调胃承气汤对重症患者胃肠功能障碍的影响

发布时间：2018-10-13 12:21

【摘要】：背景:胃肠功能障碍是ICU患者常见的并发症,若出现胃肠功能损伤的临床症状则提示预后不良或病情加重。现代医学对重症胃肠功能障碍的发病机制仍不明确,治疗亦缺乏相关特异性。而中医的治疗模式是多靶点、多途径,具有整体观念和辨证论治的特色。中医认为胃肠功能障碍的基本病机是胃失和降、腑气不通,故基本治疗原则是和胃通降、行气通腑。调胃承气汤出自《伤寒论》辨阳明病脉证并治阳明病证篇,具有泻热和胃、润燥软坚的功效,常用于阳明病胃肠燥热证。目前临床上关于调胃承气汤治疗重症胃肠功能障碍的研究相对较少。本研究旨在评估加用调胃承气汤的中西医结合治疗对于重症患者胃肠功能障碍的临床疗效。目的:通过观察在西医治疗基础上加用调胃承气汤对合并有重症胃肠功能障碍的患者的影响,证明调胃承气汤能有效的降低患者腹内压、促进胃肠蠕动、改善氧合及疾病预后,进而为调胃承气汤在临床的广泛运用提供一定的科学依据。方法:采用随机、对照、前瞻性设计方案。选择入住广州中医药大学第一附属医院重症医学科符合实验标准的患者50例,按照随机分组的方法将纳入患者分为治疗组和对照组,治疗组与对照组各自25例。所有入选的患者均给予常规基础治疗。治疗组在常规治疗的基础上加用调胃承气汤加减,疗程5天,观察腹内压、腹围、肠鸣音、氧合指数及APACHEⅡ评分治疗前后的变化情况,采用SPSS20.0统计软件对数据进行统计处理。结果:1.治疗组与对照组入组前的性别、年龄、腹内压、腹围、肠鸣音、氧合指数及APACHEⅡ评分都是P0.05,说明两组具有可比性。2.调胃承气汤能改善重症患者的胃肠功能障碍。治疗组治疗后的腹内压、腹围及肠鸣音与对照组相比明显好转,PO.05,两组具有统计学差异。3.调胃承气汤能改善重症患者的氧合情况。治疗组氧合指数升高的程度大于对照组,P0.05,两组具有统计学差异。4.调胃承气汤能改善重症患者病情的严重程度。治疗组与对照组相比APACHEⅡ评分明显下降,P0.05,两组具有统计学差异。结论:调胃承气汤可以促进胃肠蠕动,降低腹腔压,缩减腹围,增加肠鸣音次数,改善全身氧合状态及病情危重程度,对重症胃肠功能障碍的治疗效果理想。
[Abstract]:Background: gastrointestinal dysfunction is a common complication in patients with ICU. The pathogenesis of severe gastrointestinal dysfunction in modern medicine is still unclear and the treatment lacks specificity. The treatment mode of TCM is multi-target and multi-channel with the characteristics of holistic concept and differentiation of symptoms and signs. TCM believes that the basic pathogenesis of gastrointestinal dysfunction is gastric disharmony, entrails and qi impassable, so the basic principle of treatment is to make the stomach go down, and carry out qi to clear the Fu organs. The decoction of regulating stomach and Chengqi comes from the syndrome of differentiating Yangming disease and treating Yangming disease, it has the effect of purging heat and stomach, moistening dryness, and is often used in Yangming disease of gastrointestinal dryness and heat syndrome. At present, there are few clinical studies on the treatment of severe gastrointestinal dysfunction with Tiaowei Chengqi decoction. The purpose of this study was to evaluate the clinical efficacy of combined Chinese and western medicine with TWTD in the treatment of gastrointestinal dysfunction in severe patients. Objective: to observe the effect of Tiaowei Chengqi decoction on patients with severe gastrointestinal dysfunction on the basis of western medicine treatment, and to prove that Tiaowei Chengqi decoction can effectively reduce the abdominal pressure, promote gastrointestinal peristalsis, improve oxygenation and disease prognosis. It provides a scientific basis for the wide application of Tiaowei Chengqi decoction in clinical practice. Methods: a randomized, controlled and prospective design was used. Fifty patients admitted to the Department of intensive Medicine of the first affiliated Hospital of Guangzhou University of traditional Chinese Medicine were selected and divided into treatment group and control group according to the method of random grouping. There were 25 cases in treatment group and control group respectively. All selected patients were given routine basic treatment. On the basis of routine treatment, the treatment group was treated with taiwei Chengqi decoction for 5 days. The changes of abdominal pressure, abdominal circumference, bowel sound, oxygenation index and APACHE 鈪，

本文编号：2268606