英黄汤治疗脓毒症患者胃肠功能障碍的临床研究

发布时间：2018-03-03 19:47

本文选题：英黄汤　切入点：脓毒症　出处：《河北医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:通过研究英黄汤治疗脓毒症患者胃肠功能障碍的临床疗效,并观察其对急性生理与慢性健康状况(Acute Physiology and Chronic Health EvaluationⅡ,APACHEⅡ)评分、胃肠功能障碍评分、腹腔内压(Intraabdominal Pressure,IAP)、血浆胃泌素(Gastrin,GAS)、血浆胃动素(Motillin,MTL)等的影响,探究英黄汤治疗本病的作用机制。方法:观察病例全部来自我院急诊重症监护病房(Emergency treatment Intensive Care Unit,EICU)2016年7月-2017年1月收治的脓毒症胃肠功能障碍患者,合计38例。依据随机数字表法随机分为治疗组19例和对照组19例。两组病例在性别、年龄及腹腔内压等方面经SPSS 21.0分析(P0.05),差异无统计学意义,具有可比性。两组均给予西医基础治疗,同时治疗组在基础治疗上加用英黄汤鼻饲或口服,持续治疗7天,观察指标包括基础资料、急性生理与慢性健康状况评分、多器官功能障碍综合征(Multiple organ dysfunction syndrome,MODS)发生率、病死率以及胃肠功能相关指标,如腹腔内压、胃肠功能障碍评分以及胃肠激素(血浆胃泌素、血浆胃动素),并进行胃肠功能疗效评价。结果:1两组胃肠功能疗效比较治疗后,治疗组总有效率为78.9%,对照组总有效率为52.6%,治疗组与对照组比较差异有统计学意义(P=0.034)。说明针对脓毒症胃肠功能障碍患者的治疗,治疗组的效果更好。2两组急性生理与慢性健康状况(APACHEⅡ)评分变化情况比较两组病例经治疗后APACHEⅡ评分均有所下降,与治疗前比较,治疗组差异有统计学意义(t=43.344,P0.001),对照组差异无统计学意义(t=0.789,P=0.440);治疗后,治疗组与对照组之间比较差异有统计学意义(t=-3.138,P=0.003)。说明针对脓毒症胃肠功能障碍患者的治疗,治疗组的效果更好。3两组胃肠功能障碍评分变化情况比较两组病例经治疗后胃肠功能障碍评分均有所下降,与治疗前比较,两组差异均有统计学意义(治疗组t=5.117,P0.001,对照组t=2.876,P=0.010);治疗后,治疗组与对照组之间比较差异亦有统计学意义(t=-2.150,P=0.038)。说明针对脓毒症胃肠功能障碍患者的治疗,治疗组的效果更好。4两组腹腔内压(IAP)变化情况比较两组病例经治疗后IAP均有所下降,与治疗前比较,治疗组差异有统计学意义(t=18.635,P0.001),对照组差异无统计学意义(t=1.077,P=0.296);治疗后,治疗组与对照组之间比较差异有统计学意义(t=-2.796,P=0.008)。说明针对脓毒症胃肠功能障碍患者的治疗,治疗组的效果更好。5两组血浆胃泌素(GAS)变化情况比较两组病例经治疗后GAS均有所下降,与治疗前比较,治疗组差异有统计学意义(t=17.897,P0.001),对照组差异无统计学意义(t=1.495,P=0.152);治疗后,治疗组与对照组之间比较差异有统计学意义(t=-3.139,P=0.003)。说明针对脓毒症胃肠功能障碍患者的治疗,治疗组的效果更好。6两组血浆胃动素(MTL)变化情况比较两组病例经治疗后MTL均有所上升,与治疗前比较,两组差异均有统计学意义(治疗组t=-26.409,P=0.0000.05,对照组t=-22.196,P0.001);治疗后,治疗组与对照组之间比较差异亦有统计学意义(t=2.288,P=0.028)。说明针对脓毒症胃肠功能障碍患者的治疗,治疗组的效果更好。7两组多器官功能障碍综合征(MODS)发生率比较治疗后,治疗组MODS发生率为21.1%;对照组MODS发生率为57.9%,治疗组与对照组之间比较差异有统计学意义(P=0.045)。说明针对脓毒症胃肠功能障碍患者的治疗,治疗组的效果更好。8两组病死率比较治疗后,治疗组病死率为10.5%,对照组病死率为42.1%,治疗组与对照组之间比较差异无统计学意义(P=0.062)。说明尚不能证明针对脓毒症胃肠功能障碍患者的治疗,在降低病死率方面治疗组的效果更好。结论:研究结果证实,英黄汤联合西医基础治疗能够更为有效的改善脓毒症患者胃肠功能障碍,其改善胃肠功能的作用机制可能与调整胃肠激素GAS、MTL的分泌有关。
[Abstract]:Objective: through the clinical study of English Decoction in the treatment of sepsis patients with gastrointestinal dysfunction, and observe the effect on acute physiology and chronic health evaluation (Acute Physiology and Chronic Health Evaluation II, APACHE II) score, gastrointestinal dysfunction score, intra-abdominal pressure (Intraabdominal, Pressure, IAP), plasma gastrin (Gastrin, GAS), plasma motilin (Motillin, MTL) the influence mechanism of inquiry Decoction in treating this disease. The methods: observation cases all from our hospital emergency intensive care unit (Emergency treatment Intensive Care Unit, EICU) sepsis in patients with gastrointestinal dysfunction in July 2016 -2017 year in January, a total of 38 cases were randomly according to. 19 patients were divided into treatment group and control group of 19 cases. The two groups were gender, age and SPSS analysis of 21 aspects of the intra-abdominal pressure (P0.05), the difference was not statistically significant, comparable . the two groups were given the basic treatment of Western medicine, the treatment group was treated with basic therapy plus Chinese Decoction oral or nasal feeding at the same time, continued for 7 days. The observation indexes include basic data, acute physiology and chronic health evaluation, multiple organ dysfunction syndrome (MODS Multiple organ dysfunction syndrome) incidence, mortality and gastrointestinal function related indicators, such as intra-abdominal pressure, gastrointestinal dysfunction score and gastrointestinal hormones (gastrin, motilin,) and evaluate the gastrointestinal function curative effect. Results: compared with two groups of curative effect of 1 gastrointestinal function after treatment, the total efficiency of treatment group was 78.9%, control group total effective rate was 52.6%, and the treatment group was statistically significant the control group (P=0.034). In the treatment of patients with sepsis with gastrointestinal dysfunction, two groups of acute physiology and chronic health treatment group better.2 (APACHE II) score change Of the two groups were compared after treatment, APACHE score decreased, compared with before treatment, treatment group was statistically significant difference (t=43.344, P0.001), the control group had no significant difference (t=0.789, P=0.440); after treatment, the treatment group and control group compared the difference was statistically significant (t=-3.138, P=0.003 according to the instructions.) in the treatment of sepsis with gastrointestinal dysfunction, the effect of the treatment group better.3 two group of gastrointestinal dysfunction score between the two groups were compared after treatment of gastrointestinal dysfunction score were decreased, compared with before treatment, there were significant differences between two groups (t=5.117 treatment group, P0.001 control group, t=2.876, P=0.010); after treatment between the treatment group and the control group there were significant differences (t=-2.150, P=0.038). In the treatment of patients with sepsis with gastrointestinal dysfunction, the treatment group has better effect in two groups of.4 The intra-abdominal pressure (IAP) changes of the two groups were compared after treatment IAP decreased, compared with before treatment, treatment group was statistically significant difference (t=18.635, P0.001), the control group had no significant difference (t=1.077, P=0.296); after treatment between the treatment group and the control group the difference was statistically significant (t=-2.796, P=0.008). In the treatment of patients with sepsis with gastrointestinal dysfunction, the treatment group has better effect in two groups of.5 plasma gastrin (GAS) changes of the two groups were compared after treatment GAS decreased, compared with before treatment, treatment group was statistically significant difference (t=17.897, P0.001), control group. No statistical significance (t=1.495, P=0.152); after treatment between the treatment group and the control group the difference was statistically significant (t=-3.139, P=0.003). The sepsis patients gastrointestinal dysfunction, the effect of the treatment group better.6 two group The plasma motilin (MTL) changes of the two groups were compared after treatment, MTL increased, compared with before treatment, there were significant differences between two groups (treatment group, t=-26.409 control group, P=0.0000.05, t=-22.196, P0.001); after treatment, the treatment group and control group compared the difference was also statistically significant (t=2.288, P=0.028 according to the instructions.) in the treatment of sepsis with gastrointestinal dysfunction, the treatment group has better effect in two groups of.7 multiple organ dysfunction syndrome (MODS) incidence after treatment in treatment group, the incidence rate of MODS was 21.1%; the control group, the incidence rate of MODS was 57.9%, between the treatment group and the control group the difference was statistically significant (P=0.045 according to the instructions.) in the treatment of sepsis with gastrointestinal dysfunction, the treatment group has better effect on.8 mortality rate of two groups were compared after treatment, the treatment group mortality rate was 10.5%, the fatality rate was 42.1% in control group, treatment group and control group No statistically significant differences (P=0.062). There is no proof that in the treatment of patients with sepsis with gastrointestinal dysfunction, reduce the mortality rate in the treatment group, the effect is better. Conclusion: the results confirmed that the British Decoction Combined Western medicine can effectively improve sepsis in patients with gastrointestinal dysfunction, improve gastrointestinal the mechanism may be related to adjustment of gastrointestinal hormone GAS, secretion of MTL.

【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R459.7

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