肺肠合治法治疗脓毒症胃肠功能障碍患者的临床疗效及对其胃肠功能的影响  

Combined Treatment of Lung and Intestine:Clinical Efficacy and Effect on Gastrointestinal Function in Sepsis Patients with Gastrointestinal Dysfunction

作　　者：张丽雯 张高峰 鞠萍 黄翔 朱雯倩 卢斐 张宇成 ZHANG Li-wen;ZHANG Gao-feng;JU Ping;HUANG Xiang;ZHU Wen-qian;LU Fei;ZHANG Yu-cheng(Intensive Care Unit,Changshu Hospital of Traditional Chinese Medicine(New District Hospital),Changshu Jiangsu 215500)

机构地区：[1]常熟市中医院(常熟市新区医院)重症医学科,江苏常熟215500

出　　处：《世界中西医结合杂志》2024年第4期812-816,共5页World Journal of Integrated Traditional and Western Medicine

基　　金：苏州市科技发展计划(SYSD2020198)。

摘　　要：目的 探讨肺肠合治法治疗脓毒症胃肠功能障碍患者的临床疗效及对其胃肠功能的影响。方法 选取2020年10月—2022年2月期间常熟市中医院(新区医院)重症医学科收治的80例脓毒症胃肠功能障碍患者为研究对象,按随机数字表法将其分为对照组和研究组,每组各40例。对照组给予常规西医治疗,研究组在对照组治疗的基础上给予肺肠合治法治疗。均连续治疗7 d。观察比较两组患者临床疗效,治疗前后中医证候积分、胃肠功能、胃肠激素、炎症因子[降钙素(Proccalcitonin,PCT)、肿瘤坏死因子-α(Tumor necrosis factor-α,TNF-α)、白细胞介素-4(Interleukin-4,IL-4)]水平及安全性。结果 治疗后研究组总有效率97.50%(39/40)明显高于对照组82.50%(33/40),差异有统计学意义(P<0.05)。治疗后两组患者中医证候身体发热、烦渴、腹部胀满、按之疼痛、胸痛、气促、口臭或口干积分均较治疗前降低,差异有统计学意义(P<0.05);且研究组中医证候身体发热、烦渴、腹部胀满、按之疼痛、胸痛、气促、口臭或口干积分均明显低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者腹腔内压力、胃残留量、GIF评分均较治疗前降低,肠鸣音均较治疗前增多,差异有统计学意义(P<0.05);且研究组腹腔内压力、胃残留量、GIF评分均明显低于对照组,肠鸣音明显多于对照组,差异有统计学意义(P<0.05)。治疗后两组患者胃动素、血管活性肠肽水平均较治疗前升高,胃泌素水平均较治疗前降低,差异有统计学意义(P<0.05);且研究组胃动素、血管活性肠肽水平均明显高于对照组,胃泌素水平低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者PCT、TNF-α水平均较治疗前降低,IL-4水平均较治疗前升高,差异有统计学意义(P<0.05);且研究组PCT、TNF-α水平均明显低于对照组,IL-4水平明显高于对照组,差异有统计学意义(P<0.05)。治疗期间,Objective To observe the clinical efficacy of combined treatment of lung and intestine and the effect of the combined treatment on gastrointestinal function in the sepsis patients with gastrointestinal dysfunction.Methods Eighty sepsis patients with gastrointestinal dysfunction admitted to the Intensive Care Unit of Changshu Hospital of Traditional Chinese Medicine(New District Hospital)from October 2020 to February 2022 were selected and assigned into a control group and a study group according to the random number table method,with 40 patients in each group.The control group received conventional Western medicine treatment,and the study group received combined treatment of lung and intestine on the basis of the therapy in the control group.All the patients were treated continuously for 7 days.The clinical efficacy and safety were compared between the two groups.The TCM syndrome scores,gastrointestinal function,gastrointestinal hormones,and inflammatory mediators[procalcitonin(PCT),tumor necrosis factor-α(TNF-α),and interleukin-4(IL-4)]were determined before and after treatment.Results After treatment,the total response rate in the study group was 97.50%(39/40),which was higher than that(82.50%,33/40)in the control group(P<0.05).After treatment,the scores of fever,polydipsia,abdominal distension,press pain,chest pain,shortness of breath,and halitosis or dry mouth decreased in both groups,and the study group had lower scores than the control group(P<0.05).The treatment in both groups decreased the intraperitoneal pressure,gastric residue,and GIF score and increased the intestinal sounds,and the study group showed more obvious changes than the control group(P<0.05).After treatment,both groups showed elevated levels of motilin and vasoactive intestinal peptide and lowered gastrin level,and the study group had higher levels of motilin and vasoactive intestinal peptide and lower gastrin level than the control group(P<0.05).The treatment in both groups lowered the levels of PCT and TNF-α and elevated the level of I

关 键 词：肺肠合治法 脓毒症胃肠功能障碍 胃肠功能 胃肠激素 炎症因子 

分 类 号：R573[医药卫生—消化系统] R574[医药卫生—内科学]