温阳通腑活血化瘀法治疗ICU腹腔高压患者的临床疗效观察

Observation on clinical efficacy of warming yang and clearing hollow viscera and activating blood circulation to eliminate blood stasis in treatment of patients with intra-abdominal hypertension in intensive care unit

目的 观察温阳通腑、活血化瘀法对重症医学科（ICU）腹腔高压（IAH）患者临床疗效的影响.方法 采用随机、对照、单盲的方法,选择2016年9月至2018年3月在成都中医药大学附属医院ICU住院过程中出现IAH的56例危重患者,按随机数字表法分为对照组和中药治疗组,每组28例.两组常规治疗方法相同;中药治疗组在常规治疗基础上给予温阳通腑、活血化瘀中药大黄附子细辛汤合大承气汤和活络效灵丹（生大黄30 g、酒军30 g、制附片30 g、细辛9 g、芒硝30 g、枳实15 g、厚朴15 g、丹参30 g、当归15 g、乳香5 g、没药5 g）50 mL鼻饲或口服、每4 h 1次,150 mL灌肠、每6 h 1次;两组疗程均为5 d.观察两组患者治疗前后腹腔压力（IAP）的变化及腹腔间室综合征（ACS）发生率.结果 两组治疗后IAP均较治疗前降低,以中药治疗组的降低程度较对照组更显著〔mmHg（1 mmHg=0.133 kPa）：12.03±5.05比16.78±8.05,P〈0.05〕;中药治疗组ACS发生率明显低于对照组〔17.9％（5/28）比42.9％（12/28）,P〈0.05〕.结论 温阳通腑、活血化瘀法能有效降低IAH患者IAP,减少ACS发生率.

Objective To observe the effect of traditional Chinese medicine （TCM） for warming yang and clearing hollow viscera, activating blood circulation to eliminate blood stasis on clinical efficacy of treatment of patients with intra-abdominal hypertension （IAH） in intensive care unit （ICU）. Methods A randomized controlled single- blind approach was conducted. Fifty-six critically ill patients with IAH admitted to the ICU of the Affiliated Hospital of Chengdu University of TCM from September 2016 to March 2018 were enrolled, and they were divided into a control group and a TCM treatment group according to the random number table method, with 28 patients in each group. The patients of the two groups were treated with the same conventional therapy; the TCM treatment group was additionally treated with TCM methods for warming yang, clearing the hollow viscera, activating blood circulation to eliminate blood stasis, and practically, Dachengqi decoction, Dahuang Fuzi Xixin decoction and Huoluoxiaoling panacea were used （ingredients： raw rhubarb 30 g, prepared radix et rhizoma rhei 30 g, processed sliced radix aconiti lateralis 30 g, asarum 9 g, mirabilite 30 g, immature bitter orange 15 g, mangnolia offieinalis 15 g, the root of red-rooted salvia 30 g, angelica sinensis 15 g, frankincense 5 g, myrrh 5 g） 50 mL decoction q4 hours nasogastric feeding or oral administration, 150 mL enema q6 hours. The entire course of treatment was 5 days in both groups. The changes in intra-ahdominal pressures （IAP） were detected before and after treatment and the incidence of abdominal compartment syndrome （ACS） was observed in the two groups. Results After treatment, the levels of IAP in two groups were decreased, and the degree of decrease in the TCM treatment group was more significant than that of the control group [mmHg （1 mmHg = 0.133 kPa）： 12.03 ± 5.05 vs. 16.78 ± 8.05, P 〈 0.05]; the incidence of ACS in the TCM treatment group was obviously lower than that in the control group [17.9% （5/28） vs. 42.9% （12/28）, P 〈 0.05]. Conclusion The TCM methods of warming yang, clearing hollow viscera, activating blood circulation and eliminating blood stasis can effectively reduce intra-abdominal pressure and reduce the incidence of ACS.