中医综合方案治疗抗生素相关性腹泻46例临床研究

Clinical Observation on TCM Comprehensive Treatment for 46 Cases of Antibiotic-Associated Diarrhea

目的观察中医综合方案治疗重症监护病房(ICU)内抗生素相关性腹泻(AAD)的临床疗效。方法收集ICU住院期间出现AAD的患者90例,随机分为治疗组46例,对照组44例。两组均给予内科基础治疗,治疗组中脾肾阳虚证给予加味胃关煎;风湿相搏、正虚邪犯证给予加味人参败毒散治疗,每日1剂,分4次鼻饲或口服。对照组给予金双歧20000万IU、甲硝唑400mg或万古霉素0.5g鼻饲或口服,每日3次。两组均治疗7天,观察两组患者治疗腹泻的起效时间、腹泻程度积分、临床疗效。结果治疗组患者药物起效时间[(2.64±1.79)d]早于对照组[(3.77±1.45)d](P<0.05)。两组治疗后腹泻程度积分第3、5、7天与治疗后第1天比较差异均有统计学意义(P<0.05或P<0.01);治疗组与对照组治疗后第3、5、7天比较,差异均有统计学意义(P<0.05或P<0.01)。治疗组临床疗效总有效率91.3%,对照组总有效率63.64%,两组比较差异有统计学意义(P<0.05)。结论中医综合方案治疗ICU内AAD可明显缩短药物起效时间,降低腹泻程度积分,提高临床疗效。

Objective To observe the therapeutic effect of TCM comprehensive treatment on antibiotic-associated diarrhea（AAD）in intensive care unit（ICU）.Methods Ninety cases of AAD in 3ICUs were randomized into treatment group of 46 cases and control group of 44cases.Both groups were given basic medical treatment.The treatment group was nasally fed or orally taken corresponding formula according to syndrome pattern 4times daily.Jiawei Weiguan Brew（Supplemented Stomach Gate Brew）was given to the patients with spleen-kidney yang deficiency pattern.Jiawei Renshen Baidu Powder（Supplemented Ginseng Toxin-Vanquishing Powder）was given to the patients with wind-damp mutual contention and right deficiency evil invading pattern.The control group was nasally fed or orally taken 200million IU Jinshuangqi（Combined Bifidobacterium,Lactobacillus and Streptococcus Thermophilus Tablet）,400mg metronidazole or 0.5g vancomycin three times daily.Both groups were treated for 7days.The onset time,diarrhea degree integral and comprehensive therapeutic effect was observed.Results The effect-initiating time in the treatment group was（2.64±1.79）d,significantly shorter than that in the control group of（3.77±1.45）d,with significant difference（P〈0.05）.The diarrhea degree integrals on the 3rd,5th and 7th day after treatment were significantly lower than those on the 1st day after treatment in both groups（P〈0.05or P〈0.01）,especially in the treatment group（P〈0.05or P〈0.01）.The total effective rate of the treatment group and control group was 91.3%and 63.64%respectively,with significant difference between groups（P〈0.05）.Conclusion TCM comprehensive treatment for AAD in ICU can obviously shorten the effect-initiating time,decrease the diarrhea integral and improve therapeutic effect.