厚朴三物汤调节脓毒症急性胃肠功能障碍的疗效观察

目的探讨厚朴三物汤调节脓毒症急性胃肠功能障碍的疗效及对肠道微生态的影响。方法选择2022年2月至2023年2月脓毒症并发急性胃肠功能障碍患者60例。采用随机数表法分为2组。对照组予常规西医治疗,观察组在常规治疗基础上加用厚朴三物汤治疗。留取患者入ICU治疗7 d后的粪便标本进行高通量16S rRNA基因测序分析。对比患者治疗前、治疗7 d后的炎症因子、肠道通透性因子及免疫屏障功能指标水平。结果观察组患者粪便中,厚壁菌门中兼性厌氧菌属的相对丰度较高,包括颗粒链球菌、孪生球菌属、肉杆菌科属及嗜血菌属等;对照组患者粪便中以厌氧厚壁菌门菌属为主,包括梭菌属、月形单胞菌属、韦荣球菌属及厌氧棍状菌属,其肠道菌群的丰富度和多样性明显低于观察组。治疗7 d后,两组患者血清TNF-α、hs-CRP、WBC、IL-6指标水平均降低,且观察组血清TNF-α、hs-CRP、WBC、IL-6指标比对照组低(P<0.05);两组患者肠道通透性因子DAO、D-乳酸指标水平低于治疗前,观察组DAO、D-乳酸指标比对照组低(P<0.05);两组患者肠道免疫屏障功能IgA、IgM、IgG指标较治疗前升高,观察组IgA、IgM、IgG指标高于对照组(P<0.05)。结论厚朴三物汤可以有效改善脓毒症急性胃肠功能障碍患者的肠道微生态,降低炎症反应,进而提高肠道免疫屏障功能,有利改善患者预后康复质量。

Objective To analyze the application of Houpu Sanwu decoction in regulating acute gastrointestinal dysfunction patients with sepsis,explore its influence on intestinal microecology,and provide reference for formulating targeted treatment.Methods 60 cases of patients with sepsis complicated with acute gastrointestinal dysfunction who received treatment in our hospital from February 2022 to February 2023 were selected as the subjects of this study.All patients were grouped by random number table,the patients in the control group were received conventional western medicine treatment,and the patients in the observation group were treated with single flavor plus or minus Houpu Sanwu decoction on the basis of conventional treatment.Fecal samples from patients admitted to ICU 7 days after treatment were collected for high-throughput 16S rRNA gene sequencing analysis.The levels of inflammatory factors,intestinal permeability factors and immune barrier function indexes were compared before and 7 days after treatment.Results In the observation group,the relative abundance of facultative anaerobe in Firmicutes was higher,including Streptococcus,Gemella,Enterobacteriaceae,and Haemophilus.Fecal bacteria of the control group were mainly anaerobic Firmicutes,including Clostridium,Bacteroides fragilis,Veillonella,and Anaerostipes.The richness and diversity of intestinal flora in the control group were significantly lower than those in the observation group.After 7 days of treatment,the levels of serum TNF-α,hs-CRP,WBC and IL-6 in 2 groups were decreased,and the levels of serum TNF-α,hypersensitive C-reactive protein(hs-CRP),leukocyte(WBC)and IL-6 in observation group were lower than those in control group(P<0.05).The levels of intestinal permeability factor Diamine Oxidase(DAO)and D-lactic acid indexes in 2 groups were lower than before treatment,and DAO and D-lactic acid indexes in the observation group were slightly lower than the control group(P<0.05).The IgA,IgM and IgG indexes of intestinal immune barrier function in 2 groups were higher than those before treatment,and the IgA,IgM and IgG indexes in the observation group were higher than those in the control group(P<0.05).Conclusion The addition and reduction of Houpu Sanwu decoction can effectively improve the intestinal microecology of patients with acute gastrointestinal dysfunction of sepsis,reduce inflammatory response,improve the function of intestinal immune barrier,and improve the prognosis and rehabilitation quality of patients.