摘要
目的探讨大承气汤联合莫沙必利对脓毒症急性胃肠损伤患者临床症状、腹内压及生存率的影响。方法按随机数字表法将医院2018年12月—2020年11月收治的104例脓毒症急性胃肠损伤患者分入两组(每组52例),对照组采取莫沙必利治疗;观察组在对照组基础上联合大承气汤治疗,治疗1个月后随访。对比两组治疗前后腹内压、肠鸣音、中医证候积分、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ评分)、各炎性指标水平,并分析其生存率、不良反应发生率和临床疗效情况。结果观察组临床有效率高于对照组(96.15%vs 78.85%)(χ^(2)=7.121,P=0.008)。治疗前观察组与对照组腹内压、肠鸣音比较差异无统计学意义(P>0.05);观察组治疗后腹内压、肠鸣音均优于对照组(P<0.05)。观察组生存率高于对照组(94.23%vs 90.38%),但差异无统计学意义(χ^(2)=0.542,P=0.462)。治疗前观察组与对照组中医证候积分和APACHEⅡ评分对比无统计学差异(P>0.05);治疗后,观察组与对照组中医证候积分、APACHEⅡ评分降低,且观察组中医证候积分、APACHEⅡ评分低于对照组(P<0.05)。治疗前观察组与对照组血清白细胞介素-1β(IL-1β)、白细胞介素-6(IL-6)、降钙素原(PCT)和肿瘤坏死因子-α(TNF-α)比较差异无统计学意义(P>0.05);治疗后,观察组与对照组血清IL-1β、IL-6、PCT和TNF-α降低,且观察组低于对照组(P<0.05)。对照组不良反应发生率与观察组比较(7.69%vs 3.85%),差异无统计学意义(χ^(2)=0.707,P=0.400)。结论对脓毒症急性胃肠损伤患者应用大承气汤联合莫沙必利治疗能取得较佳的临床疗效,不但可改善肠鸣音次数和胃肠道动力、缓解症状,对患者肠屏障也有一定修复功能。
Objective To investigate the effect of Dachengqi Decoction(大承气汤)combined with mosapride on clinical symptoms,intra-abdominal pressure and survival rate of patients with acute gastrointestinal injury in sepsis.Methods A total of 104 patients with acute gastrointestinal injury due to sepsis in the hospital from December 2018 to November 2020 were selected as the research objects.According to the random number table method,they were divided into the control group and the observation group with 52 cases in each group.The control group was treated with mosapride and the observation group was treated with Dachengqi Decoction on the basis of the control group,and followed up after 1 month.The intra-abdominal pressure,bowel sounds,TCM symptom score,acute physiology and chronic health score II(APACHE II)and inflammatory indexes were compared between the two groups before and after treatment,and the survival rate,incidence of adverse reactions and clinical efficacy were analyzed.Results Compared with that of the control group(78.85%),the clinical effective rate of the observation group was higher(96.15%)(χ^(2)=7.121,P=0.008).Before treatment,the intra-abdominal pressure and bowel sounds was no statistical significance between two group(P>0.05).After treatment,the intra-abdominal pressure and bowel sounds of the observation group were better than those of the control group(P<0.05).Compared with that of the control group(78.85%),the survival rate of the observation group was higher(94.23%),but the difference was no statistically significant(χ^(2)=0.542,P=0.462).Before treatment,there was no significant difference in TCM symptom score or APACHEⅡscore between the observation group and the control group(P>0.05).After treatment,TCM symptom score and APACHEⅡscore of the observation group and the control group were decreased,and compared with those of the control group,TCM symptom score and APACHEⅡscore of the observation group were lower(P<0.05).Before treatment,there was no significant difference in the levels of serum inflammatory factors between the observation group and the control group(P>0.05).After treatment,the levels of serum inflammatory factors in the observation group and the control group were decreased,and compared with those of the control group,the levels of interleukin-1β(IL-1β),interleukin-6(IL-6),procalcitonin(PCT)and tumor necrosis factor-α(TNF-α)in the observation group were lower(P<0.05).Compared with that of the control group(7.69%),the incidence of adverse reactions in the observation group(3.85%)had no significant difference(χ^(2)=0.707,P=0.400).Conclusion Dachengqi Decoction combined with mosapride can effectively improve the therapeutic effect of patients with sepsis with acute gastrointestinal injury,improve the frequency of bowel sounds and gastrointestinal motility,relieve symptoms and has a certain repair function on the intestinal barrier.
作者
于乃浩
褚玉茹
张彬
李琛
牟迪
阚建英
YU Naihao;CHU Yuru;ZHANG Bin;LI Chen;MOU Di;KAN Jianying(Department of Critical Care Medicine,Affiliated Hospital of Tianjin Academy of Traditional Chinese Medicine,Tianjin 300120,China)
出处
《辽宁中医杂志》
CAS
2022年第4期123-126,共4页
Liaoning Journal of Traditional Chinese Medicine
基金
天津市中医药管理局中医中西医结合科研项目(17022)
关键词
大承气汤
莫沙必利
脓毒症
急性胃肠损伤
腹内压
生存率
Dachengqi Decoction(大承气汤)
mosapride
sepsis
acute gastrointestinal injury
intra-abdominal pressure
survival rate
作者简介
于乃浩(1974-),男,天津人,副主任医师,学士,研究方向:危重症急救领域;通讯作者:阚建英(1964-),女,天津人,主任医师,学士,研究方向:危重症急救领域,E-mail:kjy_123@yeah.net。
