小承气汤合四君子汤加减治疗脓毒症胃肠功能障碍临床研究

Clinical Study of Xiaochengqi Decoction Combined with Sijunzi Decoction in the Treatment of Sepsis with Gastrointestinal Dysfunction

目的 探讨小承气汤合四君子汤加减治疗脓毒症胃肠功能障碍的临床疗效。方法 将60例脓毒症患者随机分为观察组和对照组,每组30例。对照组给予常规西医治疗,观察组在对照组基础上给予小承气汤合四君子汤加减治疗,2组均治疗14 d。比较2组治疗前后急性胃肠损伤(acute gastrointestinal injury,AGI)分级,胃肠功能障碍、急性生理学及慢性健康评估Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)、序贯器官衰竭评估(sequential organ failure assessment,SOFA)评分,血清白细胞(white blood cell,WBC)、高敏C-反应蛋白(high-sensitivity C reactive protein,hs-CRP)、降钙素原(procalcitonin,PCT)水平。结果 治疗72 h后,观察组AGI分级中Ⅰ级患者占比升高(P<0.05),Ⅲ级患者占比降低(P<0.05),且观察组Ⅲ级患者占比低于对照组(P<0.05);对照组AGI分级占比治疗前后比较,差异无统计学意义(P>0.05);2组Ⅱ级患者占比治疗前后及组间比较,差异均无统计学意义(P>0.05)。治疗后,2组胃肠功能障碍、APACHEⅡ、SOFA评分,血清WBC、hs-CRP、PCT水平均较前降低(P<0.05),且观察组上述指标显著低于对照组(P<0.05)。结论 小承气汤合四君子汤加减能有效地抑制脓毒症患者机体炎症反应,改善胃肠道功能障碍。

Objective To explore the clinical efficacy of Xiaochengqi decoction combined with Sijunzi decoction in the treatment of sepsis with gastrointestinal dysfunction.Methods Sixty patients with sepsis were randomly divided into observation group and control group,with 30 cases in each group.The control group was treated with conventional western medicine,and the observation group was treated with Xiaochengqi decoction combined with Sijunzi decoction on the basis of the control group.Both groups were treated for 14 days.The grades of acute gastrointestinal injury(AGI),the scores of gastrointestinal dysfunction,acute physiology and chronic health evaluationⅡ(APACHEⅡ)and sequential organ failure assessment(SOFA),the levels of white blood cell(WBC)and high-sensitivity C reactive protein(hs-CRP)and procalcitonin(PCT)were compared in both groups before and after treatment.Results After 72 h of treatment,the proportion of AGI gradeⅠpatients in the observation group increased(P<0.05),while the proportion of gradeⅢpatients decreased(P<0.05),and the proportion of gradeⅢpatients in the observation group was lower than that in the control group(P<0.05).There was no significant difference in the proportion of AGI grade in the control group before and after treatment(P>0.05).There was no significant difference in the proportion of AGI gradeⅡpatients between the two groups(P>0.05).After treatment,the scores of gastrointestinal dysfunction,APACHEⅡand SOFA and the levels of serum WBC,hs-CRP and PCT in the two groups were all decreased when compared with those before treatment(P<0.05),and the observation group was significantly lower than the control group(P<0.05).Conclusion Xiaochengqi decoction combined with Sijunzi decoction could effectively inhibit the inflammatory response of patients with sepsis and improve gastrointestinal dysfunction.