本文選題：英黃湯　切入點(diǎn)：膿毒癥　出處：《河北醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:通過研究英黃湯治療膿毒癥患者胃腸功能障礙的臨床療效,并觀察其對(duì)急性生理與慢性健康狀況(Acute Physiology and Chronic Health EvaluationⅡ,APACHEⅡ)評(píng)分、胃腸功能障礙評(píng)分、腹腔內(nèi)壓(Intraabdominal Pressure,IAP)、血漿胃泌素(Gastrin,GAS)、血漿胃動(dòng)素(Motillin,MTL)等的影響,探究英黃湯治療本病的作用機(jī)制。方法:觀察病例全部來自我院急診重癥監(jiān)護(hù)病房(Emergency treatment Intensive Care Unit,EICU)2016年7月-2017年1月收治的膿毒癥胃腸功能障礙患者,合計(jì)38例。依據(jù)隨機(jī)數(shù)字表法隨機(jī)分為治療組19例和對(duì)照組19例。兩組病例在性別、年齡及腹腔內(nèi)壓等方面經(jīng)SPSS 21.0分析(P0.05),差異無統(tǒng)計(jì)學(xué)意義,具有可比性。兩組均給予西醫(yī)基礎(chǔ)治療,同時(shí)治療組在基礎(chǔ)治療上加用英黃湯鼻飼或口服,持續(xù)治療7天,觀察指標(biāo)包括基礎(chǔ)資料、急性生理與慢性健康狀況評(píng)分、多器官功能障礙綜合征(Multiple organ dysfunction syndrome,MODS)發(fā)生率、病死率以及胃腸功能相關(guān)指標(biāo),如腹腔內(nèi)壓、胃腸功能障礙評(píng)分以及胃腸激素(血漿胃泌素、血漿胃動(dòng)素),并進(jìn)行胃腸功能療效評(píng)價(jià)。結(jié)果:1兩組胃腸功能療效比較治療后,治療組總有效率為78.9%,對(duì)照組總有效率為52.6%,治療組與對(duì)照組比較差異有統(tǒng)計(jì)學(xué)意義(P=0.034)。說明針對(duì)膿毒癥胃腸功能障礙患者的治療,治療組的效果更好。2兩組急性生理與慢性健康狀況(APACHEⅡ)評(píng)分變化情況比較兩組病例經(jīng)治療后APACHEⅡ評(píng)分均有所下降,與治療前比較,治療組差異有統(tǒng)計(jì)學(xué)意義(t=43.344,P0.001),對(duì)照組差異無統(tǒng)計(jì)學(xué)意義(t=0.789,P=0.440);治療后,治療組與對(duì)照組之間比較差異有統(tǒng)計(jì)學(xué)意義(t=-3.138,P=0.003)。說明針對(duì)膿毒癥胃腸功能障礙患者的治療,治療組的效果更好。3兩組胃腸功能障礙評(píng)分變化情況比較兩組病例經(jīng)治療后胃腸功能障礙評(píng)分均有所下降,與治療前比較,兩組差異均有統(tǒng)計(jì)學(xué)意義(治療組t=5.117,P0.001,對(duì)照組t=2.876,P=0.010);治療后,治療組與對(duì)照組之間比較差異亦有統(tǒng)計(jì)學(xué)意義(t=-2.150,P=0.038)。說明針對(duì)膿毒癥胃腸功能障礙患者的治療,治療組的效果更好。4兩組腹腔內(nèi)壓(IAP)變化情況比較兩組病例經(jīng)治療后IAP均有所下降,與治療前比較,治療組差異有統(tǒng)計(jì)學(xué)意義(t=18.635,P0.001),對(duì)照組差異無統(tǒng)計(jì)學(xué)意義(t=1.077,P=0.296);治療后,治療組與對(duì)照組之間比較差異有統(tǒng)計(jì)學(xué)意義(t=-2.796,P=0.008)。說明針對(duì)膿毒癥胃腸功能障礙患者的治療,治療組的效果更好。5兩組血漿胃泌素(GAS)變化情況比較兩組病例經(jīng)治療后GAS均有所下降,與治療前比較,治療組差異有統(tǒng)計(jì)學(xué)意義(t=17.897,P0.001),對(duì)照組差異無統(tǒng)計(jì)學(xué)意義(t=1.495,P=0.152);治療后,治療組與對(duì)照組之間比較差異有統(tǒng)計(jì)學(xué)意義(t=-3.139,P=0.003)。說明針對(duì)膿毒癥胃腸功能障礙患者的治療,治療組的效果更好。6兩組血漿胃動(dòng)素(MTL)變化情況比較兩組病例經(jīng)治療后MTL均有所上升,與治療前比較,兩組差異均有統(tǒng)計(jì)學(xué)意義(治療組t=-26.409,P=0.0000.05,對(duì)照組t=-22.196,P0.001);治療后,治療組與對(duì)照組之間比較差異亦有統(tǒng)計(jì)學(xué)意義(t=2.288,P=0.028)。說明針對(duì)膿毒癥胃腸功能障礙患者的治療,治療組的效果更好。7兩組多器官功能障礙綜合征(MODS)發(fā)生率比較治療后,治療組MODS發(fā)生率為21.1%;對(duì)照組MODS發(fā)生率為57.9%,治療組與對(duì)照組之間比較差異有統(tǒng)計(jì)學(xué)意義(P=0.045)。說明針對(duì)膿毒癥胃腸功能障礙患者的治療,治療組的效果更好。8兩組病死率比較治療后,治療組病死率為10.5%,對(duì)照組病死率為42.1%,治療組與對(duì)照組之間比較差異無統(tǒng)計(jì)學(xué)意義(P=0.062)。說明尚不能證明針對(duì)膿毒癥胃腸功能障礙患者的治療,在降低病死率方面治療組的效果更好。結(jié)論:研究結(jié)果證實(shí),英黃湯聯(lián)合西醫(yī)基礎(chǔ)治療能夠更為有效的改善膿毒癥患者胃腸功能障礙,其改善胃腸功能的作用機(jī)制可能與調(diào)整胃腸激素GAS、MTL的分泌有關(guān)。
[Abstract]:Objective: through the clinical study of English Decoction in the treatment of sepsis patients with gastrointestinal dysfunction, and observe the effect on acute physiology and chronic health evaluation (Acute Physiology and Chronic Health Evaluation II, APACHE II) score, gastrointestinal dysfunction score, intra-abdominal pressure (Intraabdominal, Pressure, IAP), plasma gastrin (Gastrin, GAS), plasma motilin (Motillin, MTL) the influence mechanism of inquiry Decoction in treating this disease. The methods: observation cases all from our hospital emergency intensive care unit (Emergency treatment Intensive Care Unit, EICU) sepsis in patients with gastrointestinal dysfunction in July 2016 -2017 year in January, a total of 38 cases were randomly according to. 19 patients were divided into treatment group and control group of 19 cases. The two groups were gender, age and SPSS analysis of 21 aspects of the intra-abdominal pressure (P0.05), the difference was not statistically significant, comparable . the two groups were given the basic treatment of Western medicine, the treatment group was treated with basic therapy plus Chinese Decoction oral or nasal feeding at the same time, continued for 7 days. The observation indexes include basic data, acute physiology and chronic health evaluation, multiple organ dysfunction syndrome (MODS Multiple organ dysfunction syndrome) incidence, mortality and gastrointestinal function related indicators, such as intra-abdominal pressure, gastrointestinal dysfunction score and gastrointestinal hormones (gastrin, motilin,) and evaluate the gastrointestinal function curative effect. Results: compared with two groups of curative effect of 1 gastrointestinal function after treatment, the total efficiency of treatment group was 78.9%, control group total effective rate was 52.6%, and the treatment group was statistically significant the control group (P=0.034). In the treatment of patients with sepsis with gastrointestinal dysfunction, two groups of acute physiology and chronic health treatment group better.2 (APACHE II) score change Of the two groups were compared after treatment, APACHE score decreased, compared with before treatment, treatment group was statistically significant difference (t=43.344, P0.001), the control group had no significant difference (t=0.789, P=0.440); after treatment, the treatment group and control group compared the difference was statistically significant (t=-3.138, P=0.003 according to the instructions.) in the treatment of sepsis with gastrointestinal dysfunction, the effect of the treatment group better.3 two group of gastrointestinal dysfunction score between the two groups were compared after treatment of gastrointestinal dysfunction score were decreased, compared with before treatment, there were significant differences between two groups (t=5.117 treatment group, P0.001 control group, t=2.876, P=0.010); after treatment between the treatment group and the control group there were significant differences (t=-2.150, P=0.038). In the treatment of patients with sepsis with gastrointestinal dysfunction, the treatment group has better effect in two groups of.4 The intra-abdominal pressure (IAP) changes of the two groups were compared after treatment IAP decreased, compared with before treatment, treatment group was statistically significant difference (t=18.635, P0.001), the control group had no significant difference (t=1.077, P=0.296); after treatment between the treatment group and the control group the difference was statistically significant (t=-2.796, P=0.008). In the treatment of patients with sepsis with gastrointestinal dysfunction, the treatment group has better effect in two groups of.5 plasma gastrin (GAS) changes of the two groups were compared after treatment GAS decreased, compared with before treatment, treatment group was statistically significant difference (t=17.897, P0.001), control group. No statistical significance (t=1.495, P=0.152); after treatment between the treatment group and the control group the difference was statistically significant (t=-3.139, P=0.003). The sepsis patients gastrointestinal dysfunction, the effect of the treatment group better.6 two group The plasma motilin (MTL) changes of the two groups were compared after treatment, MTL increased, compared with before treatment, there were significant differences between two groups (treatment group, t=-26.409 control group, P=0.0000.05, t=-22.196, P0.001); after treatment, the treatment group and control group compared the difference was also statistically significant (t=2.288, P=0.028 according to the instructions.) in the treatment of sepsis with gastrointestinal dysfunction, the treatment group has better effect in two groups of.7 multiple organ dysfunction syndrome (MODS) incidence after treatment in treatment group, the incidence rate of MODS was 21.1%; the control group, the incidence rate of MODS was 57.9%, between the treatment group and the control group the difference was statistically significant (P=0.045 according to the instructions.) in the treatment of sepsis with gastrointestinal dysfunction, the treatment group has better effect on.8 mortality rate of two groups were compared after treatment, the treatment group mortality rate was 10.5%, the fatality rate was 42.1% in control group, treatment group and control group No statistically significant differences (P=0.062). There is no proof that in the treatment of patients with sepsis with gastrointestinal dysfunction, reduce the mortality rate in the treatment group, the effect is better. Conclusion: the results confirmed that the British Decoction Combined Western medicine can effectively improve sepsis in patients with gastrointestinal dysfunction, improve gastrointestinal the mechanism may be related to adjustment of gastrointestinal hormone GAS, secretion of MTL.

【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R459.7

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