大承气汤加味治疗脓毒症合并胃肠功能障碍临床研究

Clinical Study of Modified Dachengqi Decoction in the Treatment of Sepsis Complicated with Gastrointestinal Dysfunction

目的探讨大承气汤加味治疗脓毒症合并胃肠功能障碍患者的临床疗效。方法选取2019年10月—2021年3月本院重症加强护理病房(intensive care unit,ICU)住院患者34例,根据随机数字表法随机分为治疗组和对照组,每组17例。对照组患者予以西医基础治疗联合0.9%氯化钠注射液,治疗组患者予以西医基础治疗联合大承气汤加味。比较2组患者治疗前后中医症状量化积分、急性生理学和慢性健康状况评价(acute physiology and chronic health evaluation,APACHE)Ⅱ、序贯器官功能衰竭评分(sequential organ failure assessment,SOFA)、胃肠功能障碍评分,白细胞(white blood cell,WBC)、C反应蛋白(C-reactive protein,CRP)、降钙素原(procalcitonin,PCT)水平,腹围、肠鸣音评分、腹腔内压(intra-abdominal pressure,IAP)。比较2组患者住ICU天数、总住院天数。结果治疗后,2组患者中医症状量化积分、APACHEⅡ、SOFA、胃肠功能障碍评分,WBC、CRP、PCT水平,腹围、肠鸣音评分、IAP均较治疗前明显下降(P<0.05);且治疗组显著低于对照组(P<0.05)。治疗组患者住ICU天数、总住院天数均显著短于对照组(P<0.05)。结论大承气汤加味治疗脓毒症合并胃肠功能障碍可缓解患者临床症状,提高胃肠功能,降低炎症水平,缩短住院天数。

Objective To explore the clinical efficacy of modified Dachengqi decoction in the treatment of sepsis complicated with gastrointestinal dysfunction.Methods From October 2019 to March 2021,thirty-four intensive care unit inpatients of our hospital were selected and randomly divided into treatment group and control group according to the random number table method,with 17 cases in each group.The control group was given basic western medicine combined with 0.9% sodium chloride injection,while the treatment group was given basic western medicine combined with modified Dachengqi decoction.The TCM symptom quantification score,APACHEⅡ,SOFA,gastrointestinal dysfunction score,WBC,CRP,PCT,abdominal circumference,bowel song score,and IAP before and after treatment were compared between the two groups.The number of ICU days and total number of hospital days were compared between the two groups.Results After treatment,the TCM symptom quantification score,APACHEⅡ,SOFA,gastrointestinal dysfunction score,WBC,CRP,PCT,abdominal circumference,bowel song score,and IAP of two groups were significantly lower than those before treatment(P<0.05),and the levels in the treatment group were significantly lower than those in the control group(P<0.05).The number of ICU days and total hospitalization days in the treatment group were significantly shorter than those in the control group(P<0.05).Conclusion Modified Dachengqi decoction in the treatment of sepsis complicated with gastrointestinal dysfunction could relieve the clinical symptoms,improve the gastrointestinal function,reduce the inflammation level,and shorten the number of hospitalization days.