通腑攻下法对脓毒症合并急性胃肠损伤患者胃肠功能障碍影响

Effect of therapy for unblocking fu-organs and purging the lower on gastrointestinal dysfunction in patients with sepsis and acute gastrointestinal injury

目的观察通腑攻下法对脓毒症合并急性胃肠损伤(AGI)患者胃肠功能障碍的影响。方法将2017年12月-2019年1月北京中医药大学深圳医院(龙岗)收治的82例脓毒症合并AGI患者随机分为2组,对照组41例给予鱼油脂肪乳等常规治疗,观察组41例在对照组治疗基础上给予通腑攻下法治疗,连续治疗2周。对比2组治疗前后基本临床指标(腹腔内压力、肠鸣音、腹围)、APACHEⅡ评分、AGI分级、胃肠屏障标记物[肠脂肪酸结合蛋白(IFABP)、二胺氧化酶(DAO)、D-乳酸(D-Lac)]水平,统计2组临床疗效及不良反应发生情况。结果 2组治疗后腹内压、腹围、APACHEⅡ评分、AGI分级及血浆IFABP、DAO、D-Lac水平均明显降低(P均<0.05),且观察组均明显低于对照组(P均<0.05);2组治疗后肠鸣音均明显增多(P均<0.05),且观察组明显多于对照组(P<0.05);观察组总有效率为80.5%(33/41),明显高于对照组的58.5%(24/41),差异有统计学意义(χ^(2)=4.661,P<0.05);2组患者治疗期间均未出现明显不良反应。结论通腑攻下法治疗脓毒症合并AGI疗效确切,能够有效改善胃肠屏障功能,有助于缓解临床症状,提高预后效果。

Objective It is to observe the effect of therapy for unblocking fu-organs and purging the lower on gastrointestinal dysfunction in patients with sepsis and acute gastrointestinal injury(AGI). Methods Eighty-two patients with sepsis and AGI admitted to Shenzhen Hospital(Longgang) from December 2017 to January 2019 were randomly divided into 2 groups. 41 cases in the control group were given fish oil fat emulsion and other conventional treatment;41 cases in the observation group were treated with the therapy for unblocking fu-organs and purging the lower based on the treatment of the control group, both groups were continuously treated for 2 weeks. The basic clinical indicators(intra-abdominal pressure, bowel sounds, and abdominal circumference), APACHE Ⅱ score, AGI classification, the levels of gastrointestinal barrier markers [intestinal fatty acid binding protein(IFABP), diamine oxidase(DAO),D-Lactate(D-Lac)] before and after treatment were compared in the two groups, the clinical efficacy was evaluated and the occurrence of adverse reactions was recorded in the two groups. Results After treatment, the intra-abdominal pressure, abdominal circumference, APACHE Ⅱ score, AGI classification, plasma levels of IFABP, DAO, and D-Lac were significantly reduced in the two groups(all P<0.05), and the observation group was significantly lower than the control group(P<0.05);bowel sounds were significantly increased after treatment in the two groups(P<0.05), and the observation group was significantly more than the control group(P<0.05);the total effective rate of the observation group was 80.5%(33/41), which was significantly higher than 58.5%(24/41) of the control group, the difference was significant(χ^(2)=4.661, P<0.05);there were no obvious adverse reactions during the treatment in the patients of the two groups. Conclusion Therapy for unblocking fu-organs and purging the lower has a definite curative effect in the treatment of sepsis combined with AGI, which can effectively improve the gastrointestinal shielding function, help to relieve clinical symptoms and improve prognosis.