自拟胃肠复苏汤治疗脓毒症胃肠功能障碍的临床研究

Self-made Chinese Medicine Weichang Fusu Decoction on Gastrointestinal Dysfunction in Sepsis

目的观察自拟胃肠复苏汤治疗脓毒症胃肠功能障碍患者临床疗效并探讨其作用机制。方法100例患者按随机数字表法分组为对照组与观察组各50例。对照组严格按照常规脓毒症治疗相关措施进行治疗,观察组在对照组治疗基础上加用自拟胃肠复苏汤口服和灌肠治疗。分别于治疗前、治疗7 d后比较两组急性生理和慢性健康评分(APACHEⅡ评分)、序贯器官衰竭评分(SOFA评分),并检测两组C反应蛋白(CRP)、白细胞计数(WBC)、降钙素原(PCT)水平,记录两组治疗前后腹围、肠鸣音次数、胃肠功能障碍评分、腹内压、便潜血,记录两组28 d内死亡人数及平均住院时间;观察两组治疗安全性。结果观察组28 d死亡率为28.00%,低于对照组的36.00%(P<0.05)。观察组平均住院时间短于对照组(P<0.05)。两组治疗后APACHEⅡ评分、SOFA评分均较治疗前下降,且观察组各评分下降程度均较对照组更显著(均P<0.05);两组治疗后WBC、CRP、PCT水平较治疗前均下降,且观察组各炎症指标水平下降较对照组更显著(均P<0.05);且观察组治疗后胃肠功能障碍评分低于对照组(P<0.05);两组治疗后腹围、腹腔内压较治疗前下降,而且观察组腹围、腹腔内压下降程度较对照组明显(均P<0.05),而观察组治疗后肠鸣音次数则较治疗前增加(P<0.05)。观察组治疗后便潜血试验阳性率为2.00%,低于对照组的14.0%(P<0.05)。两组治疗期间均未见明显不良反应。结论自拟中医胃肠复苏汤口服和灌肠治疗脓毒症胃肠功能障碍,可更好地改善患者临床症状,控制炎症反应,加速胃肠功能恢复,降低腹腔内压,同时还有助于促进患者胃肠黏膜修复,且安全性较好。

Objective:To investigate Weichang Fusu Decoction for oral and enema on patients with gastrointesti⁃nal dysfunction of sepsis.Methods:100 patients were randomly divided into the control group and the observa⁃tion group,50 cases in each.The control group was treated in strict accordance with the relevant measures of sep⁃sis treatment.On this basis,the observation group was treated with Weichang Fusu Decoction for oral and enema.The APACHE II score and SOFA score were compared before treatment and 7 days after treatment,and the levels of CRP,WBC and PCT were measured.The abdominal circumference of the two groups were recorded before and after treatment.The number of bowel sounds,gastrointestinal dysfunction score,intra-abdominal pressure,and fe⁃cal occult blood were recorded.The number of deaths and the average hospital stay in the two groups were record⁃ed within 28 days.The safety of the two groups was observed.Results:The 28 day mortality rate of the observa⁃tion group was 28.00%,lower than that of the control group(36.00%)(P<0.05).The average hospitalization time of the observation group was shorter than that of the control group(P<0.05).There was no significant difference in APACHE II score and SOFA score between the two groups before treatment(P>0.05).They decreased after treatment,and the decrease degree of the observation group was more significant than that of the control group(P<0.05).There was no significant difference in the levels of inflammatory factors between the two groups before treat⁃ment(P>0.05);after treatment,the levels of WBC,CRP and PCT were lower than before treatment,and those in the observation group were lower than those in the control group(P<0.05).There was no significant difference in the score of gastrointestinal dysfunction between the two groups before treatment(P>0.05),and those in the obser⁃vation group were lower than those in the control group after treatment(P<0.05).After treatment,the peritoneum and intra-abdominal pressure of the two groups decreased,and the degree of the observation group was significant⁃ly lower than that of the control group(P<0.05),while the number of bowel sounds in the observation group in⁃creased after the treatment(P<0.05).The positive rate of fecal occult blood test in the observation group was 2.00%,lower than that in the control group(14.00%)(P<0.05).No obvious adverse reactions were found in the two groups.Conclusion:Weichang Fusu Decoction for oral and enema on patients with gastrointestinal dysfunc⁃tion of sepsis can better improve their clinical symptoms,control the inflammatory response,accelerate the improve⁃ment of gastrointestinal function,reduce intra-abdominal pressure,helpful to promote the repair of gastrointestinal mucosa in patients,with good safety.