增液通腑逐瘀方灌肠对脓毒症急性胃肠损伤患者肠屏障的修复作用

Repair of Zengye Tongfu Zhuyu Decoction enema therapy on intestinal barrier in septic patients with acute gastrointestinal injury

[目的]观察增液通腑逐瘀方灌肠对脓毒症患者肠屏障的修复作用。[方法]选取2016年6月-2018年8月天津市中医药研究院附属医院重症医学病房收治的60例脓毒症合并急性胃肠损伤(AGI)的患者为研究对象,按随机数字表法随机分为治疗组(30例)和对照组(30例)。对照组给予单纯西医治疗,治疗组在单纯西医治疗基础上予增液通腑逐瘀方灌肠,每次150 mL,每日2次,两组患者均以10 d为1个疗程。观察两组患者治疗前后AGI分级的差异,以及治疗前、治疗后5、10 d两组患者腹内压、中医证候积分、APACHEⅡ评分、肠屏障标记物水平以及炎症指标水平。[结果]两组患者治疗后AGI分级差异有统计学意义(P<0.05)。治疗后5、10 d,两组患者腹内压、中医证候积分、APACHEⅡ评分、肠屏障标记物水平以及炎症指标水平,均明显低于治疗前水平,其中治疗组上述指标下降更明显,与对照组同期水平比较,差异有统计学意义(P<0.05)。[结论]在单纯西医治疗基础上联合增液通腑逐瘀方灌肠对脓毒症急性胃肠损伤患者的肠屏障具有一定的改善、修复功能。

[Objective]To observe the impair of Zengye Tongfu Zhuyu Decoction enema therapy on intestinal barrier function in patients with sepsis.[Methods]Sixty septic patients with acute gastrointestinal injury admitted to department of intensive care unit of Tianjin academy of traditional Chinese medicine affiliated hospital from June 2016 to August 2018 were enrolled.They were divided into the treatment group and the control group randomly,and each had 30 cases.The patients in the control group were treated with western medicine alone,and the patients in the treatment group were treated with enema of Zengye Tongfu Zhuyu Decoction on the basis of western medicine,150 mL once,2 times a day.The patients in both groups were treated with 10 days as a course of treatment.The differences of AGI grading before and after treatment were observed.Before the treatment and at the 5th day and 10th day after treatment,the intra-abdominal pressure,TCM syndromes,APACHEⅡscore,intestinal barrier markers and inflammation markers level in the two groups were also observed.[Results]There was a statistically significant difference in AGI grading between the two groups(P<0.05).At 5th day and 10th day after treatment,the abdominal pressure,TCM syndromes,APACHEⅡscore,intestinal barrier marker level,and inflammation index level of the two groups of patients were all significantly lower than the pre-treatment level,and the above indicators in the treatment group decreased significantly.Compared with the control group,the difference was statistically significant(P<0.05).[Conclusion]On the basis of simple western medicine treatment,the combined treatment of enema of Zengye Tongfu Zhuyu Decoction can improve and repair intestinal barrier in septic patients with acute gastrointestinal injury.