大黄附子合小承气汤对脓毒症患者胃肠功能及炎症因子的影响
Effect of Dahuang Fuzi Decoction Combined with Xiaochengqi Decoction on Gastrointestinal Function and Inflammatory Factors in Patients with Sepsis
  
DOI:
中文关键词:  脓毒症  胃肠功能  炎症因子  大黄附子汤  小承气汤
英文关键词:Sepsis  Gastrointestinal function  Inflammatory factor  Dahuang Fuzi Decoction  Xiaochengqi Decoction
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魏凤琴,吕 健,孟 浩,倪海滨 南京中医药大学附属中西医结合医院江苏 南京 210028 
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中文摘要:
      目的 观察大黄附子合小承气汤对脓毒症患者胃肠功能及炎症因子的影响。方法 将50例脓毒症患者随机分为治疗组和对照组,每组25例。两组均给予西医基础治疗,治疗组另经胃管注入大黄附子合小承气汤治疗,疗程为2周。评估两组患者治疗前和治疗72 h后急性胃肠损伤(acute gastrointestinal injury,AGI)分级情况;比较两组患者治疗前后胃肠功能障碍评分、急性生理学及慢性健康评估Ⅱ(acute physiology and chronic health evaluation Ⅱ,APACHE Ⅱ)评分、序贯器官衰竭评估(sequential organ failure assessment,SOFA)评分变化及炎症指标[白细胞(white blood cell,WBC),高敏C-反应蛋白(high-sensitivity C-reactive protein,hs-CRP),降钙素原(procalcitonin,PCT)]变化情况;比较两组患者住院时间及病死率。结果 经72 h的治疗后,对照组AGI分级无明显变化(P>0.05),治疗组患者AGI分级明显降低(P<0.05),且治疗组AGI分级改善程度明显优于对照组(P<0.05)。与治疗前比较,两组患者治疗前胃肠功能障碍评分、APACHE Ⅱ评分、SOFA评分和WBC、hs-CRP、PCT均显著降低(P<0.05),且治疗组上述指标下降程度显著大于对照组(P<0.05)。两组病死率和总住院时间比较,差异无统计学意义(P>0.05)。结论 早期运用泻热通腑法能显著改善脓毒症患者胃肠功能障碍,改善预后。
英文摘要:
      Objective To investigate the effect of Dahuang Fuzi Decoction combined with Xiaochengqi Decoction on gastrointestinal function and inflammatory factors in patients with sepsis. Methods A total of 50 patients with sepsis were randomly divided into treatment group and control group, with 25 patients in each group. Both groups were given basic Western medicine treatment, and the patients in the treatment group were given Dahuang Fuzi Decoction combined with Xiaochengqi Decoction via a stomach tube. The course of treatment was 2 weeks. The grade of acute gastrointestinal injury (AGI) was evaluated before treatment and after 72 hours of treatment, and the two groups were compared in terms of the changes in gastrointestinal dysfunction score, Acute Physiology and Chronic Health Evaluation Ⅱ(APACHEⅡ) score, Sequential Organ Failure Assessment (SOFA) score, and inflammation markers [white blood cell count (WBC), high-sensitivity C-reactive protein (hs-CRP), and procalcitonin (PCT)] after treatment. Length of hospital stay and mortality rate were compared between the two groups. Results After 72 hours of treatment, there was no significant change in AGI grade in the control group (P>0.05),while the treatment group had a significant reduction in AGI grade (P<0.05);the treatment group had a significantly greater improvement in AGI grade than the control group (P<0.05). Both groups had significant reductions in gastrointestinal dysfunction score,APACHEⅡ score,SOFA score, WBC, hs-CRP, and PCT after treatment (P<0.05), and the treatment group had significantly greater reductions than the control group (P<0.05). There were no significant differences in length of hospital stay and mortality rate between the two groups (P>0.05). Conclusion Early application of the heat-clearing and bowel-relaxing method can significantly improve gastrointestinal dysfunction and prognosis in patients with sepsis.
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