补中益气联合大承气汤治疗脓毒症胃肠功能障碍气虚腑实证临床观察

Clinical Observation of Buzhong Yiqi Combined with Dachengqi Decoction in the Treatment of Sepsis with Gastrointestinal Dysfunction

目的:基于益气通腑法探讨补中益气联合大承气汤对脓毒症胃肠功能障碍气虚腑实证患者炎症因子、胃肠激素及肠黏膜屏障功能的影响。方法:将70例脓毒症胃肠功能障碍气虚腑实证患者随机分成观察组和对照组各35例,剔除/脱落后观察组33例、对照组32例完成试验。对照组在脓毒症常规治疗基础上给予胃肠道调节治疗,观察组在对照组基础上加用补中益气汤联合大承气汤治疗,两组疗程均为14天。采用SOFA及APACHE II评分评价脓毒症预后;采用胃肠功能障碍评分、肠鸣音评分、腹腔内压评价胃肠功能;比较两组患者治疗前后炎症反应、胃肠激素及肠黏膜屏障功能指标。结果:观察组与对照组治疗1天、7天、14天后SOFA、APACHE Ⅱ、胃肠功能障碍评分、肠鸣音评分、腹腔内压均降低。观察组治疗7天、14天后SOFA、APACHE Ⅱ、胃肠功能障碍评分、肠鸣音评分、腹腔内压较对照组降低。观察组与对照组治疗14天后PCT、hs-CRP、IL-6、WBC、NEUT、NEUT%均降低;GAS、MTL均升高;D-LAC、DAO、ET均降低。观察组治疗14天后PCT、hs-CRP、IL-6、WBC、NEUT、NEUT%较对照组降低;GAS、MTL较对照组升高;D-LAC、DAO、ET较对照组降低。结论:补中益气合大承气汤在常规西医治疗的基础上能更好地促进胃肠激素分泌,修复肠道屏障功能,降低炎症反应,改善胃肠道功能,进而有效改善脓毒症胃肠功能障碍患者的预后。

Objective:To investigate the effect of Buzhong Yiqi combined with Dachengqi Decoction on inflammatory factors,gastrointestinal hormones and intestinal mucosal barrier function in patients with sepsis with gastrointestinal dysfunction and qi deficiency and fu organs.Methods:The patients with sepsis and gastrointestinal dysfunction with positive qi deficiency and fu organs were randomly divided into observation group and control group,35 cases in each group,33 cases in observation group and 32 cases in control group after excluding/dropping off to complete the experiment.The control group was given gastrointestinal regulation treatment on the basis of conventional treatment of sepsis;the observation group was treated with Buzhong Yiqi Decoction combined with Dachengqi Decoction on the basis of the control group.The treatment course of both groups was 14 days.SOFA and APACHE Ⅱ scores were used to evaluate the prognosis of sepsis;the gastrointestinal dysfunction score,bowel sound score,and intra-abdominal pressure were used to evaluate gastrointestinal function;the two groups of patients were compared before and after treatment,gastrointestinal hormones and intestinal mucosal barrier function indicators.Results:The observation group and the control group decreased SOFA,APACHE Ⅱ,gastrointestinal dysfunction score,bowel sound score,and intra-abdominal pressure after 1 d,7 d,and 14 dtreatment.The observation group was treated for 7 d,14 dafter SOFA,APACHE II,gastrointestinal The dysfunction score,bowel sound score,and intra-abdominal pressure were lower than those in the control group.PCT,hs-CRP,IL-6,WBC,NEUT,NEUT% were decreased in the observation group and the control group after14 days of treatment;GAS and MTL increased;D-LAC,DAO,ET decreased,and the observation group was treated with PCT after 14 days of treatment,Hs-CRP,IL-6,WBC,NEUT,NEUT% were lower than the control group;GAS,MTL were higher than the control group;D-LAC,DAO,ET were lower than the control group.Conclusion:Buzhong Yiqi and Dachengqi Decoction can better promote gastrointestinal hormone secretion,repair intestinal barrier function,reduce inflammation,improve gastrointestinal function,and effectively improve sepsis on the basis of conventional western medicine treatment.Prognosis of patients with gastrointestinal dysfunction.