香砂平胃汤辅助治疗缺血性脑卒中后胃肠功能障碍临床研究

Clinical study of Xiangsha-Pingwei Decoction in treatment of gastrointestinal dysfunction after ischemic stroke

目的评价香砂平胃汤辅助治疗缺血性脑卒中后胃肠功能障碍的临床疗效。方法将符合入选标准的2016年8月-2019年8月本院缺血性脑卒中后胃肠功能障碍患者120例按治疗方法分为2组,每组60例。对照组给予常规对症治疗,观察组在对照组基础上口服香砂平胃汤。2组均治疗2周。采用ELISA法检测血清降钙素原(procalcitonin, PCT)、CRP、降钙素基因相关肽(calcitonin gene related peptide, CGRP)、促胃液素(gastrin, GAS)、促胃动素(motilin, MTL)、生长抑素(somatostatin, SS)水平;采用滴注法将粪便标本接种至细菌培养基中行定量、定性检测,进行乳酸杆菌、肠球菌、双歧杆菌、肠杆菌计数;观察并记录患者肠鸣音恢复时间、首次排气时间及肠内营养耐受时间,评价临床疗效。结果观察组总有效率为91.67%(55/60)、对照组为78.33%(47/60),2组比较差异有统计学意义(χ2=4.183,P=0.041)。观察组肠鸣音恢复时间、首次排气时间、肠内营养耐受时间均早于对照组(t值分别为7.147、16.512、11.039,P值均<0.001)。治疗后,观察组血清PCT[(2.94±0.17)μg/L比(3.85±0.29)μg/L,t=20.969]、CGRP[(124.02±22.56)ng/L比(140.45±31.05)ng/L,t=3.316]、CRP[(4.12±0.91)mg/L比(5.89±1.11)mg/L,t=9.552]水平均低于对照组(P<0.01);血清GAS[(128.74±28.54)ng/L比(105.88±25.98)ng/L,t=4.588]、MTL[(251.02±35.22)ng/L比(205.14±31.47)ng/L,t=7.524]水平高于对照组(P<0.01);SS[(6.59±1.01)μg/L比(7.85±1.23)μg/L,t=6.132]水平低于对照组(P<0.01)。观察组治疗后乳酸杆菌、双歧杆菌计数高于对照组(t值分别为12.478、14.128,P值均<0.001);肠球菌、肠杆菌计数低于对照组(t值分别为16.593、16.315,P值均<0.001)。结论香砂平胃汤辅助治疗可改善缺血性脑卒中后胃肠功能障碍患者的胃肠激素、PCT、CGRP、CRP水平,平衡肠道菌群,提高疗效。

Objective To evaluate the efficacy of Xiangsha-Pingwei Decoction in the treatment of gastrointestinal dysfunction after ischemic stroke.Methods From August 2016 to August 2019,a total of 120 patients with gastrointestinal dysfunction after ischemic stroke were divided into 2 groups,60 in each group.The control group was given routine treatment,and the observation group was given Xiangsha-Pingwei Decoction on the basis of the control group.Both groups were treated for 2 weeks.Serum procalcitonin(procalcitonin,PCT),CRP levels,calcitonin gene-related peptides(CGRP),gastrin(GAS),motilin(MTL),and somatostatin(SS)level were detected by ELISA method.A quantitative and qualitative test was performed on the bacterial culture medium(Sigma,Record Lactobacillus,Enterococcus,Bifidobacterium bacilli and enterobacter count).The recovery time of bowel sounds,the first exhaust time and the time of enteral nutrition tolerance were observed and recorded,and the clinical efficacy was evaluate.Results The total effective rate in the observation group was 91.67%(55/60)and the control group was 78.33%(47/60).The difference between the two groups was statistically significant(χ2=4.183,P=0.041).The recovery time,first exhaust time and enteral nutrition tolerance time of the observation group were significantly earlier than those in the control group(t values were 7.147,16.512,11.039,respectively,all Ps<0.001).After treatment,serum PCT(2.94±0.17μg/L vs.3.85±0.29μg/L,t=20.969),CGRP(124.02±22.56 ng/L vs.140.45±31.05 ng/L t=3.316),CRP(4.12±0.91 mg/L vs.5.89±1.11 mg/L,t=9.552)of the observation group were significantly lower than those in the control group(P<0.01),while the serum GAS(128.74±28.54 ng/L vs.105.88±25.98 ng/L,t=4.588),MTL(251.02±35.22 ng/L vs.205.14±31.47,t=7.524)were significantly higher than those in the control group(P<0.01),and SS(6.59±1.01µg/L vs.7.85±1.23µg/L,t=6.132)was significantly lower than that of the control group(P<0.01).After treatment,the numbers of Lactobacillus and Bifidobacterium in the observation group were significantly higher than those in the control group(t values were 12.478,14.128,respectively,all Ps<0.001).The counts of Enterococcus and Enterobacter were significantly lower than those in the control group(t values were 16.593,16.315,respectively,all Ps<0.001).Conclusion Xiangsha-Pingwei Decoction and routine treatment can improve the level of gastrointestinal hormones and PCT,CGRP,CRP in patients with gastrointestinal dysfunction after ischemic stroke,balance the intestinal flora and improve the curative effect.