电针足三里联合大承气汤敷脐对脓毒症患者肠屏障功能的保护作用

Protective Effect of Electroacupuncturing Zusanli(ST36) and Umbilical Compression with Dachengqi Decoction on Intestinal Barrier Function of Septic Patients

目的探讨电针足三里联合大承气汤敷脐对脓毒症肠功能障碍患者在降低炎症指标、保护肠黏膜屏障功能以及改善病情转归方面的影响。方法将70例脓毒症肠功能障碍(阳明腑实证)患者随机分为治疗组和对照组,每组35例。对照组给予西医的常规治疗,治疗组在常规治疗的基础上加用电针足三里联合大承气汤敷脐治疗,均治疗5天。观察两组治疗前及治疗后第1、3、7天患者降钙素原(PCT)、TNF-α、肠脂肪酸结合蛋白(IFABP)、瓜氨酸、D-乳酸以及腹内压(IAP)水平。记录患者机械通气时间、ICU住院时间及28天生存情况,并对其与炎症因子及肠功能血清标志物水平相关性进行分析。结果与本组治疗前比较,除对照组治疗后第1天TNF-α水平外,两组患者治疗后各时间点PCT、TNF-α、IFABP、D-乳酸及IAP水平均降低,瓜氨酸水平升高(P<0.05)。与本组治疗后第1天比较,两组治疗后第3、7天患者PCT、TNF-α、IFABP、D-乳酸及IAP水平均降低,治疗组瓜氨酸水平升高(P<0.05),且治疗后第7天明显优于第3天(P<0.05)。与对照组同期比较,治疗组治疗后各时间点PCT、TNF-α、IFABP、D-乳酸及IAP水平降低明显,瓜氨酸水平升高明显(P<0.05)。两组患者机械通气时间、ICU住院时间以及28天病死率比较,差异无统计学意义(P>0.05)。患者血浆IFABP、瓜氨酸、D-乳酸及IAP水平两两间互有相关性(P<0.01),并与血清PCT及TNF-α水平有相关性(P<0.01),但与机械通气及ICU住院时间无显著相关性。结论电针足三里联合大承气汤敷脐可以减轻脓毒症肠功能障碍患者的炎症反应,对脓毒症肠功能障碍患者肠屏障功能具有保护作用。

Objective To investigate the effect of the combined therapy of electroacupuncturing Zusanli（ST36） and umbilical compression with Dachengqi Decoction on septic patients with intestinal dysfunction in reducing inflammation index, protecting intestinal mucosal barrier function and improving the prognosis of disease. Methods Totally 70 septic patients with intestinal dysfunction（Yangming vis- ceral syndrome） were randomly assigned to the treatment group and the control group, 35 in each group. Patients in the control group were administered with routine treatment of Western medicine, and as for the treatment group, electroacupuncturing Zusanli （ST36） combined with umbilical compression with Dachengqi Decoction were applied based on routine treatment. All treatment course lasted for 5 days. Be- fore treatment and at 1st, 3rd and 7th day of treatment, the levels of procalcitonin / PCT）, TNF-α, intesti- nal fatty acid binding protein （IFABP）, citrulline, D-lactic acid and Intra-abdominal pressure（IAP） were observed. The duration of mechanical ventilation, stay in ICU and the 28th day survival were recorded.The correlation with the level of inflammatory factors and the serum markers of intestinal function was an- alyzed. Results Compared with before treatment, although the level of TNF-α was not significantly de- creased in the control group at 1st day of treatment, the levels of PCT, TNF-α, IFABP, D-lactic acid and lAP decreased at all time points after treatment in the two groups, and the level of citrulline increased （P 〈0.05）. Compared with the 1st day after treatment, the levels of PCT, TNF-α, IFABP, D- lactic acid and lAP decreased in the two groups at 3rd and 7th day of treatment, and the levels of citrulline were in- creased at the 3rd and 7th day after treatment, the levels of PCT, TNF-α, IFABP, D-lactic acid, citrulline and lAP were better at the 7th day than the 3rd day in the two groups（P 〈0.05）. Compared with the con- trol group, the levels of PCT, TNF-, IFABP, D-lactic acid and lAP in the treatment group all decreased and the level of citrulline increased at time points after treatment （P 〈0.05）. There were no statistical differences in duration of mechanical ventilation and stay in ICU and the 28th day mortality between the two groups （P 〉0.05）. The plasma level of IFABP, citrulline, D-lactic acid and lAP were pairwise correla- ted （P 〈0.01 ）, all of which had significant correlation with the level of serum PCT and TNF-α（P 〈0.01 ）, and there was no significant correlation with duration of mechanical ventilation and stay in ICU. Conclu- sion Electroacupuncturing Zusanli （ST36） combined with umbilical compression with Dachengqi Decoc- tion could relieve the inflammatory response and protect their intestinal barrier functions in septic patients with intestinal dysfunction.