养阴通络方辅助西医常规疗法治疗脓毒症胃肠功能障碍56例前瞻性队列研究

Prospective Cohort Study on Yangyin Tongluo Fang (养阴通络方) Combined with Conventional Western Medicine Therapy in Treatment of 56 Cases of Gastrointestinal Dysfunction in Sepsis

目的评价养阴通络方辅助西医常规疗法治疗脓毒症胃肠功能障碍的临床疗效。方法采用前瞻性队列研究方法,纳入120例脓毒症胃肠功能障碍患者,按患者意愿将自愿采用常规西医疗法的60例患者作为对照组,自愿采用养阴通络方联合常规西医疗法治疗的60例患者作为治疗组,两组均治疗14d。比较两组患者治疗前后急性生理及慢性健康状况评价Ⅱ(APACHEⅡ)评分、胃肠功能障碍评分、血小板计数(PLT)及血浆降钙素原(PCT)、D-二聚体水平,并评价两组临床疗效。结果治疗组最终纳入统计病例56例,对照组58例。治疗组临床疗效总有效率为92. 86%,高于对照组的79. 31%(P <0. 05)。治疗后两组患者APACHEⅡ评分、胃肠功能障碍评分、血浆PCT水平均较治疗前降低,且治疗组改善优于对照组(P <0. 01)。治疗后治疗组患者D-二聚体水平较治疗前明显下降,PLT水平升高(P <0. 01),对照组D-二聚体、PLT水平与治疗前比较差异无统计学意义(P> 0. 05)。治疗后治疗组D-二聚体水平显著低于对照组,PLT水平高于对照组(P <0. 01)。结论养阴通络方辅助西医常规疗法治疗脓毒症胃肠功能障碍疗效优于西医常规疗法,可改善患者炎症反应、凝血功能及胃肠功能障碍。

Objective To evaluate the clinical efficacy of Yangyin Tongluo Fang( 养阴通络方,YYTLF) combined with conventional western medicine therapy in the treatment of gastrointestinal dysfunction in sepsis. Methods Prospective cohort study method was conducted,and 120 patients with gastrointestinal dysfunction of sepsis were included. Sixty patients who voluntarily adopted the routine western medicine therapy were set as the control group according to the patient’s wishes,and 60 patients who were treated with YYTLF combined with conventional western medicine therapy were set as the treatment group. Both groups were treated for 14 days. The acute physiological and chronic health assessment Ⅱ( APACHE Ⅱ) score,gastrointestinal dysfunction score,platelet count( PLT),plasma procalcitonin( PCT),and D-dimer levels were compared between groups before and after treatment,and the clinical efficacy of the 2 groups was compared. Results There were 56 patients in the treatment group and 58 in the control group finally analyed statistically. The total effective rate of the treatment group was 92. 86%,which was higher than79. 31% of the control group( P < 0. 05). After treatment,the APACHE Ⅱ score,gastrointestinal dysfunction score,and plasma PCT level were decreased than those before treatment,and the improvement of the treatment group was better than that of the control group( P < 0. 01). After treatment,the level of D-dimer in the treatment group was significantly lower than that before treatment,and the level of PLT was increased( P < 0. 01),while there was no significant difference in D-dimer and PLT levels in the control group( P > 0. 05). After treatment,the level of D-dimer in the treatment group was significantly lower than that in the control group,and the PLT level was higher than that in the control group( P < 0. 01). Conclusion YYTLF combined with conventional western medicine therapy in the treatment of gastrointestinal dysfunction in sepsis is superior to conventional western medicine therapy in improving the inflammatory response,coagulation function and gastrointestinal dysfunction.