凉膈散加减方治疗脓毒症致急性胃肠损伤的临床观察  

Clinical Observation of Modified Liangge Powder in the Treatment of Acute Gastrointestinal Injury Caused by Sepsis

作　　者：金岳 施荣[1] Jin Yue;Shi Rong(Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 201203,China)

机构地区：[1]上海中医药大学附属曙光医院,上海201203

出　　处：《中国中医急症》2025年第1期120-124,共5页Journal of Emergency in Traditional Chinese Medicine

基　　金：上海市卫生健康委员会中医药科研项目(2022QN078);上海市卫生健康委员会上海市“十三五”临床重点专科建设项目(中医专业)中医急诊科(shslczdzk04402)。

摘　　要：目的 观察凉膈散加减方治疗脓毒症致急性胃肠损伤(AGI)患者的临床疗效。方法 将82例患者随机分为治疗组与对照组各41例,两组患者均予指南常规治疗,治疗组加予凉膈散加减方,疗程7 d。治疗后,观察两组主要疗效指标(AGI分级),次要疗效指标[中医临床疗效、急性生理与慢性健康状况Ⅱ(APACHE Ⅱ)评分、序贯器官衰竭量表(SOFA)评分、腹围、腹内压、肠鸣音],以及D-乳酸、二胺氧化酶(DAO)、细菌内毒素、白细胞计数(WBC)、C反应蛋白(CRP)、降钙素原(PCT)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)水平。结果 治疗组AGI分级改善程度显著优于对照组(P<0.05);治疗组中医临床显效率为82.93%,显著高于对照组的46.34%(P<0.05);治疗组APACHE Ⅱ评分、SOFA评分、腹围、腹内压均低于对照组(P<0.05);治疗后肠鸣音次数显著增加(P<0.05);治疗组血清D-乳酸、DAO及细菌内毒素水平显著降低(P<0.05);治疗组WBC、CRP、PCT、TNF-α、IL-6水平均低于对照组(P<0.05)。结论 凉膈散加减方能显著改善脓毒症AGI患者胃肠功能,减轻炎症反应,提高中医临床疗效。Jin Yue;Shi Rong;Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine;Objective:To observe the effects of Modified Liangge Powder in improving acute gastrointestinal injury(AGI)caused by sepsis. Methods:A total of 82 patients were randomly divided into a treatment group and a control group,each with 41 cases,using a randomized controlled trial method. Both groups received standard guideline-based treatments,while the treatment group was additionally given Modified Liangge Powder for a course of 7days. After treatment,the primary efficacy indicator(AGI grading)and secondary efficacy indicators[TCM clinical efficacy,Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ)score,Sequential Organ Failure Assessment(SOFA)score,abdominal circumference,intra-abdominal pressure,bowel sounds],as well as serum D-lactate,diamine oxidase(DAO),bacterial endotoxin,white blood cell count(WBC),C-reactive protein(CRP),procalcitonin(PCT),tumor necrosis factor-α(TNF-α),and interleukin-6(IL-6)levels were observed. Results:The improvement in AGI grading in the treatment group was significantly better than that in the control group(P< 0.05).The TCM clinical efficacy rate in the treatment group was 82.93%,which was significantly higher than 46.34% in the control group(P< 0.05). The APACHE Ⅱ score,SOFA score,abdominal circumference,and intra-abdominal pressure in the treatment group were all lower than those in the control group(P< 0.05). Bowel sound frequency significantly increased after treatment(P< 0.05). Serum D-lactate,DAO,and bacterial endotoxin levels in the treatment group were significantly lower(P< 0.05). The WBC,CRP,PCT,TNF-α,and IL-6 levels in the treatment group were all lower than those in the control group(P< 0.05). Conclusion:Modified Liangge Powder can significantly improve gastrointestinal function and reduce inflammatory responses in patients with sepsis-induced AGI,thereby enhancing TCM clinical efficacy.

关 键 词：脓毒症 急性胃肠损伤 胃肠功能 凉膈散加减方 炎症因子 

分 类 号：R631[医药卫生—外科学]