發(fā)布時(shí)間：2019-04-23 09:29

【摘要】：目的:目前膿毒癥胃腸功能障礙的治療以對(duì)癥支持為主,方法單一,療效甚微。中醫(yī)藥基于整體觀念及辨證論治,在胃腸功能障礙的治療有獨(dú)特的優(yōu)勢(shì),已有研究證實(shí)其在治療膿毒癥胃腸功能障礙方面有一定的療效。但大多研究只針對(duì)某種療法進(jìn)行研究,未對(duì)中醫(yī)眾方案進(jìn)行優(yōu)化組合。本研究旨在探索中醫(yī)綜合療法對(duì)膿毒癥胃腸功能障礙的臨床療效,制定一個(gè)內(nèi)外結(jié)合、針?biāo)幉⒂玫闹嗅t(yī)綜合診療方案,以期發(fā)揮傳統(tǒng)醫(yī)學(xué)在膿毒癥治療的作用。方法:本研究采用前瞻性隨機(jī)對(duì)照的設(shè)計(jì)方法,納入2016年5月-2017年3月廣東省中醫(yī)院大學(xué)城醫(yī)院重癥醫(yī)學(xué)科(ICU)收治的膿毒癥胃腸功能障礙患者共60例。使用隨機(jī)數(shù)字表分組方法,將其分為治療組和對(duì)照組各30例。兩組均按2012年國(guó)際拯救膿毒癥指南予西醫(yī)常規(guī)處理,治療組在此基礎(chǔ)上加用中醫(yī)綜合療法(靜滴血必凈注射液、電針足三里及吳茱萸外敷神闕穴),療程均為7日。觀察兩組28天病死率、ICU住院天數(shù),治療前及治療后(第7日)的APACHE-Ⅱ評(píng)分、血白細(xì)胞(WBC)、降鈣素原(PCT)、C反應(yīng)蛋白(CRP)、血沉(ESR)、胃腸疾病中醫(yī)證候評(píng)分、胃腸功能障礙評(píng)分、胃腸動(dòng)力功能(胃動(dòng)素、胃泌素、血管活性腸肽)、胃腸免疫屏障功能(免疫球蛋白、T淋巴細(xì)胞亞群)和胃腸粘膜屏障功能(二胺氧化酶、D-乳酸)。結(jié)果:1.病情嚴(yán)重度及預(yù)后評(píng)估比較:經(jīng)治療,治療組與對(duì)照組28天病死率比較,差異無統(tǒng)計(jì)學(xué)意義(P0.05)。與對(duì)照組比較,治療組ICU住院天數(shù)明顯縮短(P0.05),治療組第7日APACHE-Ⅱ評(píng)分明顯降低(P0.05)。2.炎癥指標(biāo)比較:治療第7日,與對(duì)照組比較,治療組WBC、PCT、CRP明顯降低(P0.05);治療組與對(duì)照組ESR比較,差異無統(tǒng)計(jì)學(xué)意義(P0.05)。3.胃腸疾病中醫(yī)證侯評(píng)分比較:治療第7日,與對(duì)照組比較,治療組胃腸疾病中醫(yī)證侯評(píng)分明顯降低(P0.05)。4.胃腸功能障礙評(píng)分比較:治療第7日,與對(duì)照組比較,治療組胃腸功能障礙評(píng)分明顯降低(P0.05)。5.胃腸動(dòng)力功能指標(biāo)比較:治療第7日,與對(duì)照組比較,治療組MTL明顯升高(P0.05),治療組GAS明顯降低(P0.05);治療組與對(duì)照組VIP比較,差異無統(tǒng)計(jì)學(xué)意義(P0.05)。6.胃腸免疫屏障功能指標(biāo)比較:治療第7日,與對(duì)照組比較,治療組IgG、IgA、IgM、CD3+均明顯升高(P0.05);治療組與對(duì)照組CD4+/CD8+比較,差異無統(tǒng)計(jì)學(xué)意義(P0.05)。7.胃腸粘膜屏障功能指標(biāo)比較:治療第7日,與對(duì)照組比較,治療組DAO、D-LAC均明顯降低(P0.05)。結(jié)論:在西醫(yī)常規(guī)治療基礎(chǔ)上,應(yīng)用中醫(yī)綜合療法治療膿毒癥胃腸功能障礙,可改善病情嚴(yán)重度,縮短ICU住院天數(shù),不能改變病死率;減輕炎癥反應(yīng);改善中醫(yī)證候;改善胃腸功能,包括胃腸動(dòng)力功能、免疫屏障及粘膜屏障功能。
[Abstract]:Objective: at present, the treatment of gastrointestinal dysfunction in sepsis is mainly symptomatic support, the method is simple, and the curative effect is very little. On the basis of holistic concept and syndrome differentiation, Chinese medicine has unique advantages in the treatment of gastrointestinal dysfunction, which has been proved to be effective in the treatment of gastrointestinal dysfunction in sepsis. However, most of the studies only focus on a certain therapy, not to optimize the combination of traditional Chinese medicine schemes. The purpose of this study is to explore the clinical efficacy of traditional Chinese medicine (TCM) on gastrointestinal dysfunction in sepsis and to formulate a comprehensive diagnosis and treatment scheme of TCM combined with internal and external combination of acupuncture and medicine in order to give full play to the role of traditional medicine in the treatment of sepsis. Methods: from May 2016 to March 2017, 60 patients with gastrointestinal dysfunction due to sepsis were enrolled in (ICU), Department of critical Medicine, University City Hospital of Guangdong traditional Chinese Medicine Hospital, a prospective randomized controlled design method was used. The patients were divided into two groups: treatment group (n = 30) and control group (n = 30). The two groups were treated by western medicine according to the international rescue sepsis in 2012. On this basis, the treatment group was treated with traditional Chinese medicine comprehensive therapy (intravenous drip of Xuebijing injection, electroacupuncture of Zusanli and Evodia on Shenque point), and the course of treatment was 7 days. The mortality of 28 days, the days of hospitalization of ICU, the scores of APACHE- 鈪，

本文編號(hào)：2463340