing 210023,Jiangsu,China)

机构地区：[1]南京中医药大学第二附属医院(江苏省第二中医院)急诊科,江苏南京210017 [2]南京中医药大学,江苏南京210023

出　　处：《中华危重病急救医学》2023年第9期975-979,共5页Chinese Critical Care Medicine

基　　金：南京市中西医结合疫病研究中心科研基金项目(NCMIC-2022-08);南京中医药大学自然科学基金项目(XZR2020052);江苏省中医药科技发展计划项目(MS2022042,MS2022036)。

摘　　要：目的探讨床旁超声测量胃窦横截面积(CSA)评估大承气汤治疗脓毒症胃肠功能障碍的临床价值.方法采用平行分组随机对照研究方法,选择南京中医药大学第二附属医院急危重症医学科2021年1月至2022年10月收治的80例脓毒症合并胃肠功能障碍的患者作为研究对象,根据患者入院后是否同意使用大承气汤,按照1∶1等量随机原则分为大承气汤组(观察组)和常规治疗组(对照组),每组40例.两组患者均给予液体复苏、抗感染、维持呼吸循环稳定、早期滋养型喂养、促进胃肠道动力、调节肠道菌群等处理.观察组在西医常规治疗的基础上联合大承气汤口服治疗,30 mL浓煎剂早晚分服.两组疗程均为7d.分别于治疗前及治疗后采用床旁超声测量两组患者的CSA,分别用公式、传统胃管回抽方式计算胃残余量(GRV1、GRV2),并检测患者胃肠功能障碍评分、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)、腹腔内压(IAP)、血清前蛋白(PA)、白蛋白(Alb)、白细胞计数(WBC)、降钙素原(PCT)、超敏C-反应蛋白(hs-CRP)、重症监护病房(ICU)住院时间及误吸发生率,评估大承气汤的临床疗效,并对比分析床旁超声测量CSA与脓毒症胃肠道功能障碍的其他评价指标的相关性及优劣性.结果两组患者治疗前各指标差异均无统计学意义,具有可比性.与治疗前比较,两组患者治疗后CSA、GRV、胃肠功能障碍评分、APACHEⅡ评分、IAP、WBC、PCT、hs-CRP均明显下降,PA、Alb明显升高,且观察组治疗后各指标下降或升高均较对照组更为显著[CSA(cm^(2)):4.53±1.56比6.04±2.52,GRV1(mL):39.85±8.21比53.05±11.73,GRV2(mL):29.22±5.20比40.91±8.97,胃肠功能障碍评分(分):0.87±0.19比1.35±0.26,APACHEⅡ评分(分):11.54±3.43比14.28±3.07,IAP(cmH2O,1 cmH2O≈0.098 kPa):9.79±2.01比13.30±2.73,WBC(×109/L):9.35±1.24比12.35±1.36,PCT(μg/L):3.68±1.12比6.43±1.45,hs-CRP(mg/L):24.76±5.41比46.76±6.38,PA(mg/L):370.2Objective To evaluate the clinical value of Dachengqi decoction in the treatment of sepsis complication with gastrointestinal dysfunction via gastric antrum cross-sectional area(CSA)measured by bedside ultrasound.Methods A parallel group randomized controlled trial was conducted.A total of 80 patients with sepsis with gastrointestinal dysfunction admitted to the Second Affiliated Hospital of Nanjing University of Chinese Medicine from January 2021 to October 2022 were enrolled.According to whether patients agree to use Dachengqi decoction after admission,all patients were divided into Dachengqi decoction group(observation group)and conventional treatment group(control group)by 1:1 randomization,each group has 40 patients.Both groups were treated with fluid resuscitation,anti-infection,maintaining stable respiratory circulation,early nourishing feeding,promoting gastrointestinal motility,and regulating intestinal flora.The observation group was treated with Dachengqi decoction on the basis of western medicine,30 mL decoction was taken in the morning and evening.Both groups were treated for 7 days.The CSA of the two groups was measured by bedside ultrasound before and after treatment.The gastric residual volume(GRV1 and GRV2)were calculated by formula and traditional gastric tube withdrawal method.The gastrointestinal dysfunction score,acute physiology and chronic health evaluationⅡ(APACHEⅡ),intraperitoneal pressure(IAP),serum preprotein(PA),albumin(Alb),white blood cell count(WBC),procalcitonin(PCT),hypersensitivity C-reactive protein(hs-CRP),length of intensive care unit(ICU)stay and incidence of aspiration were detected to evaluate the clinical efficacy of Dachengqi decoction,the correlation and advantages and disadvantages between CSA measured by bedside ultrasound and other evaluation indicators of gastrointestinal dysfunction in sepsis were also analyzed.Results There were no significant differences in the indicators before treatment between the two groups,which were comparable.In comparison with the pre-

关 键 词：脓毒症 胃肠功能障碍 大承气汤 床旁超声 胃窦横截面积 

分 类 号：R278[医药卫生—中医学]