加味桃核承气汤治疗脓毒症胃肠功能障碍的临床观察

Clinical Effect of Jiawei Taohe Chengqi Decoction on Sepsis Gastrointestinal Dysfunction

目的探讨加味桃核承气汤治疗脓毒症胃肠功能障碍的临床疗效。方法选取2018年6月—2019年6月期间,河北省沧州中西医结合医院重症医学科和急诊ICU收治的脓毒症胃肠功能障碍患者120例作为研究对象,按随机数字表法分为对照组60例和治疗组60例。对照组采用常规西医治疗,治疗组在对照组基础上加用加味桃核承气汤治疗。两组患者均连续治疗1周后对两组临床疗效、炎症指标[C反应蛋白(C reactive proteins,CRP)、降钙素原(procalcitonin,PCT)、淀粉样蛋白A(serum amyloid A,SAA)、白细胞介素-6(Interleukin-6,IL-6)]、胃肠功能指标[血清胃泌素-17(Gastrin-17,G-17)、胃蛋白酶原(pepsinogen,PG)]、腹内压、病情严重程度[采用急性生理和慢性健康量表(Acute Physiology And Chronic Health Evaluation,APACHEⅡ)及序贯器官功能衰竭量表(Sequential Organ Failure Assessment,SOFA)进行评估]及胃肠功能障碍评分进行分析比较。结果治疗后治疗组临床总有效率为96.67%(58/60),对照组临床总有效率为76.67%(46/60),两组比较,差异有统计学意义(P<0.05)。治疗7 d后两组患者肠鸣音、腹围及腹内压指标均优于治疗前,差异有统计学意义(P<0.05);且治疗组治疗7 d后肠鸣音、腹围及腹内压指标优于对照组,两组比较,差异有统计学意义(P<0.05)。治疗7 d后治疗组患者肠道功能0分、1分占比与对照组比较明显升高,2分、3分占比与对照组比较明显降低,两组比较,差异有统计学意义(P<0.05)。治疗3 d后治疗组患者SOFA及APACHEⅡ评分与治疗前比较明显降低,差异有统计学意义(P<0.05);治疗7 d后两组患者SOFA及APACHEⅡ评分与治疗前、治疗3 d后比较明显降低,差异有统计学意义(P<0.05);且治疗组治疗3 d、7 d后SOFA及APACHEⅡ评分均明显低于对照组同期水平,两组比较,差异有统计学意义(P<0.05)。治疗3 d后治疗组患者炎症指标CRP、IL-6、PCT及SAA水平与治疗前比较明显降低,差异有统计学意义(P<0.05);治疗7 d后两组患者炎症指标CRP、IL-6、PCT及SAA水平与治疗前、治疗3 d后比较明显降低,差异有统计学意义(P<0.05);且治疗组治疗3 d、7 d后炎症指标CRP、IL-6、PCT及SAA水平均明显低于对照组同期水平,两组比较,差异有统计学意义(P<0.05)。治疗3 d后治疗组患者胃肠功能指标G-17、PGⅠ、PGⅡ及PGⅠ/PGⅡ水平与治疗前比较明显降低,差异有统计学意义(P<0.05);治疗7 d后两组患者胃肠功能指标G-17、PGⅠ、PGⅡ及PGⅠ/PGⅡ水平与治疗前、治疗3 d后比较明显降低,差异有统计学意义(P<0.05);且治疗组治疗3 d、7 d后胃肠功能指标G-17、PGⅠ、PGⅡ及PGⅠ/PGⅡ水平均明显低于对照组同期水平,两组比较,差异有统计学意义(P<0.05)。结论加味桃核承气汤能明显改善脓毒症患者的胃肠功能障碍,通过升高血清PG和G-17水平,促进胃肠功能恢复,且能减轻患者炎症反应。

Objective To explore the clinical efficacy of Jiawei Taohe Chengqi Decoction in the treatment of septic gastrointestinal dysfunction.Methods From June 2018 to June 2019,120 patients with sepsis and gastrointestinal dysfunction admitted to the Department of Critical Care Medicine and Emergency ICU of Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine in Hebei Province were selected as the research objects.They were divided into controls according to the random number table method.60 cases in the group and 60 cases in the treatment group.The control group was treated with conventional western medicine,and the treatment group was treated with Jiawei Taohe Chengqi Decoction on the basis of the control group.The two groups of patients were treated for 1 week on the clinical efficacy and inflammatory indicators of the two groups[C reactive proteins(CRP),procalcitonin(PCT),and amyloid A(SAA),Interleukin-6(IL-6)],gastrointestinal function indexes[serum gastrin-17(G-17),pepsinogen(PG)],intra-abdominal Pressure,severity of illness[using Acute Physiology And Chronic Health Evaluation(APACHE)and Sequential Organ Failure Assessment(SOFA)for assessment]and gastrointestinal dysfunction score were analyzed and compared.Results After treatment,the total clinical effective rate of the treatment group was 96.67%(58/60),and the total clinical effective rate of the control group was 76.67%(46/60).The difference between the two groups was statistically significant(P<0.05).After 7 days of treatment,the bowel sounds,abdominal circumference and intra-abdominal pressure indexes of the two groups of patients were better than those before treatment,and the difference was statistically significant(P<0.05);and the treatment group was treated for 7 days after bowel sounds,abdominal circumference and abdominal pressure.The internal pressure index was better than the control group,and the difference between the two groups was statistically significant(P<0.05).After 7 days of treatment,the proportions of intestinal function 0 and 1 in the treatment group were significantly higher than those in the control group,and the proportions of 2 and 3 points were significantly lower than those in the control group.The difference between the two groups was statistically significant(P<0.05).After 3 days of treatment,the SOFA and APACHEⅡscores of the patients in the treatment group were significantly lower than those before treatment,and the difference was statistically significant(P<0.05);after 7 days of treatment,the SOFA and APACHEⅡscores of the two groups were significantly higher than those before and after 3 days of treatment.Decrease,the difference was statistically significant(P<0.05);and the SOFA and APACHEⅡscores of the treatment group were significantly lower than those of the control group after 3 and 7 days of treatment.The difference between the two groups was statistically significant(P<0.05).After 3 days of treatment,the levels of inflammatory indexes CRP,IL-6,PCT and SAA in the treatment group were significantly lower than those before treatment,and the difference was statistically significant(P<0.05);after 7 days of treatment,the two groups of patients′inflammatory indexes CRP and IL-6.The levels of PCT and SAA were significantly lower than those before treatment and after 3 days of treatment,and the difference was statistically significant(P<0.05);and the inflammation indexes CRP,IL-6,PCT and SAA of the treatment group after 3 days and 7 days of treatment The level was significantly lower than that of the control group over the same period,and the difference between the two groups was statistically significant(P<0.05).After 3 days of treatment,the gastrointestinal function indexes G-17,PGⅠ,PGⅡand PGⅠ/PGⅡlevels of the patients in the treatment group were significantly lower than those before treatment,and the difference was statistically significant(P<0.05);after 7 days of treatment,the gastrointestinal function of the two groups of patients The levels of functional indicators G-17,PGⅠ,PGⅡand PGⅠ/PGⅡwere significantly lower than those before treatment and 3 days after treatment,and the difference was statistically significant(P<0.05);and the gastrointestinal function of the treatment group was 3 and 7 days after treatment The levels of indicators G-17,PGⅠ,PGⅡand PGⅠ/PGⅡwere significantly lower than those of the control group over the same period.The difference between the two groups was statistically significant(P<0.05).Conclusion Jiawei Taohe Chengqi decoction can obviously improve the gastrointestinal dysfunction of patients with sepsis.By increasing the levels of serum PG and G-17,it can promote the recovery of gastrointestinal function and reduce the inflammatory reaction in patients.