【摘要】：目的:觀察腸胃舒聯(lián)合西醫(yī)常規(guī)療法治療膿毒癥腸功能障礙患者的臨床療效,并研究其對(duì)白細(xì)胞計(jì)數(shù)(WBC)、降鈣素原(PCT)、腹腔內(nèi)壓力(IAP)、腸功能障礙評(píng)分、急性生理學(xué)及慢性健康狀況評(píng)分系統(tǒng)(APACHE II)評(píng)分的影響,探討腸胃舒對(duì)膿毒癥腸功能障礙患者的干預(yù)機(jī)制。為中西醫(yī)結(jié)合治療膿毒癥腸功能障礙提供新的思路。方法:收集2014年9月至2016年9月于河北省中醫(yī)院重癥醫(yī)學(xué)科(ICU)收住院的膿毒癥患者,篩選出符合納入標(biāo)準(zhǔn)的、感染部位明確且伴有腸功能障礙的120例患者作為研究對(duì)象,將120例膿毒癥腸功能障礙患者隨機(jī)分為治療組和對(duì)照組各60例。對(duì)照組給予西醫(yī)常規(guī)療法治療,治療組在給予西醫(yī)常規(guī)療法治療的同時(shí)給予腸胃舒1劑/日,濃煎取汁150ml,分上、下午兩次鼻飼,方中藥物有:大黃9g,蒲公英20g,當(dāng)歸15g,赤芍12g,白芍12g,川芎9g,仙鶴草20g,川黃連6g,清半夏6g,瓜蔞15g,地榆20g,茯苓20g。7d后比較兩組患者治療前后WBC、PCT、IAP、腸功能障礙評(píng)分、APACHE II評(píng)分的變化情況,評(píng)價(jià)兩組的臨床療效及安全性。結(jié)果:1基線資料比較:治療組60例患者中,男36例,女24例;年齡18-89歲,平均(55.33±14.59)歲。對(duì)照組60例患者中,男32例,女28例;年齡21-90歲,平均(56.26±13.94)歲。兩組患者的性別、年齡等一般資料比較,差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),具有可比性。2兩組患者完成治療情況比較:兩組各納入研究病例60例,治療過(guò)程中,治療組脫落1例,剔除1例,最終納入統(tǒng)計(jì)病例58例;對(duì)照組脫落4例,剔除2例,最終納入統(tǒng)計(jì)病例54例。3兩組患者臨床療效比較:治療后,治療組的總有效率為91.38%,對(duì)照組為88.89%,治療組療效優(yōu)于對(duì)照組,組間比較,差異有統(tǒng)計(jì)學(xué)意義(Z=-2.471,P0.05)。4兩組患者治療前后WBC、PCT及IAP比較:治療前,兩組患者的WBC、PCT等炎癥指標(biāo)及IAP比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);治療后,兩組患者的WBC、PCT等炎癥指標(biāo)及IAP均較治療前明顯改善(P0.01),且治療組的改善作用均優(yōu)于對(duì)照組,差異均有統(tǒng)計(jì)學(xué)意義(P0.01)。5兩組患者治療前后腸功能障礙評(píng)分、APACHEⅡ評(píng)分比較:治療前,兩組患者的腸功能障礙評(píng)分、APACHE II評(píng)分比較,差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);治療后,兩組患者的腸功能障礙評(píng)分、APACHEⅡ評(píng)分均明顯低于治療前(P0.01),且治療組的降低作用均優(yōu)于對(duì)照組,差異均有統(tǒng)計(jì)學(xué)意義(P0.01)。6不良反應(yīng):試驗(yàn)過(guò)程中,治療組有4例出現(xiàn)惡心,對(duì)照組有5例出現(xiàn)惡心,均未作處理,1周后癥狀自行消失。兩組患者的肝、腎功能均未見(jiàn)明顯異常。結(jié)論:本研究表明,在西醫(yī)常規(guī)療法治療的基礎(chǔ)上加用腸胃舒治療可減輕膿毒癥腸功能障礙患者的炎癥反應(yīng),改善腸功能障礙,并減輕膿毒癥腸功能障礙患者病情的嚴(yán)重程度。
[Abstract]:Objective: to observe the clinical efficacy of Changweishu combined with western medicine in the treatment of septic intestinal dysfunction, and to study the score of (IAP), intestinal dysfunction with leukocyte count (WBC),) and procalcitonin (PCT),) intraperitoneal pressure. Effects of acute physiology and chronic health status scoring system (APACHE II) on the interventional mechanism of Changwei Shu in patients with septic intestinal dysfunction. To provide a new idea for the treatment of sepsis intestinal dysfunction by integrated traditional Chinese and western medicine. Methods: from September 2014 to September 2016, 120 patients with sepsis were collected from (ICU) Department of intensive Medicine, Hebei traditional Chinese Medicine Hospital, and 120 patients with definite infection site and intestinal dysfunction were selected as study objects. 120 patients with septic intestinal dysfunction were randomly divided into treatment group and control group. The control group was treated with routine western medicine therapy, while the treatment group was given 1 dose / day of Changwei Shu while the treatment group was given two times nasal feeding in the afternoon. The drugs included: rhubarb 9g, dandelion 20g, Angelica sinensis 15g, Radix Paeoniae lanceolata 12g, White Peony 12g, Chuanxiong 9g, Herba Celestrae 20g, Chuanghuanglian 6g, Prunus ternata 6g, Trichosanthes 15g, Ulmus pumila 20g, Poria cocos 20g.7d. The changes of WBCPCTTIAPs, intestinal dysfunction score and Apache II were compared between the two groups before and after treatment. To evaluate the clinical efficacy and safety of the two groups. Results comparison of baseline data with 1: 1: in the treatment group, there were 36 males and 24 females, aged 18-89 years with an average age of (55.33 鹵14.59) years. In the control group, there were 32 males and 28 females, aged 21-90 years (mean 56.26 鹵13.94 years). There was no significant difference in sex, age and other general data between the two groups (P0.05). 2 comparison of the two groups: 60 cases were included in the study, and 1 case was lost in the treatment group. One case was eliminated, 58 cases were included in the statistics, 4 cases dropped out in the control group, 2 cases were eliminated, and 54 cases were included in the statistical case. 3 the clinical curative effect of the two groups was compared: after treatment, The total effective rate of the treatment group was 91.38 and that of the control group was 88.89.The curative effect of the treatment group was better than that of the control group. The difference between the two groups was statistically significant (P 0.05). 4 comparison of IAP and WBC before and after treatment: before and after treatment, the inflammatory indexes and IAP of the two groups were compared. There was no significant difference between the two groups (P0.05). After treatment, the inflammatory indexes such as WBC, PCT and IAP in the two groups were significantly improved compared with those before treatment (P0.01), and the improvement of the treatment group was better than that of the control group. The difference was statistically significant (P0.01) .5 before and after treatment, the intestinal dysfunction score and Apache 鈪，

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