大黄外敷神阙穴治疗机械通气的脓毒症患者胃肠功能障碍的应用

Application of rhubarb root and rhizome external application at Shenque in the treatment of gastrointestinal dysfunction in septic patients with mechanical ventilation

目的探讨大黄外敷神阙穴对机械通气的脓毒症患者胃肠功能障碍的影响。方法选取2019年4月至2022年4月江西省肿瘤医院收治的机械通气的脓毒症伴胃肠功能障碍患者60例,根据随机数字表法将其分为对照组和观察组,每组各30例。对照组患者给予基础常规支持治疗,观察组患者在常规治疗的同时采用大黄外敷神阙穴。比较治疗前后两组患者的白细胞介素-6(interleukin-6,IL-6)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、肠脂肪酸结合蛋白(intestinal fatty acid binding protein,IFABP)、二胺氧化酶(diamine oxidase,DAO)、D-乳酸水平、腹围、腹腔压、肠鸣音、急性生理学和慢性健康状况评价Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)评分、机械通气时间、中医证候积分及临床疗效。结果治疗后,观察组患者的IL-6、TNF-α、IFABP、DAO、D-乳酸水平、腹腔压均显著低于对照组,腹围显著小于对照组,肠鸣音次数显著多于对照组,机械通气时间显著短于对照组(P<0.05);治疗后,观察组患者的胃脘胀痛、恶心呕吐、发热、肠鸣泄泻、咳喘痰黄、下肢浮肿中医证候积分均显著低于对照组(P<0.05);观察组患者的治疗总有效率显著高于对照组(P<0.05)。结论大黄外敷神阙穴可减轻机械通气脓毒症患者体内炎性反应,改善胃肠功能,促进机体内环境稳定,缩短机械通气时间,有一定的临床疗效,值得推广。

Objective To explore the effect of rhubarb root and rhizome external application at Shenque on gastrointestinal dysfunction in septic patients with mechanical ventilation.Methods Sixty patients with sepsis and gastrointestinal dysfunction who were admitted to Jiangxi Provincial Cancer Hospital from April 2019 to April 2022 were selected and divided into control group and observation group according to the random number table method,with 30 patients in each group.The patients in control group were given basic routine supportive treatment,and the patients in observation group received rhubarb root and rhizome external application at Shenque at the same time as the conventional treatment.Interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),intestinal fatty acid binding protein(IFABP),diamine oxidase(DAO),D-lactic acid,abdominal circumference,abdominal pressure,bowel sounds,acute physiology and chronic health evaluationⅡ(APACHEⅡ)scores,duration of mechanical ventilation,TCM syndrome scores between the two groups before and after treatment and clinical efficacy were compared.Results After treatment,IL-6,TNF-α,IFABP,DAO,D-lactic acid and abdominal pressure in observation group were significantly lower than those in control group,abdominal circumference was significantly lower than that in control group,bowel sounds were significantly more frequent than those in control group,and mechanical ventilation time was significantly shorter than that in control group(P<0.05).After treatment,the scores of TCM syndromes of epigastric distention,nausea and vomiting,fever,diarrhea,cough,asthma,phlegm and edema of lower limbs in observation group were significantly lower than those in control group(P<0.05).The total effective rate in observation group was higher than that in control group(P<0.05).Conclusion Rhubarb root and rhizome external application at Shenqiu can reduce the inflammatory response in patients with mechanical ventilation of sepsis,improve gastrointestinal function,promote the stability of the internal environment of the body,shorten the duration of mechanical ventilation,which has a certain clinical effect and is worthy of promotion.