腹针联合大柴胡汤治疗脓毒症胃肠功能障碍的临床疗效观察  

Clinical observation of abdominal acupuncture combined with Dachaihu decoction in treating sepsis gastrointestinal dysfunction

作　　者：曾圆圆 黄壑霏[1] 彭晓洪 黄亚秀 黄永莲 陈冬杰 李少萍 王评 Zeng Yuanyuan;Huang Hefei;Peng Xiaohong;Huang Yonglian;Huang Yaxiu;Chen Dongjie;Li Shaoping;Wang Ping(Department of Intensive Care Unit,Shenzhen Hospital(Longgang),Beijing University of Chinese Medicine,Shenzhen 518127,Guangdong,China;Beijing University of Chinese Medicine,Beijing 100029,China)

机构地区：[1]北京中医药大学深圳医院(龙岗)重症监护室,广东深圳518172 [2]北京中医药大学,北京100029

出　　处：《中国中西医结合急救杂志》2024年第6期659-664,共6页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：广东省深圳市龙岗区科技发展专项资金(LGKCYLWS2020069)。

摘　　要：目的观察腹针联合大柴胡汤治疗脓毒症胃肠功能障碍的临床疗效。方法采用前瞻性随机对照研究方法,选择2020年12月至2023年5月北京中医药大学深圳医院(龙岗)收治的90例脓毒症且存在胃肠功能障碍患者作为研究对象。按随机数字表法将患者分为对照组、中药治疗组、综合治疗组,每组30例。3组入院后均接受西医常规治疗,对照组在常规治疗基础上加用枸橼酸莫沙必利、双歧杆菌三联活性胶囊;中药治疗组在常规治疗基础上加用大柴胡汤(组成:柴胡40 g、黄芩15 g、法半夏15 g、赤芍15 g、枳实20 g、大枣15 g、大黄10 g、生姜25 g)治疗,每日1剂,分3次服用;综合治疗组在中药治疗组治疗基础上联合腹针治疗。腹针采用薄氏腹针疗法,拟定取穴中脘、下脘、气海、关元、大横、关门、天枢、太乙,每日施针1次,每次20 min;3组疗程均为8 d。观察3组治疗前后急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)、中医证候积分、胃肠功能障碍积分和血清肠脂肪酸结合蛋白(I-FABP)、闭锁蛋白(Occludin)、闭锁小带蛋白-1(ZO-1)、脂多糖(LPS)、Toll样受体4(TLR4)、白细胞介素-6(IL-6)、降钙素原(PCT)、核转录因子-B(NF-B)水平的变化;记录3组28 d病死率、机械通气时间、重症监护病房(ICU)住院时间和总住院时间。结果治疗4 d、8 d,3组APACHEⅡ评分、胃肠功能障碍积分、中医证候积分和血清I-FABP、Occludin、ZO-1、LPS、TLR4、IL-6、PCT、NF-B水平均呈明显降低趋势,于治疗8 d达到谷值,且以综合治疗组和中药治疗组的降低程度较对照组更明显,综合治疗组的降低程度较中药治疗组更明显〔APACHEⅡ评分(分):13.37±4.54比16.28±5.36,中医证候积分(分):15.37±5.69比18.72±6.34,胃肠功能障碍积分(分):6.22±1.56比7.17±1.93,I-FABP(ng/L):8.38±2.69比10.62±3.24,Occludin(ng/L):64.72±9.58比75.66±11.45,ZO-1(ng/L):26.38±4.39比30.26±5.77,LPS(EU/L):26.23±5.17比34.52±Objective To observe the clinical efficacy of abdominal acupuncture combined with Dachaihu decoction in the treatment of gastrointestinal dysfunction in sepsis.Methods A prospective randomized controlled study was conducted.A total of 90 patients with sepsis and gastrointestinal dysfunction admitted to Shenzhen Hospital(Longgang),Beijing University of Chinese Medicine from December 2020 to May 2023 were selected as the research subjects.Patients were divided into a control group,a traditional Chinese medicine treatment group,and a comprehensive treatment group using a random number table method,with 30 cases in each group.After admission,all three groups received routine western medicine treatment,while the control group received a triple active capsule of mosapride citrate and bifidobacteria in addition to routine treatment;The traditional Chinese medicine treatment group was treated with Dachaihu decoction(consisting of Radix bupleuri 40 g,Scutellaria baicalensis 15 g,Pinellia ternata 15 g,Paeonia lactiflora 15 g,Fructus Aurantii 20 g,Jujube 15 g,Rhubarb 10 g,and Ginger 25 g)in addition to conventional treatment.This regimen involved one daily dose divided into 3 administrations.The comprehensive treatment group was treated with abdominal acupuncture in addition to the traditional Chinese medicine treatment group.Abdominal acupuncture adopts the Bo's abdominal acupuncture therapy,with a plan to select acupoints in Zhongwan,Xiawan,Qihai,Guanyuan,Daheng,Guanmen,Tianshu,and Taiyi.Acupuncture is administered once a day for 20 minutes each time.All 3 treatment groups have a duration of 8 days.Observe three groups of acute physiology and chronic health evaluationⅡ(APACHEⅡ),traditional Chinese medicine syndrome score,gastrointestinal dysfunction score,serum intestinal fatty acid binding protein(I-FABP),Occludin,zonula occludens-1(ZO-1),lipopolysaccharide(LPS),Toll like receptor 4(TLR4),interleukin-6(IL-6),procalcitonin(PCT),and nuclear factors-B(NF-B)before and after treatment changes in level.Record 3 groups of 2

关 键 词：脓毒症胃肠功能障碍 大柴胡汤 腹针 临床观察 

分 类 号：R285.6[医药卫生—中药学] R459.7[医药卫生—中医学]