六君子汤加减对ICU机械通气患者胃肠动力障碍、肠内营养状况及外周血PBMCs中TLR2、TLR4表达的影响

Effects of Liujunzi Decoction on gastrointestinal motility disorder,enteral nutrition status,TLR2 and TLR4 expression in PBMCs of patients with mechanical ventilation in ICU

目的观察六君子汤加减对ICU机械通气患者胃肠动力障碍、肠内营养状况和胃黏膜张力及外周血PBMCs中Toll样受体(TLR2、TLR4)表达的影响。方法选择于濮阳市安阳地区医院治疗的120例ICU机械通气患者,以随机数字表法分组,60例参照组给予常规西医治疗,60例观察组给予常规西医及六君子汤治疗,治疗前、后检测2组炎症指标[核因子κB(NF-κB)、TLR2、TLR4、IL-32]、免疫指标[T淋巴细胞亚群CD4^(+)、CD8^(+)、免疫球蛋白G(Ig G)]、胃动力指标[胃泌素-17(G-17)、胃动素(MTL)、胆囊收缩素(CCK)、生长素释放肽(Ghrelin)、胃窦收缩幅度及胃窦收缩频率]、营养状态指标[转铁蛋白(TEN)、白蛋白(ALB)、前白蛋白(PA)]及胃黏膜张力指标[胃黏膜二氧化碳分压(Pg CO_(2))、黏膜酸碱度(p Hi)、胃黏膜内-动脉血二氧化碳分压差(Pg-a CO_(2))]水平,给予患者症候积分评价,比较2组疗效。结果观察组炎症指标NF-κB、TLR2、TLR4、IL-32水平低于参照组(P<0.05);观察组免疫指标CD8^(+)水平低于参照组,Ig G、CD4^(+)水平高于参照组(P<0.05);观察组胃动力指标Ghrelin、G-17、MTL水平、胃窦收缩幅度、胃窦收缩频率高于参照组,CCK水平低于参照组(P<0.05);观察组胃黏膜张力指标Pg CO_(2)、Pg-a CO_(2)水平低于参照组,p Hi水平高于参照组(P<0.005);观察组营养状态指标ALB、TEN、PA水平均高于参照组(P<0.05),观察组症候积分水平较参照组低(P<0.05),观察组患者总有效率(96.67%)高于参照组(85.00%)(P<0.05)。结论六君子汤加减治疗ICU机械通气患者,可改善患者免疫状态,抑制炎症指标,增加机体胃肠动力,改善胃黏膜张力及肠内营养状况,提升患者临床疗效。

Objective To observe the effects of Liujunzi Decoction on gastrointestinal motivity disorder,enteral nutrition status,gastric mucosal tension and toll-like receptor(TLR)2 and TLR4 expression in PBMCs in patients with mechanical ventilation in ICU.Methods A total of 120 patients with mechanical ventilation in ICU treated in Anyang District Hospital were divided by random number table method.60 patients in the reference group were given conventional western medicine,and 60 patients in the observation group were given conventional western medicine and Liujunzi decoction.Inflammatory indexes[nuclear factorκB(NF-κB),TLR2,TLR4,IL-32],immune indexes[T lymphocyte subsets CD4^(+),CD8^(+),immunoglobulin G(IgG)],gastric motility indexes[gastrin-17(G-17),motilin(MTL),gallbladder contraction hormone(CCK),growth hormone releasing peptide(Ghrelin),antrum contraction amplitude and frequency),nutritional status indicators(transferrin(TEN),albumin(ALB),prealbumin(PA)]and gastric mucosal tension indicators[gastric mucosal partial pressure of carbon dioxide(PgCO_(2)),mucosal pH(pHi),and gastric mucosal-arterial partial pressure difference of carbon dioxide(Pg-a CO_(2))]were detected in both groups before and after treatment.The patients were evaluated by symptom score,and the treatment effects of the two groups were compared.Results The levels of inflammatory indexes NFκB,TLR2,TLR4 and IL-32 in the observation group were lower than those in the reference group(P<0.05).The level of CD8^(+)in the observation group was lower than that in the reference group,while the levels of IgG and CD4^(+)were higher than that in the reference group(P<0.05).Ghrelin,G-17,MTL level,gastric antrum contraction amplitude and frequency in the observation group were higher than those in the reference group,while CCK level was lower than that in the reference group(P<0.05).The gastric mucosal tension indexes PgCO_(2)and Pg-a CO_(2)levels in the observation group were lower than those in the reference group,and the pHi level was higher than that in the reference group(P<0.005).The nutritional status indicators ALB,TEN and PA levels in the observation group were higher than those in the reference group(P<0.05).The symptom score level of the observation group was lower than that of the reference group(P<0.05).The total effective rate of patients in the observation group(96.67%)was higher than that in the reference group(85.00%)(P<0.05).Conclusion Liujunzi Decoction can improve the immune status of patients with mechanical ventilation in ICU,inhibit inflammatory indexes,increase gastrointestinal motivity,improve gastric mucosa tension and enteral nutrition status,and enhance clinical efficacy of patients.