早期泻下治疗对危重症患者胃肠功能障碍的影响

Effect of early purgative therapy on gastrointestinal dysfunction in critically ill patients

目的与传统治疗比较,观察早期泻下治疗对危重症患者胃肠功能障碍的防治作用。方法纳入危重症患者74例,随机分为早期泻下治疗组A(n=26)、泻下治疗组B(n=26)与对照组C(n=22),予相同基础治疗。B组患者内环境稳定48 h后,增加大承气汤治疗;A组患者则在入选48 h内,即增加大承气汤治疗。记录治疗前、治疗后第3、7、14天APACHEⅡ评分、MODS评分、胃肠功能评分、腹内压及ICU死亡率。数据作方差分析和χ2检验。结果治疗后A组患者死亡6例,C组死亡13例。A组胃肠功能评分第7天较治疗前下降,第14天较治疗前下降显著。第14天胃肠功能评分C组较治疗前增高,而A组、B组均较C组低。第14天A组APACHEⅡ评分较C组低,MODS评分较C组低,腹内压较治疗前、第3天、第7天低,C组腹内压较治疗前、第3天、第7天高,A组、B组均较C组下降显著,差异存在统计学意义。A组第3天血钾较C组高,第7天血钠较B组低,第14天血钠较B组、C组低。B组、C组治疗前后及组间血钾、钠、氯变化,差异无统计学意义。腹内压、胃肠功能评分与APACHEⅡ评分、MODS评分、ICU死亡率呈正相关性。结论早期泻下治疗和泻下治疗降低腹内压、胃肠功能评分、危重症评分和ICU死亡率,对危重症患者胃肠功能障碍具有防治作用,而且早期泻下治疗作用更为显著。

Objective To observe the preventive and therapeutic effect of early purgative therapy on the gastrointestinal dysfunction in critically ill patients. Methods A total of 74 cases of critically ill patients were randomly divided into early purgative therapy group （ group A, n = 26 ）, purgative therapy group （ group B, n = 26 ） and control group （ group C, n = 22 ）, all the patients received the routine treatment. Daehengqi decoction was administrated in group B when internal environment stable for 48 hours, and in group A group within 48 hours. APACHE Ⅱ score, MODS score, gastrointestinal function score,intra-abdominal pressure and ICU mortality before the treatment and 3,7,14 days after the treatment. The data were analyzed by the variance analysis and Chi square test. Results After the treatment, there were 6 patients died in group A, while 13 cases died in group C. Gastrointestinal function score in group Awas decreased when compared with that before treatmenton d7, and more significantly on d14. On d14, the gastrointestinal function score in group C increased, and was higher than that in group A and group B;On d14, APACHE Ⅱ score of group A was lower than that in group C, MODS score also was lower than that in C group;and the intra-abdominal pressure decreased when compared with that before the treatment and on d3 and d7 ; The intraabdominal pressure of group C increased as compared with that before the treatment or 3d and 7d after the treatment, which was significantly higher than that in group A and B, the difference was statistical significance. In group A, the blood potassium on d3 was higher than that in group C, and the blood sodium on d7 was lower than that in group B, and the blood sodium on d14 was lower than that in both group B and C. The difference in blood potassium, sodium and chlorine before and after treatment were not statistically significant between group B and C. Intra-abdominal pressure and gastrointestinal function score was positively correlated with APACHE score, MODS score and ICU mortality. Conclusion The purgative therapy especially early purgative therapy can reduce the intra-abdominal pressure, gastrointestinal function score, severe symptom score and mortality, have preventive and therapeutic effect on the gastrointestinal dysfunction in critically ill patients, and the effect of early purgative therapy is more significant.