MODS胃肠功能障碍腹胀满病中医诊疗方案的临床研究

发布时间：2018-05-09 08:18

本文选题：MODS胃肠功能障碍 + 腹胀满病　；参考：《南京中医药大学学报》2017年06期

【摘要】：目的探讨多器官功能障碍综合征(MODS)胃肠功能障碍腹胀满病中医诊疗方案的临床疗效。方法纳入自2012年7月至2016年12月于南京中医药大学附属医院重症监护病房(ICU)收治的腹胀满病患者共78例,随机分为对照组(n=35)和试验组(n=43)。2组均采用积极抗感染、脏器功能支持、营养免疫调理等基础治疗,试验组经中医辨证为热毒中阻证者予大黄黄连泻心化裁方消导化积,清热解毒;气滞血瘀证者予血府逐瘀化裁方理气通腑,活血祛瘀;肺脾气虚证者予自拟益气通腑方益气健脾,通腑泄浊。各证型均配以针灸、穴位贴敷等治疗。记录并比较2组患者治疗前和治疗后第7、14天腹部症状、体征、腹内压等胃肠道功能相关指标的变化、ICU住院天数及住院期间病死率。结果治疗后2组患者中医症状评分、腹部体征评分、腹内压水平均呈下降趋势,但在试验组治疗第7、14天各指标较对照组下降更为明显,具有显著统计学差异(P0.05),且治疗第14天以中医症状评分及腹部体征评分下降更明显(P0.01)。2组28d死亡率相比无明显统计学差异,但试验组患者平均ICU住院时间明显低于对照组(P0.05)。试验组分析显示,以热毒中阻证患者占比最高,且痊愈率明显高于气滞血瘀证和脾肺气虚证患者,而无效率明显低于气滞血瘀证和脾肺气虚证患者(P0.05)。结论在MODS腹胀满病住院患者中应用诊疗方案进行诊疗可显著提高第14天的临床疗效,缩短ICU住院时间。
[Abstract]:Objective to investigate the clinical effect of traditional Chinese medicine (TCM) regimen for multiple organ dysfunction syndrome (MODS) with gastrointestinal dysfunction. Methods from July 2012 to December 2016, 78 patients with abdominal fullness were randomly divided into two groups: control group (control group) and experimental group (n = 43.2), which were treated with active anti-infection and visceral function support, respectively, from July 2012 to December 2016 in the intensive care unit (ICU) of Nanjing University of traditional Chinese Medicine (Nanjing University of traditional Chinese Medicine). Nutrition and immune conditioning and other basic treatment, the experimental group according to the syndrome differentiation of heat toxin in the syndrome of heat toxin in the treatment of rhubarb Huanglian Xiexinghua prescription Xiaotong Huanghuanxiahua prescription, clearing away heat and detoxification, Qi stagnation and blood stasis syndrome of blood stasis, blood circulation, blood stasis; Lung-spleen-qi deficiency syndrome for self-formulation of Qi-tonifying-qi-invigorating spleen-qi-draining turbid. All syndromes were treated with acupuncture and acupuncture, acupoint application and so on. To record and compare the changes of gastrointestinal function indexes such as abdominal symptoms, physical signs and intra-abdominal pressure before treatment and at day 714 after treatment in both groups. The length of stay in ICU and the fatality rate during hospitalization were compared. Results after treatment, the scores of TCM symptoms, abdominal signs, and the level of intra-abdominal pressure in the two groups showed a downward trend, but on the 14th day after treatment, the indexes in the experimental group were significantly lower than those in the control group. There was significant statistical difference (P 0.05), and on the 14th day after treatment, the scores of TCM symptoms and abdominal signs decreased more significantly than that of the control group (P 0.01), but the average ICU hospitalization time in the trial group was significantly lower than that in the control group (P 0.05). The analysis of the test group showed that the proportion of the patients with heat toxin and middle obstruction syndrome was the highest, and the cure rate was significantly higher than that of the patients with qi stagnation and blood stasis syndrome and spleen lung qi deficiency syndrome, while the inefficiency rate was significantly lower than that of the patients with qi stagnation blood stasis syndrome and spleen lung qi deficiency syndrome (P0.05). Conclusion the clinical effect of MODS on the 14th day can be improved and the hospitalization time of ICU can be shortened by using the diagnosis and treatment scheme in the inpatients with MODS abdominal fullness disease.
【作者单位】：南京中医药大学附属医院;
【基金】：国家中医药管理局“十二五”重点专科重点专病协作组研究项目(ZP1001ZZ011) 国家中医临床研究基地和中国中医科学院江苏分院开放课题资助江苏省中医药局科技计划项目(JD201501)
【分类号】：R259

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