添加参苓白术散的肠内营养剂对危重症患者免疫功能的影响

发布时间：2018-03-26 17:11

本文选题：危重症　切入点：参苓白术散　出处：《广州中医药大学》2017年硕士论文

【摘要】：目的:本研究旨在应用添加参苓白术散的肠内营养剂在益气健脾、调节肠道菌群、改善胃肠道功能、提高免疫功能等方面的优势来改善脾虚证危重症患者的免疫功能。在患者入住ICU24小时内与治疗后1周分别抽取患者外周静脉血检测患者T淋巴细胞亚群与免疫球蛋白治疗前后的数值变化情况,通过测得数据初步评价参苓白术散对脾虚证危重患者免疫功能的影响,为益气健脾中药在临床救治危重患者提供新的思路与方法。方法:采用前瞻、随机、单盲、对照研究,将2016年6月至2017年3月入住广州中医药大学第一附属医院重症医学科且中医表现为脾胃气虚证侯的危重症患者54例纳入研究,按照排除标准、纳入标准1:1随机分配的方法将合格病例分别划分为治疗组(27例)、对照组(27例)。所有纳入病例在血流动力学、内环境稳定的情况下,且无肠内营养的禁忌后开始尽早实施肠内营养(24-48小时),对照组予以标准配方的肠内营养剂能全力,治疗组用胃管或鼻空肠管注入200ml参苓白术散汤剂,次/日,疗程7天。同时收集整理纳入病例的四诊资料及急性生理学与慢性健康状况Ⅱ(APACHE Ⅱ)评分,记录两组患者在入住ICU24小时内及治疗1周后的T淋巴细胞亚群(CD4+、CD3+、CD4+/CD8+)、NK细胞活性、免疫球蛋白水平变化等相关指标,进行资料整理,统计学分析,评估在中医药参苓白术散干预下对危重症患者免疫功能的影响。结果:共有47例入组,治疗组25例,对照组22例。研究前通过对比治疗组和对照组的APACHE-Ⅱ评分、年龄、性别构成比等基线资料,发现无统计学意义(P0.05),说明两组资料具有可比性;治疗前对照组与治疗组患者所测得T淋巴细胞亚群、NK细胞活性、免疫球蛋白水平变化无明显差异(P0.05),具有可比性;对比治疗前后两组组内之间数据发现两组患者T淋巴细胞亚群、NK细胞活性、免疫球蛋白水平均较治疗前升高,有统计学意义(P0.05);对比治疗后两组组间数据发现治疗组所测得T淋巴细胞亚群、NK细胞活性、免疫球蛋白水平较对照组明显升高,有统计学差异(P0.05),对比两组治疗前后差值比较发现,所测得T淋巴细胞亚群、NK细胞活性、免疫球蛋白水平差值治疗组明显大于对照组。结论:无论是对照组西医常规治疗,还是治疗组西医常规治疗联合添加参苓白术散的肠内营养支持,均能升高NK细胞活性,提高CD4+、CD3+、CD4+/CD8+、IgG、IgA、IgM水平,降低危重症患者APACHE-Ⅱ评分,改善机体免疫功能。治疗1周后,治疗组与对照组的T淋巴细胞亚群水平、NK细胞活性及免疫球蛋白水平均升高,而治疗组明显高于对照组(P0.05),有统计学差异。说明中药制剂参苓白术散确实能改善危重症患者的免疫功能,改善疾病预后。
[Abstract]:Objective: This study aims to use the add SHENLINGBAISHU enteral nutrition in Qi and spleen, regulate the intestinal flora, improving gastrointestinal function, improve immune function and other advantages to improve the immune function of patients with spleen deficiency syndrome in critically ill patients. In patients admitted to ICU24 hours and 1 weeks after treatment were collected in patients with peripheral venous blood detection of T lymphocyte subsets in patients with numerical changes before and after immunoglobulin treatment, the measured data through the evaluation of the effect of Shenlingbaizhu powder on immune function in critically ill patients with spleen deficiency syndrome, Qi and spleen for traditional Chinese medicine to provide new ideas and methods in clinical treatment of critically ill patients. Methods: a prospective, randomized, single blind, controlled study. The First Affiliated Hospital of Guangzhou University of Chinese Medicine from June 2016 to March 2017 in intensive medicine and Chinese medicine for stomach qi deficiency Hou 54 critically ill patients included in the study, according to the According to the exclusion criteria, into the standard 1:1 method will be randomly assigned to qualified patients were divided into treatment group (27 cases) and control group (27 cases). All cases in hemodynamics, internal environment stable, and no contraindication of enteral nutrition after the start of the early implementation of enteral nutrition (24-48 hours), the control group was given standard formulations of enteral nutrition can fully, the treatment group was treated with gastric tube or nasojejunal injection 200ml shenlingbaizhusan decoction, time / day, a course of 7 days. At the same time to collect the cases of the four diagnostic information and acute physiology and chronic health evaluation (APACHE II) score in the two groups were recorded in ICU24 hours and 1 weeks after treatment T lymphocyte subsets (CD4+, CD3+, CD4+/CD8+), NK cell activity and related indexes of immunoglobulin level changes, to collect data, statistical analysis, evaluation of traditional Chinese medicine in the intervention of critically ill shenlingbaizhupowder Effect of immune function of patients. Results: a total of 47 cases, 25 cases in the treatment group, 22 cases in the control group. Before the study by comparing the treatment group and control group, APACHE- score, age, gender ratio of baseline data, found no statistical significance (P0.05), the two groups that have comparable data before treatment; the control group and the treatment group were measured T lymphocyte subsets, NK cell activity, no significant difference between the changes of the level of immunoglobulin (P0.05), with comparable data; compared before and after treatment in the two groups was found between two groups of patients T lymphocyte subsets, NK cell activity, immune globulin the level was higher than that before treatment, there was statistical significance (P0.05); comparison of data between the two groups after treatment treatment group measured T lymphocyte subsets, NK cell activity, immune globulin level was significantly higher than the control group, there was statistical difference (P0.05), comparing the two groups before and after treatment The difference is found, the measured T lymphocyte subsets, NK cell activity, immune globulin levels between treatment group was significantly higher than the control group. Conclusion: both the control group conventional western medicine treatment, treatment group and routine treatment of Western medicine combined with SHENLINGBAISHU enteral nutrition support can increase the activity of NK cells, increased CD4+ CD3+, CD4+/CD8+, IgG, IgA, IgM, APACHE- in patients with critical level, reduce the score, improve the immune function. After 1 weeks of treatment, the levels of T lymphocyte subsets in the treatment group and control group, NK cell activity and immunoglobulin levels were elevated, while the treatment group was significantly higher than the control group (P0.05), there was statistically significant difference. Conclusion: the traditional Chinese medicine preparation SHENLINGBAISHU indeed can improve the immune function of critically ill patients, improve the prognosis of the disease.

【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R459.7

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