通腑颗粒治疗MODS胃肠功能障碍140例

Efficacy of Tongfu granules in treatment of grastrointestinal dysfunction in patients with multiple organ dysfunction syndromes:an analysis of 140 cases

目的:观察通腑颗粒治疗MODS时胃肠功能障碍的临床疗效.方法:采用前瞻性、多种心、临床随机对照研究方法,收集10家北京三级医院ICU病房符合入选标准的140例患者,随机分为A组和B组,分别以加斯清和通腑颗粒治疗.于入选后0h、给药后48h、第7天或死亡前,观察患者肠鸣音及腹部B超肠管积气、积液的情况;抽血并测定血浆内毒素含量、血浆二胺氧化酶(DAO)活性及血浆D-乳酸水平;进行两组胃肠功能评分的比较.结果:治疗第7天加斯清组与通腑颗粒组患者肠鸣音(2.29±1.685次/minvs3.62±1.762次/min,P<0.01),腹部B超积气或积液阳性率(34.4%vs13.5%,P<0.05),血浆内毒素(180±30EU/Lvs111±21EU/L,P<0.05),血浆DAO(4.45±1.67μkat/Lvs3.17±0.83μkat/L,P<0.01),血浆D-乳酸(14.594±2.022mg/Lvs10.49±4.185mg/L,P<0.05),胃肠功能评分(0.407±0.12vs1.32±0.14,P<0.01),各项监测指标差异显著.结论:通腑颗粒能够明显促进MODS时胃肠功能障碍患者肠蠕动,改善肠黏膜屏障功能.

AIM： To observe the effect of Tongfu granules on the intestinal dysfunction of patients with multiple organ dysfunction syndromes （MODS）. METHODS： Prospective, multi-center and randomized controlled trial was used in this study. A total of 140 patients selected from the ICU of 10 hospitals in Beijing were randomly divided into group A and B, treated with Mosapride Citrate and Tongfu granules, respectively. The experimental indexes, including peristaltic sound, the condition of pneumatosis and fluid in intestine （performing abdominal B-type ultrasound）, serum endotoxin, diamine oxidase （DAO）, D-lactic acid were observed at the 0, 48^th hour, and the 7^th day after treatment （or before death）, respectively, and the scores for intestinal dysfunction were compared between the two groups according to Lushan meeting criteria in 1995. RESULTS： At the 7^th day after treatment, the ratio of peristaltic sound （beat/min）, the positive ratio of abdominal B-type ultrasound for pneumatosis and fluid, the levels of serum en- dotoxin, serum DAO, serum D-lactic acid, and intestinal dysfunction scores were significantly different between group A and B （2.29 ± 1.685 vs 3.62 ± 1.762, P 〈 0.01; 34.4% vs 13.5%, P 〈 0.05; 180 ± 30 EU/L vs 111 ± 21 EU/L, P 〈 0.05; 4.45 ± 1.67 μkat/L vs 3.17 ± 0.83 μkat/L, P 〈 0.01; 14.594 ± 2.022 mg/L vs 10.49 ± 4.185 mg/L, P 〈 0.05; 0.41± 0.12 vs 1.32 ± 0.14, P 〈 0.01）. CONCLUSION： Tongfu granules can obviously promote intestinal motility and improve intestinal mucosal barrier function.