加味桃核承气汤治疗脓毒症胃肠功能障碍的临床研究

Clinical Study on Modified Taohe Chengqi Decoction(加味桃核承气汤) in the Treatment of Gastrointestinal Dysfunction in Sepsis

目的:探讨加味桃核承气汤对脓毒症胃肠功能障碍患者外周血细胞因子、血内毒素水平及肠道机械屏障修复的影响。方法:将114例脓毒症胃肠功能障碍患者随机分为治疗组与对照组各57例。对照组患者在抗感染、脏器支持的同时给予枸橼酸莫沙必利片促进胃动力,治疗组患者在对照组基础上给予加味桃核承气汤治疗。1周后评价临床疗效,并比较两组患者外周血细胞因子、血内毒素水平、肠道机械屏障修复情况及不良反应,统计28 d病死率。结果:治疗组总有效率为70.18%(40/57),对照组总有效率为50.88%(29/57),治疗组高于对照组(P<0.05);两组患者28 d病死率比较,差异无统计学意义(P>0.05)。治疗后两组患者降钙素原(PCT)、血清淀粉样蛋白A(SAA)、C反应蛋白(CRP)、内毒素(ET)、D-乳酸、二胺氧化酶(DAO)、肠脂肪酸结合蛋白(I-FABP)水平均低于治疗前,且治疗组患者治疗后上述指标均低于对照组(P<0.05);治疗后两组患者腹内压(IAP)、急性生理学及慢性健康状况评分系统(APACHEⅡ)、序贯器官衰竭评分(SOFA)、胃肠功能障碍评分和中医证候积分均低于治疗前,且治疗组患者治疗后上述指标均低于对照组(P<0.05)。两组患者治疗过程中未见明显不良反应。结论:加味桃核承气汤能通过抑制外周血炎症因子、内毒素、D-乳酸、DAO、I-FABP的表达,修复肠道机械屏障,抑制炎症反应,提升脓毒症胃肠功能障碍患者整体疗效。

Objective:To investigate the effect of modified Taohe Chengqi decoction on the level of peripheral blood cytokines,blood endotoxin and the repair of intestinal mechanical barrier in patients with sepsis and gastrointestinal dysfunction.Methods:A total of 114 patients with sepsis and gastrointestinal dysfunction were randomly divided into treatment group and control group,with 57 cases in each group.Patients in the control group were given mosapride citrate tablets to promote gastric motility while fighting infection and organ support.Patients in the treatment group were treated with modified Taohe Chengqi decoction on the basis of the control group.One week later,the clinical efficacy was evaluated,and the levels of peripheral blood cytokines,blood endotoxin,intestinal mechanical barrier repair and adverse reactions were compared between the two groups of patients.The 28-day mortality rate was counted.Results:The total effective rate in the treatment group was 70.18%(40/57),and the total effective rate in the control group was 50.88%(29/57).The treatment group was higher than the control group(P<0.05).There was no statistically significant difference in the 28-day mortality between the two groups(P>0.05).After treatment,the levels of PCT,SAA,CRP,ET,D-lactic acid,DAO,and I-FABP in the two groups were lower than those before treatment,and the above indicators in the treatment group were lower than those in the control group after treatment(P<0.05).After treatment,the IAP,APACHEⅡ score,SOFA score,gastrointestinal dysfunction score and TCM syndrome scores of the two groups of patients were lower than those before treatment,and the above-mentioned indexes of patients in the treatment group were lower than those in the control group after treatment(P<0.05).There were no obvious adverse reactions during the treatment of the two groups of patients.Conclusion:Modified Taohe Chengqi decoction can repair intestinal mechanical barrier,inhibit inflammatory reaction and improve the overall efficacy of patients with sepsis gastrointestinal dysfunction by inhibiting the expression of inflammatory factors,endotoxin,D-lactic acid,DAO and I-FABP in peripheral blood.