本文選題：危重癥　切入點：參苓白術散　出處：《廣州中醫(yī)藥大學》2017年碩士論文

【摘要】：目的:本研究旨在應用添加參苓白術散的腸內營養(yǎng)劑在益氣健脾、調節(jié)腸道菌群、改善胃腸道功能、提高免疫功能等方面的優(yōu)勢來改善脾虛證危重癥患者的免疫功能。在患者入住ICU24小時內與治療后1周分別抽取患者外周靜脈血檢測患者T淋巴細胞亞群與免疫球蛋白治療前后的數(shù)值變化情況,通過測得數(shù)據(jù)初步評價參苓白術散對脾虛證危重患者免疫功能的影響,為益氣健脾中藥在臨床救治危重患者提供新的思路與方法。方法:采用前瞻、隨機、單盲、對照研究,將2016年6月至2017年3月入住廣州中醫(yī)藥大學第一附屬醫(yī)院重癥醫(yī)學科且中醫(yī)表現(xiàn)為脾胃氣虛證侯的危重癥患者54例納入研究,按照排除標準、納入標準1:1隨機分配的方法將合格病例分別劃分為治療組(27例)、對照組(27例)。所有納入病例在血流動力學、內環(huán)境穩(wěn)定的情況下,且無腸內營養(yǎng)的禁忌后開始盡早實施腸內營養(yǎng)(24-48小時),對照組予以標準配方的腸內營養(yǎng)劑能全力,治療組用胃管或鼻空腸管注入200ml參苓白術散湯劑,次/日,療程7天。同時收集整理納入病例的四診資料及急性生理學與慢性健康狀況Ⅱ(APACHE Ⅱ)評分,記錄兩組患者在入住ICU24小時內及治療1周后的T淋巴細胞亞群(CD4+、CD3+、CD4+/CD8+)、NK細胞活性、免疫球蛋白水平變化等相關指標,進行資料整理,統(tǒng)計學分析,評估在中醫(yī)藥參苓白術散干預下對危重癥患者免疫功能的影響。結果:共有47例入組,治療組25例,對照組22例。研究前通過對比治療組和對照組的APACHE-Ⅱ評分、年齡、性別構成比等基線資料,發(fā)現(xiàn)無統(tǒng)計學意義(P0.05),說明兩組資料具有可比性;治療前對照組與治療組患者所測得T淋巴細胞亞群、NK細胞活性、免疫球蛋白水平變化無明顯差異(P0.05),具有可比性;對比治療前后兩組組內之間數(shù)據(jù)發(fā)現(xiàn)兩組患者T淋巴細胞亞群、NK細胞活性、免疫球蛋白水平均較治療前升高,有統(tǒng)計學意義(P0.05);對比治療后兩組組間數(shù)據(jù)發(fā)現(xiàn)治療組所測得T淋巴細胞亞群、NK細胞活性、免疫球蛋白水平較對照組明顯升高,有統(tǒng)計學差異(P0.05),對比兩組治療前后差值比較發(fā)現(xiàn),所測得T淋巴細胞亞群、NK細胞活性、免疫球蛋白水平差值治療組明顯大于對照組。結論:無論是對照組西醫(yī)常規(guī)治療,還是治療組西醫(yī)常規(guī)治療聯(lián)合添加參苓白術散的腸內營養(yǎng)支持,均能升高NK細胞活性,提高CD4+、CD3+、CD4+/CD8+、IgG、IgA、IgM水平,降低危重癥患者APACHE-Ⅱ評分,改善機體免疫功能。治療1周后,治療組與對照組的T淋巴細胞亞群水平、NK細胞活性及免疫球蛋白水平均升高,而治療組明顯高于對照組(P0.05),有統(tǒng)計學差異。說明中藥制劑參苓白術散確實能改善危重癥患者的免疫功能,改善疾病預后。
[Abstract]:Objective: This study aims to use the add SHENLINGBAISHU enteral nutrition in Qi and spleen, regulate the intestinal flora, improving gastrointestinal function, improve immune function and other advantages to improve the immune function of patients with spleen deficiency syndrome in critically ill patients. In patients admitted to ICU24 hours and 1 weeks after treatment were collected in patients with peripheral venous blood detection of T lymphocyte subsets in patients with numerical changes before and after immunoglobulin treatment, the measured data through the evaluation of the effect of Shenlingbaizhu powder on immune function in critically ill patients with spleen deficiency syndrome, Qi and spleen for traditional Chinese medicine to provide new ideas and methods in clinical treatment of critically ill patients. Methods: a prospective, randomized, single blind, controlled study. The First Affiliated Hospital of Guangzhou University of Chinese Medicine from June 2016 to March 2017 in intensive medicine and Chinese medicine for stomach qi deficiency Hou 54 critically ill patients included in the study, according to the According to the exclusion criteria, into the standard 1:1 method will be randomly assigned to qualified patients were divided into treatment group (27 cases) and control group (27 cases). All cases in hemodynamics, internal environment stable, and no contraindication of enteral nutrition after the start of the early implementation of enteral nutrition (24-48 hours), the control group was given standard formulations of enteral nutrition can fully, the treatment group was treated with gastric tube or nasojejunal injection 200ml shenlingbaizhusan decoction, time / day, a course of 7 days. At the same time to collect the cases of the four diagnostic information and acute physiology and chronic health evaluation (APACHE II) score in the two groups were recorded in ICU24 hours and 1 weeks after treatment T lymphocyte subsets (CD4+, CD3+, CD4+/CD8+), NK cell activity and related indexes of immunoglobulin level changes, to collect data, statistical analysis, evaluation of traditional Chinese medicine in the intervention of critically ill shenlingbaizhupowder Effect of immune function of patients. Results: a total of 47 cases, 25 cases in the treatment group, 22 cases in the control group. Before the study by comparing the treatment group and control group, APACHE- score, age, gender ratio of baseline data, found no statistical significance (P0.05), the two groups that have comparable data before treatment; the control group and the treatment group were measured T lymphocyte subsets, NK cell activity, no significant difference between the changes of the level of immunoglobulin (P0.05), with comparable data; compared before and after treatment in the two groups was found between two groups of patients T lymphocyte subsets, NK cell activity, immune globulin the level was higher than that before treatment, there was statistical significance (P0.05); comparison of data between the two groups after treatment treatment group measured T lymphocyte subsets, NK cell activity, immune globulin level was significantly higher than the control group, there was statistical difference (P0.05), comparing the two groups before and after treatment The difference is found, the measured T lymphocyte subsets, NK cell activity, immune globulin levels between treatment group was significantly higher than the control group. Conclusion: both the control group conventional western medicine treatment, treatment group and routine treatment of Western medicine combined with SHENLINGBAISHU enteral nutrition support can increase the activity of NK cells, increased CD4+ CD3+, CD4+/CD8+, IgG, IgA, IgM, APACHE- in patients with critical level, reduce the score, improve the immune function. After 1 weeks of treatment, the levels of T lymphocyte subsets in the treatment group and control group, NK cell activity and immunoglobulin levels were elevated, while the treatment group was significantly higher than the control group (P0.05), there was statistically significant difference. Conclusion: the traditional Chinese medicine preparation SHENLINGBAISHU indeed can improve the immune function of critically ill patients, improve the prognosis of the disease.

【學位授予單位】：廣州中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R459.7

【參考文獻】

相關期刊論文 前10條

1 董開忠;高永盛;秦寧恩加;蘇露;;參苓白術散對抗生素引起腸道菌群失調小鼠的影響[J];中國實驗方劑學雜志;2015年01期

2 王小雯;;血漿白蛋白水平與全身水腫情況對危重患者預后的影響[J];中國實用醫(yī)藥;2012年36期

3 姬曉偉;謝波;;重癥患者合并急性胃腸功能障礙的病因及其對預后的影響[J];全科醫(yī)學臨床與教育;2012年06期

4 高飛雁;賀慧蕾;何冬梅;;參苓白術散對婦科腹部術后免疫功能的影響[J];內蒙古中醫(yī)藥;2011年23期

5 袁丕瑞;;參苓白術散對免疫抑制小鼠免疫功能的影響研究[J];臨床合理用藥雜志;2011年29期

6 侯維;孟慶華;;腸黏膜屏障功能的損傷與修復[J];中國全科醫(yī)學;2010年20期

7 張仲林;鐘玲;臧志和;辛志偉;;參苓白術散對動物胃腸動力影響的實驗研究[J];時珍國醫(yī)國藥;2009年12期

8 楊旭東;張杰;王崴;;參苓白術散對脾虛小鼠腸保護作用及其機制的研究[J];牡丹江醫(yī)學院學報;2009年05期

9 肖喜春;;免疫腸內營養(yǎng)支持對危重病患者細胞免疫功能及并發(fā)癥的影響[J];中國醫(yī)藥導報;2009年16期

10 游錦安;王明義;林澤想;;早期診治胃腸功能障礙對小兒危重癥搶救成功率的影響[J];嶺南急診醫(yī)學雜志;2007年03期

相關碩士學位論文 前1條

1 賴金枚;參苓白術散對脾胃虛弱型D-IBS患者T淋巴細胞亞群的影響[D];福建中醫(yī)藥大學;2011年

，

本文編號：1668787