早期通里攻下治疗对危重症患者胃肠激素的影响

Tongli Gongxia Treatments Effect on Gastrointestinal Hormones in Critically Ill Patients at Early Stage

目的:观察早期通里攻下治疗对危重症患者胃肠激素的影响,探究其防治胃肠功能障碍的可能机制。方法:纳入危重症患者74例,随机分为早期通里攻下组(n=26)、通里攻下组(n=26)与对照组(n=22),予相同基础治疗。通里攻下组病人内环境稳定48 h后,增加大承气汤通里攻下治疗;早期通里攻下组病人则在入选48h内,即增加大承气汤通里攻下治疗。记录治疗前、治疗后第3、7、14天胃动素、胃泌素、肠型脂肪酸结合蛋白、APACHEⅡ、MODS、胃肠功能评分、腹内压及ICU死亡率。结果:治疗后早期通里攻下组与通里攻下组比较治疗前胃动素、胃泌素增高,肠型脂肪酸结合蛋白、APACHEⅡ、MODS、胃肠功能评分、腹内压下降,并且这种变化在早期通里攻下组更为显著(P<0.01或P<0.05);对照组治疗后胃动素、胃泌素下降,肠型脂肪酸结合蛋白、APACHEⅡ、MODS、胃肠功能评分、腹内压增高。早期通里攻下组与通里攻下组比较对照组胃动素、胃泌素增高,肠型脂肪酸结合蛋白、APACHEⅡ、MODS、胃肠功能评分、腹内压及死亡率降低,同样存在统计学差异(P<0.01或P<0.05),并且早期通里攻下组亦更为显著。结论:早期通里攻下和通里攻下治疗降低腹内压、胃肠功能评分、危重症评分和死亡率,对胃肠功能障碍具有防治作用,而且早期通里攻下作用更为显著,其机制可能与促进危重症患者胃动素、胃泌素分泌,从而增强胃肠蠕动,减轻肠缺血相关。

Objective： To observe the Tongli Gongxia treatments effect on gastrointestinal hormones in critically ill patients at early stage and to investigate the possible mechanism of the preventive and therapeutic effect on the gastrointestinal dysfunction. Methods： A total of 74 cases of critically ill patients were randomly divided into early Tongli Gongxia treatment group（ n = 26）,Tongli Gongxia treatment group（ n = 26） and control group（ n = 22）. They received the same basic treatment. Tongli Gongxia treatment group after 48 hours used Dachengqi Decoction. The early Tongli Gongxia treatment group used Dachengqi Decoction within 48 hours. We recorded motilin,gastrin,intestinal fatty acid binding protein,APACHEII,MODS,gastrointestinal function score,intra- abdominal pressure and ICU mortality before treatment and 3,7,14 days after treatment. Results： After treatment,motilin and gastrin in early Tongli Gongxia treatment group and Tongli Gongxia treatment group increased and intestinal fatty acid binding protein,APACHEII,MODS,gastrointestinal function score and intra- abdominal pressure decreased and the changes in the early Tongli Gongxia treatment group were more significant（ P〈 0. 01 or P〈 0. 05）. In the control group,motilin and gastrin decreased and intestinal fatty acid binding protein,APACHEII,MODS,gastrointestinal function score and intra- abdominal pressure increased. Compared with control group,early Tongli Gongxia treatment group and Tongli Gongxia treatment group＇s motilin and gastrin increased and intestinal fatty acid binding protein,APACHEII,MODS,gastrointestinal function score,intra- abdominal pressure and mortality decreased. There was also significant difference（ P〈 0. 01 or P〈 0. 05） and early Tongli Gongxia treatment group was also more obvious. Conclusion： Early Tongli Gongxia treatment and Tongli Gongxia treatment can reduce intra-abdominal pressure,gastrointestinal function score,severe symptom score and mortality and have effect of prevention and treatment of gastrointestinal dysfunction. And early Tongli Gongxia treatment is more significant and its mechanism may be related to promoting the secretion of motilin and gastrin in critically ill patients,thereby enhancing the gastrointestinal peristalsis,reducing intestinal ischemia.