自拟健脾调肠方加减对脓毒症患者肠内营养耐受性及免疫指标的影响

The Study of the Influence of Self-formulated Jianpi Tiaochang Decoction on Intestinal Nutritional Tolerance and Immune Indexes in Patients with Sepsis

目的观察自拟健脾调肠中药方对脓毒症患者早期肠内营养耐受性及营养指标、免疫指标的影响。方法采用前瞻性对照研究,用随机数字表法选取符合标准的脓毒症患者共40例,分为观察组和对照组,两组患者均按照脓毒症指南给予规范治疗,观察组在对照组基础上在肠内营养启动第1天开始予以中药健脾调肠方随证加减应用,治疗7 d,对两组患者年龄、性别、肠内营养开始前急性生理和慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、急性胃肠功能损伤(AGI)分级进行统计学分析;比较两组患者7 d肠内营养耐受性总积分、治疗前、后营养指标(总蛋白、白蛋白、前白蛋白)及免疫指标(CD3、CD4、CD8)。结果两组肠内营养耐受性总积分比较,观察组积分低于对照组(P<0.05);两组肠内营养治疗7 d后,营养指标(总蛋白、白蛋白、前白蛋白)及T淋巴细胞亚群指标(CD3、CD4、CD8)均较治疗前有提高,观察组提高更明显(P<0.05)。结论自拟健脾调肠中药方随证加减应用可提高脓毒症患者早期肠内营养耐受性,能改善患者营养及免疫指标,表明中药在脓毒症患者有一定应用价值。

Objective:To observe the effect of self-formulated traditional Chinese medicine Tiaochang Decoction on early enteral nutrition tolerance,nutritional indexes and immune indexes in patients with sepsis.Methods:A prospective controlled study was used to select a total of 40 patients with sepsis that met the standard by random number table method,and the patients were divided into the observation group and control group.On the first day of the start of enteral nutrition,the observation group was given the Chinese medicine Jianpi Tiaochang Decoction on the basis of the control group.After 7 days of treatment,the age,sex,APACHEⅡscores and acute gastrointestinal impairment(AGI)grading before the start of enteral nutrition were statistically analyzed;the7 d total enteral nutrition tolerance score,nutrition indicators(total protein,albumin,prealbumin)and immune indicators(CD3,CD4,CD8)of the two groups of patients were compared.Results:Comparing the total scores of enteral nutrition tolerance between the two groups,the scores of the observation group were lower than those of the control group(P<0.05);after 7 days of enteral nutrition treatment,the nutritional indicators(total protein,albumin,prealbumin)and T lymph nodes,the cell subpopulation indexes(CD3,CD4,CD8)were improved compared with before treatment,and the increases were more obvious in the observation group(P<0.05).Conclusion:The application of self-formulated Jianpi Tiaochang Decoction can increase the early enteral nutrition tolerance of patients with sepsis and improve the nutrition and immune indexes of patients with sepsis,indicating that Chinese medicine has certain application value in patients with sepsis.