【摘要】：目的：本研究旨在研究四逆湯對腎陽虛危重癥患者甲狀腺功能的影響。通過研究患者外周血甲狀腺激素及血清白蛋白的變化情況,初步評價四逆湯對腎陽虛危重癥患者甲狀腺功能的影響,并探討其可能的機(jī)制,可為中醫(yī)藥微觀治療腎陽虛危重癥患者提供新的思路和參考。方法：采用前瞻、隨機(jī)、單盲、對照研究,對2015年3月-2016年3月入住廣州中醫(yī)藥大學(xué)第一附屬醫(yī)院ICU、CCU 46名住院危重癥患者進(jìn)行調(diào)查,按照納入標(biāo)準(zhǔn)、排除標(biāo)準(zhǔn)1：1隨機(jī)分成對照組及治療組。所有納入研究的患者在血流動力學(xué)穩(wěn)定、內(nèi)環(huán)境趨于穩(wěn)態(tài)、無腸內(nèi)營養(yǎng)禁忌癥的情況下,早期開始鼻飼腸內(nèi)營養(yǎng)(24-48小時),治療組同時用胃管／鼻空腸管灌入四逆湯50ml bid,療程共7天。分別收集患者的四診資料,并記錄患者予以四逆湯干預(yù)前一天和第七天外周血甲功五項(xiàng)(TSH、FT3、FT4、 TT3、TT4)、白蛋白、急性生理學(xué)與慢性健康狀況Ⅱ (APACHE Ⅱ)評分,采用SPSS20.0統(tǒng)計軟件包進(jìn)行數(shù)據(jù)處理。計量資料用均數(shù)±標(biāo)準(zhǔn)差表示(X±s),兩組均數(shù)的比較用t檢驗(yàn),組內(nèi)治療前后比較用配對t檢驗(yàn),計數(shù)資料采用秩和檢驗(yàn),相關(guān)性比較采用直線相關(guān)分析,P0.05.為差異有統(tǒng)計學(xué)意義。通過相關(guān)統(tǒng)計學(xué)計算,評估四逆湯對腎陽虛危重癥患者甲狀腺功能的影響。結(jié)果：治療組23例,對照組23例。研究前治療組與對照組的性別構(gòu)成比、年齡、APACHE Ⅱ評分等指標(biāo)差異無統(tǒng)計學(xué)意義,治療前治療組與對照組所測得TT3、TT4、FT3、FT4、TSH和ALB的變化無明顯差異。治療7天后,研究組與治療組TT3、TT4、FT3和FT4的變化均明顯提升,治療組高于對照組。治療組總體療效優(yōu)于對照組,并且腸內(nèi)營養(yǎng)不耐受的胃腸道并發(fā)癥少于對照組。結(jié)論：①四逆湯能夠有效改善腎陽虛危重癥患者甲狀腺功能,特別是合并有心力衰竭患者效果更優(yōu)；②低蛋白血癥對于NTIS發(fā)病機(jī)制密切相關(guān)；③甲狀腺激素動態(tài)變化能夠作為患者病情、預(yù)后分析的危險因素之一,特別是與其他預(yù)后因素相結(jié)合,能提高對患者病情危險性的判斷。
[Abstract]:Objective: to study the effect of Sini decoction on thyroid function in severe patients with deficiency of kidney-yang. By studying the changes of thyroid hormone and serum albumin in peripheral blood of patients, the effect of Sini decoction on thyroid function in patients with severe deficiency of kidney yang was evaluated, and the possible mechanism was discussed. It can provide new ideas and references for micro-treatment of critical patients with deficiency of kidney yang. Methods: a prospective, randomized, single-blind, controlled study was conducted on 46 ICU,CCU patients admitted to the first affiliated Hospital of Guangzhou University of traditional Chinese Medicine from March 2015 to March 2016. The exclusion criteria were randomly divided into control group and treatment group at 1:1. All patients in the study started nasogastric enteral nutrition (24-48 hours) at an early stage with stable hemodynamics, homeostasis, and no contraindications for enteral nutrition. The treatment group was treated with 50ml bid, for 7 days. The data of four diagnoses were collected, and the scores of five items (TSH,FT3,FT4, TT3,TT4), albumin, acute physiology and chronic health status 鈪，

本文編號：2414453