中医综合疗法治疗脓毒症胃肠功能障碍的临床研究
发布时间：2019-04-23 09:29
【摘要】：目的:目前脓毒症胃肠功能障碍的治疗以对症支持为主,方法单一,疗效甚微。中医药基于整体观念及辨证论治,在胃肠功能障碍的治疗有独特的优势,已有研究证实其在治疗脓毒症胃肠功能障碍方面有一定的疗效。但大多研究只针对某种疗法进行研究,未对中医众方案进行优化组合。本研究旨在探索中医综合疗法对脓毒症胃肠功能障碍的临床疗效,制定一个内外结合、针药并用的中医综合诊疗方案,以期发挥传统医学在脓毒症治疗的作用。方法:本研究采用前瞻性随机对照的设计方法,纳入2016年5月-2017年3月广东省中医院大学城医院重症医学科(ICU)收治的脓毒症胃肠功能障碍患者共60例。使用随机数字表分组方法,将其分为治疗组和对照组各30例。两组均按2012年国际拯救脓毒症指南予西医常规处理,治疗组在此基础上加用中医综合疗法(静滴血必净注射液、电针足三里及吴茱萸外敷神阙穴),疗程均为7日。观察两组28天病死率、ICU住院天数,治疗前及治疗后(第7日)的APACHE-Ⅱ评分、血白细胞(WBC)、降钙素原(PCT)、C反应蛋白(CRP)、血沉(ESR)、胃肠疾病中医证候评分、胃肠功能障碍评分、胃肠动力功能(胃动素、胃泌素、血管活性肠肽)、胃肠免疫屏障功能(免疫球蛋白、T淋巴细胞亚群)和胃肠粘膜屏障功能(二胺氧化酶、D-乳酸)。结果:1.病情严重度及预后评估比较:经治疗,治疗组与对照组28天病死率比较,差异无统计学意义(P0.05)。与对照组比较,治疗组ICU住院天数明显缩短(P0.05),治疗组第7日APACHE-Ⅱ评分明显降低(P0.05)。2.炎症指标比较:治疗第7日,与对照组比较,治疗组WBC、PCT、CRP明显降低(P0.05);治疗组与对照组ESR比较,差异无统计学意义(P0.05)。3.胃肠疾病中医证侯评分比较:治疗第7日,与对照组比较,治疗组胃肠疾病中医证侯评分明显降低(P0.05)。4.胃肠功能障碍评分比较:治疗第7日,与对照组比较,治疗组胃肠功能障碍评分明显降低(P0.05)。5.胃肠动力功能指标比较:治疗第7日,与对照组比较,治疗组MTL明显升高(P0.05),治疗组GAS明显降低(P0.05);治疗组与对照组VIP比较,差异无统计学意义(P0.05)。6.胃肠免疫屏障功能指标比较:治疗第7日,与对照组比较,治疗组IgG、IgA、IgM、CD3+均明显升高(P0.05);治疗组与对照组CD4+/CD8+比较,差异无统计学意义(P0.05)。7.胃肠粘膜屏障功能指标比较:治疗第7日,与对照组比较,治疗组DAO、D-LAC均明显降低(P0.05)。结论:在西医常规治疗基础上,应用中医综合疗法治疗脓毒症胃肠功能障碍,可改善病情严重度,缩短ICU住院天数,不能改变病死率;减轻炎症反应;改善中医证候;改善胃肠功能,包括胃肠动力功能、免疫屏障及粘膜屏障功能。
[Abstract]:Objective: at present, the treatment of gastrointestinal dysfunction in sepsis is mainly symptomatic support, the method is simple, and the curative effect is very little. On the basis of holistic concept and syndrome differentiation, Chinese medicine has unique advantages in the treatment of gastrointestinal dysfunction, which has been proved to be effective in the treatment of gastrointestinal dysfunction in sepsis. However, most of the studies only focus on a certain therapy, not to optimize the combination of traditional Chinese medicine schemes. The purpose of this study is to explore the clinical efficacy of traditional Chinese medicine (TCM) on gastrointestinal dysfunction in sepsis and to formulate a comprehensive diagnosis and treatment scheme of TCM combined with internal and external combination of acupuncture and medicine in order to give full play to the role of traditional medicine in the treatment of sepsis. Methods: from May 2016 to March 2017, 60 patients with gastrointestinal dysfunction due to sepsis were enrolled in (ICU), Department of critical Medicine, University City Hospital of Guangdong traditional Chinese Medicine Hospital, a prospective randomized controlled design method was used. The patients were divided into two groups: treatment group (n = 30) and control group (n = 30). The two groups were treated by western medicine according to the international rescue sepsis in 2012. On this basis, the treatment group was treated with traditional Chinese medicine comprehensive therapy (intravenous drip of Xuebijing injection, electroacupuncture of Zusanli and Evodia on Shenque point), and the course of treatment was 7 days. The mortality of 28 days, the days of hospitalization of ICU, the scores of APACHE- 鈪，
本文编号：2463340
[Abstract]:Objective: at present, the treatment of gastrointestinal dysfunction in sepsis is mainly symptomatic support, the method is simple, and the curative effect is very little. On the basis of holistic concept and syndrome differentiation, Chinese medicine has unique advantages in the treatment of gastrointestinal dysfunction, which has been proved to be effective in the treatment of gastrointestinal dysfunction in sepsis. However, most of the studies only focus on a certain therapy, not to optimize the combination of traditional Chinese medicine schemes. The purpose of this study is to explore the clinical efficacy of traditional Chinese medicine (TCM) on gastrointestinal dysfunction in sepsis and to formulate a comprehensive diagnosis and treatment scheme of TCM combined with internal and external combination of acupuncture and medicine in order to give full play to the role of traditional medicine in the treatment of sepsis. Methods: from May 2016 to March 2017, 60 patients with gastrointestinal dysfunction due to sepsis were enrolled in (ICU), Department of critical Medicine, University City Hospital of Guangdong traditional Chinese Medicine Hospital, a prospective randomized controlled design method was used. The patients were divided into two groups: treatment group (n = 30) and control group (n = 30). The two groups were treated by western medicine according to the international rescue sepsis in 2012. On this basis, the treatment group was treated with traditional Chinese medicine comprehensive therapy (intravenous drip of Xuebijing injection, electroacupuncture of Zusanli and Evodia on Shenque point), and the course of treatment was 7 days. The mortality of 28 days, the days of hospitalization of ICU, the scores of APACHE- 鈪，
本文编号：2463340
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