黄连解毒汤对脓毒症患者肠内营养供给量及营养支持时间的影响

Effect of Huanglian Jiedu Decoction on enteral nutrition supply and nutritional support time in patients with sepsis

目的研究黄连解毒汤对脓毒症患者肠内营养不耐受的情况发生和供给量及营养支持时间的影响。方法选取2018年1月~2019年9月收住诸暨市中医院ICU的符合“毒热证和瘀血证”的脓毒症患者78例,随机分为对照组(常规西医治疗)与干预组(黄连解毒汤治疗),每组各39例,分析两组患者肠内营养热卡达标率,目标热卡达标时间,血清清蛋白、前白蛋白、血红蛋白和转铁蛋白的各项营养指标,并观察机械通气时间、ICU住院时间和60 d死亡率的整体预后指标。结果对照组喂养不耐受总发生率为66.67%,干预组为23.08%,干预组明显低于对照组(P<0.05)。对照组与干预组的耐受情况相比,第10天、第14天,干预组耐受情况明显升高(P<0.05)。干预组患者血清清蛋白、前白蛋白、血红蛋白、转铁蛋白水平在第7天、第10天和第14天显著高于对照组(P<0.05)。干预组患者机械通气时间、ICU住院时间明显短于对照组(P<0.05),干预组患者60 d病死率低于对照组,但差异无统计学意义(P>0.05)。结论黄连解毒汤能减少肠内营养不耐受的发生,早期达到目标热卡,改善患者的营养状况,缩短机械通气时间和ICU住院时间。

Objective To study the effect of Huanglian Jiedu Decoction on the incidence of enteral nutritional intolerance,the supply amount and nutritional support time in patients with sepsis.Methods A total of 78 sepsis patients with"toxic heat syndrome and blood stasis syndrome"who were admitted to the ICU in Zhuji Traditional Chinese Medicine Hospital from January 2018 to September 2019 were randomly divided into the control group(treated with conventional western medicine treatment),the intervention group(treated with Huanglian Jiedu Decoction),with 39 cases in each group.The intestinal nutritional heat calories compliance rate,target heat calories compliance time,albumin,prealbumin,hemoglobin,and transferrin in the two groups were analyzed.Overall prognostic indicators of mechanical ventilation time,ICU hospital stay,and 60-day mortality were observed.Results Comparative analysis of feeding intolerance in the two groups showed that the incidence of feeding intolerance in the control group was 66.67%,the incidence of feeding intolerance in the intervention group was 23.08%,and the incidence of feeding intolerance of the intervention group was lower than the control group(P<0.05).Compared with that of the control group,the tolerance of the intervention group increased significantly on the 10th and 14th days(P<0.05).The levels of albumin,prealbumin,hemoglobin,and transferrin in the intervention group were significantly higher than those in the control group on the day 7,10,and 14(P<0.05).The mechanical ventilation time and ICU hospitalization time in the intervention group were significantly lower than those in the control group(P<0.05),and the 60-day mortality rate was lower in the intervention group than in the control group,but there was no significant difference(P>0.05).Conclusion Huanglian Jiedu Decoction can reduce the incidence of enteral nutrition intolerance,reach the target heat calories early,improve the nutritional status of patients,shorten the mechanical ventilation time and ICU hospitalization time.