黄龙汤加减方联合常规西药治疗老年脓毒症合并胃肠功能障碍临床研究

Clinical Study on Modified Huanglong Tang Combined with Routine Western Medicine for Senile Patients with Sepsis Complicated with Gastrointestinal Dysfunction

目的:观察黄龙汤加减方联合常规西药治疗老年脓毒症合并胃肠功能障碍的临床疗效。方法:将60例老年脓毒症合并胃肠功能障碍患者按照随机数字表法分为对照组和试验组各30例。对照组给予常规西药治疗,试验组在对照组的基础上给予黄龙汤加减方治疗。治疗7 d后,观察比较2组治疗前后患者急性胃肠损伤(AGI)分级情况,2组治疗前后的急性生理与慢性健康(APACHEⅡ)评分、序贯器官衰竭估计(SOFA)评分、营养状态,治疗前、治疗3 d、7 d外周血白细胞计数、血清白细胞介素-6(IL-6)、白细胞介素-10(IL-10)、肿瘤坏死因子-α(TNF-α)、C-反应蛋白(CRP)水平变化,记录治疗3 d内首次排便情况、入组后28 d死亡率以及不良反应发生情况。结果:治疗7 d,2组AGI分级均较治疗前显著改善,且试验组AGI分级改善优于对照组,经秩和检验,差异均有统计学意义(P<0.05)。治疗7 d,2组APACHEⅡ、SOFA评分均较治疗前降低(P<0.05),且试验组2项评分均低于对照组(P<0.05)。治疗3 d、7 d,2组IL-6、白细胞计数、CRP水平均较治疗前降低(P<0.05),且试验组IL-6、白细胞计数、CRP水平均低于对照组(P<0.05)。治疗后3 d、7 d,2组TNF-α水平有下降趋势,但与治疗前比较,差异均无统计学意义(P>0.05)。治疗3 d,2组IL-10水平均较治疗前升高(P<0.05),但2组间IL-10水平比较,差异无统计学意义(P>0.05)。治疗7 d,试验组IL-10水平较治疗前降低(P<0.05),且IL-10水平低于对照组(P<0.05);而对照组IL-10水平较治疗前仍升高,差异有统计学意义(P<0.05)。治疗后,试验组白蛋白(Alb)、前白蛋白(PA)水平均较治疗前升高(P<0.05),且Alb、PA水平均高于对照组(P<0.05)。治疗7 d,对照组Alb水平有升高趋势,但差异无统计学意义(P>0.05);而PA水平较治疗前降低,差异有统计学意义(P<0.05)。试验组在治疗3 d内排便率为76.7%,对照组为46.7%,2组比较,差异有统计学意义(P<0.05)。试验组死亡率为6.7%,对照组为30.0%,2组比较,差异有统计学意义(P<0.05)。结论:黄龙汤加减方联合常规西药治疗能提高老年脓毒症合并胃肠功能障碍患者的临床疗效,有效改善患者胃肠功能,降低炎症介质的释放,调控抗炎介质的释放,改善机体免疫功能,促进预后。

Objective:To observe the clinical effect of modified Huanglong tang combined with routine western medicine for senile patients with sepsis complicated with gastrointestinal dysfunction.Methods:A total of 60 cases of senile patients with sepsis complicated with gastrointestinal dysfunction were divided into the control group and the experiment group according to the random number table method,30 cases in each group.The control group was given routine western medicine,and the experiment group was additionally given modified Huanglong tang based on the treatment of the control group.After seven-day treatment,grading of acute gastrointestinal injury(AGI)of severe patients was observed and compared in the two groups before and after treatment;scores of Acute Physiology and Chronic Health Evaluation(APACHEⅡ)and Sequential Organ Failure Assessment(SOFA)as well as nutritional status were observed and compared in the two groups before and after treatment.Before treatment as well as on the 3 rdand 7 thday after treatment,changes in levels of interleukin-6(IL-6),interleukin-10(IL-10),tumor necrosis factor-α(TNF-α),and C-reactive protein(CRP)in serum as well as levels of leukocyte in peripheral blood were observed and compared in the two groups.During the first three days after treatment,the first defecation was recorded.On the 28 thday after enrollment in both groups,the death rate and the incidence of adverse reactions were recorded.Results:On the 7 th day after treatment,AGI grading in the two groups was significantly improved when compared with that before treatment,and the improvement in the experiment group was better than that in the control group,differences being significant(P<0.05).On the 7 thday after treatment,scores of APACHEⅡand SOFA in the two groups were decreased when compared with those before treatment(P<0.05),and the two scores in the experiment group were lower than those in the control group(P<0.05).On the 3 rdand 7 thday after treatment,levels of IL-6,leukocyte,and CRP in the two groups were decreased when compared with those before treatment(P<0.05),and the three levels in the experiment group were lower than those in the control group(P<0.05).On the 3 rdand 7 thday after treatment,levels of TNF-αin the two groups showed a downtrend,but there was no significance in differences when compared with those before treatment(P>0.05).On the 3 rdday after treatment,levels of IL-10 in the two groups were increased when compared with those before treatment(P<0.05),but there was no significance in the difference between the two groups(P>0.05).On the 7 thday after treatment,level of IL-10 in the experiment group was decreased when compared with that before treatment(P<0.05),and the level was lower than that in the control group(P<0.05);level of IL-10 in the control group was still increased when compared with that before treatment,the difference being significant(P<0.05).After treatment,levels of albumin(Alb)and prealbumin(PA)in the experiment group were increased when compared with those before treatment(P<0.05),and the two levels were higher than those in the control group(P<0.05).On the 7 thday after treatment,level of Alb in the control group showed an uptrend,but there was no significance in the difference(P>0.05);level of PA was decreased when compared with that before treatment,the difference being significant(P<0.05).During the first three days after treatment,the defecation rate was 76.7%in the experiment group,and 46.7%in the control group,the difference being significant(P<0.05).The death rate was 6.7%in the experiment group,and 30.0%in the control group,the difference being significant(P<0.05).Conclusion:The therapy of modified Huanglong tang combined with routine treatment can enhance clinical effect in the treatment of senile patients with sepsis complicated with gastrointestinal dysfunction.It can effectively improve gastrointestinal function,reduce release of inflammation mediator,regulate release of anti-inflammatory mediator,enhance immune function of body and promote prognosis.