六君子汤联合肠内营养对机械通气患者胃肠功能障碍的影响  

Clinical study of Liujunzi decoction combined with enteral nutrition on gastrointestinal dysfunction in patients with mechanical ventilation

作　　者：周成亮 边玉玺 耿文婧 王毅 何志红 ZHOU Cheng-liang;BIAN Yu-xi;GENG Wen-jing(Department of Emergency Medicine,Shijiazhuang People's Hospital,Shijiazhuang(050000),China)

机构地区：[1]石家庄市人民医院急诊医学科,石家庄050000 [2]石家庄市人民医院中医科,石家庄050000

出　　处：《中国中西医结合外科杂志》2024年第4期481-485,共5页Chinese Journal of Surgery of Integrated Traditional and Western Medicine

基　　金：2021年河北省中医药类科研计划项目(2021219)。

摘　　要：目的:观察六君子汤联合肠内营养对机械通气患者胃肠功能障碍的临床疗效。方法:选择2020年11月—2022年11月我院收治的80例ICU机械通气胃肠功能障碍患者,以随机数字表法分为两组。肠内营养组40例,给予基础对症治疗同时进行肠内营养治疗,六君子汤联合组40例,在肠内营养组治疗同时给予六君子汤治疗,比较两组临床疗效,治疗前、后进行胃肠功能障碍评分、急性生理及慢性健康评分Ⅱ(APACHEⅡ)、营养风险筛查评估表(NRS 2002)评价,记录两组患者机械通气时间、住ICU时间,检查胃窦收缩幅度、胃半排空时间、胃窦收缩频率,测定可溶性髓样细胞触发型受体-1(sTREM-1)、胃泌素-17(G-17)、生长素释放肽(Ghrelin)、中性粒细胞百分比、T淋巴细胞亚群CD4^(+)、CD8^(+)、白蛋白、转铁蛋白水平,记录治疗期间两组腹胀、腹泻、胃潴留、感染发生情况。结果:六君子汤联合组总有效率为97.50%,显著高于肠内营养组总有效率80.00%(P<0.05);六君子汤联合组APACHEⅡ评分、胃肠功能障碍评分、NRS 2002评分低于肠内营养组(P<0.05),六君子汤联合组机械通气时间、住ICU时间、胃半排空时间短于肠内营养组(P<0.05);六君子汤联合组胃窦收缩幅度、胃窦收缩频率高于肠内营养组(P<0.05);六君子汤联合组G-17、Ghrelin、CD4^(+)、白蛋白、转铁蛋白水平高于肠内营养组(P<0.05),六君子汤联合组sTREM-1、中性粒细胞百分比、CD8^(+)水平低于肠内营养组(P<0.05);六君子汤联合组并发症发生率为5.00%,显著低于肠内营养组并发症发生率27.50%(P<0.05)。结论:六君子汤联合肠内营养治疗机械通气胃肠功能障碍患者,可抑制机体炎症,改善营养状态及免疫功能,提升胃动力,改善病情,提升临床疗效,减少并发症。Objective To analyze the clinical effect of Liujunzi decoction combined with enteral nutrition on gastrointestinal dysfunction patients with mechanical ventilation.Methods A total of 80 ICU patients with mechanical ventilation gastrointestinal dysfunction treated in hospital from November 2020 to November 2022 were selected,and grouped into random number tables.40 cases of enteral nutrition group were treated with enteral nutrition at the same time as basic symptomatic treatment;40 cases of Liujunzi decoction combined group were treated with Liujunzi decoction at the same time as enteral nutrition group.The clinical efficacy of the two groups was compared.Gastrointestinal dysfunction,acute physiological and chronic health scoreⅡ(APACHEⅡ),and nutritional risk screening evaluation Form(NRS 2002)were evaluated before and after treatment.Mechanical ventilation time and ICU stay time of patients in the two groups were recorded,and antrum contraction amplitude,gastric half-emptying time and antrum contraction frequency were examined.Soluble myelocyte trigger receptor 1(sTREM-1),gastrin-17(G-17),growth hormone releasing peptide(Ghrelin),percentage of neutrophils,CD4^(+),CD8^(+),albumin,transferrin levels of T lymphocyte subsets were measured,and the incidence of abdominal distension,diarrhea,gastric retention,and infection in the two groups were recorded during treatment.Results The total effective rate of Liujunzi decoction combined group was 97.50%,which was significantly higher than that of enteral nutrition group(80.00%)(P<0.05).The scores of APACHEⅡ,gastrointestinal dysfunction and NRS 2002 in Liujunzi decoction combined group were lower than those in enteral nutrition group(P<0.05),and the mechanical ventilation time,ICU stay time and stomach half-empty time in Liujunzi decoction combined group were shorter than those in enteral nutrition group(P<0.05).The magnitude and frequency of antrum contraction in Liujunzi decoction combined group were higher than those in enteral nutrition group(P<0.05).The levels of

关 键 词：六君子汤 肠内营养 重症监护室 机械通气 胃肠功能障碍 炎症 免疫功能 

分 类 号：R656.6[医药卫生—外科学] R278[医药卫生—临床医学]