增液通腑逐瘀方灌肠治疗脓毒症急性胃肠损伤的临床观察

A clinical study on using enema of Zengye Tongfu Zhuyu formulation to improve sepsis patients with acute gastrointestinal injury

目的:观察增液通腑逐瘀方灌肠治疗脓毒症急性胃肠损伤的疗效。方法:选取2016年6月~2018年8月我院重症医学病房收治的60例脓毒症合并急性胃肠损伤患者为研究对象,随机分为治疗组(30例)和对照组(30例)。两组均给予常规西医基础治疗,治疗组在常规治疗基础上给予增液通腑逐瘀方灌肠,对照组给予开塞露治疗,两组灌肠治疗均为150mL/次,2次/d,连续10天。分析比较两组治疗前后AGI分级以及中医症候评分的差异,比较两组肠内营养治疗后3d、5d的肠内营养达标率;分析比较两组于治疗前和治疗后5d、10d腹内压、序贯器官衰竭评分(SOFA)、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分以及白细胞计数、降钙素原、C反应蛋白的差异。结果:两组治疗后不同AGl分级患者数比较差异有统计学意义(Z=-2.02,P<0.05)。两组肠内营养后3d营养达标率差异不具有统计学意义(治疗组3d达标率46.7%,对照组3d达标率33.3%,P>0.05);肠内营养后5d营养达标率差异具有统计学意义(治疗组5d达标率73.3%,对照组5d达标率46.7%,P<0.05)。两组治疗5d及10d后腹内压、炎症指标及症状评分均较治疗前下降,治疗5d后,治疗组除SOFA评分外,上述指标均低于治疗前水平,差异具有统计学意义(P<0.05);治疗组腹内压、炎症指标及症状评分均低于对照组同期水平,但差异不存在统计学意义(P>0.05);治疗结束后,治疗组腹内压、炎症指标及症状评分均明显低于对照组同期水平,差异具有统计学意义(P<0.05)。治疗结束后,治疗组中医症候评分愈显率明显高于对照组,差异具有显著性(P<0.05)。结论:对脓毒症急性胃肠损伤患者早期应用增液通腑逐瘀方可以改善胃肠功能,提高早期肠内营养达标率,减低肠内营养不耐受的发生率,有利于感染的控制,进而促进病情的良性转归,改善预后。

Objective:To evaluate the influence of using Zengye Tongfu Zhuyu formulation for enema treatment of sepsis patients with acute gastrointestinal injury(AGI).Methods:Sixty sepsis patients with acute gastrointestinal injury admitted to department of intensive care unit of Tianjin academy of traditional Chinese medicine affiliated hospital from Jun 2016 to August 2018 were enrolled.They were divided into a treatment group and a control group randomly,each 30 cases.All of the groups were given the basic western medicine.Beside the basic treatment above,the treatment group were given the Zengye Tongfu Zhuyu formulation as the enema treatment.Meanwhile the control group were given Glycerin as the enema treatment.The two groups of patients enema treatment is 150mL once,2 times a day,10 consecutive days.The differences of AGI grading and TCM syndrome scores before and after treatment were compared between the two groups,and the enteral nutrition compliance rate was compared between 3 days and 5 days after enteral nutrition treatment in the two groups.Analyzed and compared of two groups of patients with intraabdominal pressure,sequential organ failure score(SOFA),Acute Physiology and chronic health status scoring systemⅡ(APACHEⅡ)score and differences in leukocyte count,calcitonin and C-reactive protein before and treatment after 5d,10d.Result:There was statistical significant difference in AGI grade between the two groups after the treatment(Z=-2.02,P<0.05).The difference between the two groups of 3day nutrition compliance rate was not statistically significant(treatment group 3d Compliance Rate 46.7%,the control group 3d Compliance Rate 33.3%,P>0.05),the difference between the two groups of 5 day nutrition compliance rate was statistically significant(treatment group 5d Compliance Rate 73.3%,the control group 5d Compliance Rate 46.7%,P<0.05).After the treatment of 5d and 10d,the abdominal pressure,inflammatory index and symptom score of the two groups were lower than before treatment,and after the treatment of 5d,exclude the score of SOFA from the above indexes,the treatment group was lower than the pre-treatment level,the difference was statistically significant(P<0.05),and the abdominal pressure in the treatment group,inflammatory index and symptom score were lower than the same level in the control group,but there was no statistically significant difference(P>0.05),after the end of treatment,The abdominal pressure,inflammatory index and symptom score of the treatment group were significantly lower than those in the control group,and the difference was statistically significant(P<0.05).The increasing rate of TCM symptom score in the treatment group was significantly higher than that in the control group,and the difference was significant(P<0.05).Conclusion:Giving the enema treatment with Zengye Tongfu Zhuyu formulation to the sepsis patients suffered AGI in the early stage could improve the gastrointestinal function,increase the rate of reaching the nutrition standard,reduce the rate of intestinal malnutrition tolerance and strengthen the control of infection.All of above can promote the postoperative recovery and improve prognosis of the sepsis patients.