摘要
目的观察直肠滴人通腑理肺汤对严重脓毒症／多器官功能障碍综合征（MODS）患者胃肠功能的调节作用及其可能机制。方法选择本院重症医学科（ICU）收治的严重脓毒症／MODS患者98例，按随机数字表法分为对照组（49例）和通腑理肺汤组（49例），两组均给予内科常规治疗，通腑理肺汤组在常规治疗基础上直肠缓慢滴人通腑理肺汤；对照组在常规治疗基础上每日给予等量生理盐水直肠滴人，均每日2次。于治疗前、治疗3d、7d观察两组患者临床症状、中医证候学积分、C-反应蛋白（CRP）水平、胃液pH值、胃排空试验、腹腔内压力、急性生理学与慢性健康状况评分系统Ⅱ（APACHEII）评分、MODS病情严重程度评分的变化，并进行胃肠功能障碍疗效评价。结果通腑理肺汤组患者临床症状较对照组明显改善，两组治疗后中医证候学积分（分）均有所降低，治疗7d与对照组同期比较差异有统计学意义（6．2±1．3比10．9±3．7，P〈0．05）；胃肠功能障碍疗效评分显示显效、有效及总有效率均明显高于对照组（显效率：55．1％比30．6％，有效率：20．4％比12．2％，总有效率：75．50％比42．80％，均P〈0．05）；两组血清CRP水平（mg／L）、胃排空试验（ml）、腹腔内压力（cmH2O，1cmH：0=0．098kPa）、APACHEII评分（分）、MODS病情严重程度评分（分）均明显降低，而胃液pH值明显增高，且通腑理肺汤组上述指标的改善程度明显优于对照组，以治疗7d变化更显著（CRP：12．5±5．3比17．3±6．3，胃液pH值：6．97±1．59比6．27±1．84，胃排空试验：65±49比150±58，腹腔内压力：7．3±4．1比12．5±5．4，APACHEⅡ评分：11．5±6．1比15．9±5.3，MODS病情严重程度评分：9．5±3．9比13．8±4．7，P〈0．05或P〈0．01）。结论通腑理肺汤直肠滴入能够有效地改善严重脓毒症／MODS患者的临床症状，显著降低中医证候学积分、血清CRP水平、腹腔内压力水平及APACHEⅡ评分及MODS病情严重程度评分，提高胃液pH值，改善及调节胃肠功能，显著提高治疗严重脓毒症／MODS患者胃肠功能障碍的有效率，其可能机制与其降低血CRP水平、减轻炎症反应及降低腹腔内压力等密切相关。
Objective To study the regulation of gastrointestinal function and possible mechanism of rectal instillation of Tongfu Lifei soup in patients with severe sepsis or multiple organ dysfunction syndrome （MODS）. Methods Ninety-eight patients with severe sepsis or MODS in Intensiv Care Unit （ICU） of this Hospital were selected, and they were randomly divided into control group （group A,49 cases） and Tongfu Lifei soup group （group B,49 cases）. Conventional treatment was given to the two groups, additionally, in group B, Tongfu Lifei soup instillation via rectum was applied, while in group A, the same amount of normal saline was instilled into the rectum, both twice a day. Before the treatment and 3 days and 7 days after treatment, the changes of clinical symptoms, traditional Chinese medicine （TCM） symptom scores, C-reactive protein （CRP） level, gastric juice pH value, gastric emptying test, intra-abdominal pressure, acute physiology and chronic health evaluation II （APACHE Ⅱ） score, MODS severity score were observed, and the therapeutic effect of gastrointestinal dysfunction was evaluated in the two groups. Results The improvement of clinical symptoms of group B was significantly better than that of group A, after treatment, the TCM symptom scores of the two groups were lower, on the 7th day, the score in group B compared with that of the same time in group A had statistical significant difference （score ： 6.2 ± 1.3 vs. 10.9± 3.7, P〈0.05） ; the gastrointestinal dysfunction score showed marked effectiveness and effectiveness, and the total effective rate were obviously higher in group B than those in group A （marked effectiveness ： 55.1% vs. 30.6%, effectiveness ： 20.4% vs. 12.2%, the total effective rate ： 75.50% vs. 42.80%, all P〈0.05） ; The CRP level in serum, gastric emptying test, intra-abdominal pressure, APACHE Ⅱ score and the MODS severity score of the two groups were markedly decreased, while the gastric juice pH value was significantly increased, and the improvement degree of above indexes in group B were obviously better than those in group A ; the changes of CRP （nag/L）, gastric emptying test （ml）, intra-abdominal pressure （cm H20, 1 cm H20 = 0.098 kPa）, APACHE Ⅱ score and the gastric juice pH value after the treatment for 7 days were more significant （CRP： 12.5±5.3 vs. 17.3±6.3 , gastric emptying test ： 65±49 vs. 150±58, intra-abdominal pressure ： 7.3±4.1 vs. 12.5±5.4, APACHE Ⅱscore ： 11.5±6.1 vs. 15.9±5.3, MODS severity score ： 9.5±3.9 vs. 13.8±4.7,gastric juice pH value： 6.97±1.59 vs. 6.27±1.84, P〈0.05 orP〈O.O1）. Conclusions Rectalinstillation of Tongfu Lifei soup can effectively improve the clinical symptoms of patients with severe sepsis/MODS, such as fever, abnormal bowel movements and digestive tract bleeding, etc, significantly reduce the TCM symptom scores, blood CRP level, intra-abdominal pressure, APACHE Ⅱ score and MODS severity score, increase gastric pH value, improve and regulate gastrointestinal function, significantly increase the therapeutic efficacy of patients with severe sepsis/MODS and gastrointestinal dysfunction. The mechanism is possibly related to the reduction of CRP level, inflammatory reaction and intra-abdominal pressure closely.
出处
《中国中西医结合急救杂志》
CAS
北大核心
2012年第4期209-212,共4页
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
基金
贵州省中医药管理局项目，贵阳中医学院项目
关键词
严重脓毒症/多器官功能障碍综合征
胃肠功能
直肠滴入
通腑理肺汤
Severe sepsis/multiple organ dysfunction syndrome
Gastrointestinal function
Rectalinstillation
Tongfu Lifei soup
