中西医结合治疗严重脓毒症不同中医证型急性胃肠损伤患者临床研究.docVIP

中西医结合治疗严重脓毒症不同中医证型急性胃肠损伤患者的临床研究 　　[摘要] 目的 观察中西医结合治疗严重脓毒症不同中医证型急性胃肠损伤（acute gas-trointestinal injury，AGI）患者的疗效。 方法 对照组（n=30）采用西医治疗；治疗组（n=136）中医辨证分型：气机阻滞、气滞血瘀、脾胃虚弱、湿热内蕴，各型在西医基础上加中医疗法：中药汤剂灌胃，芒硝敷脐，治疗周期7 d。 结果 （1）第1天：APACHE-Ⅱ评分、AGI分级比较，差异无统计学意义（P0.05）。GAS、MTL含量比较：脾胃虚弱型较其他三型均低，差异有统计学意义（P0.05）。（2）第7天：APACHE-Ⅱ评分、AGI分级较第1天降低；气机阻滞型、气滞血瘀型、脾胃虚弱型较对照组低，差异均有统计学意义（P0.05）。治疗后GAS含量均下降，MTL含量均上升；GAS含量：气机阻滞型、气滞血瘀型、脾胃虚弱型较对照组低；MTL含量：各治疗组均较对照组高，差异均有统计学意义（P0.05）。（3）气机阻滞型、气滞血瘀型28 d死亡率较对照组低，各治疗组存活者入住ICU时间较对照组少，差异均有高度统计学意义（P0.01）。结论 严重脓毒症急性胃肠损伤患者各中医证型病情危重程度、胃肠功能有差异，中西医结合治疗能取得一定疗效。 　　[关键词] 严重脓毒症；急性胃肠损伤；中医证型；胃肠激素； APACHE-Ⅱ 　　[中图分类号] R459.7 [文献标识码] A [文章编号] 1673-9701（2016）09-0020-05 　　[Abstract] Objective To observe the difference of the curative effect of the combination of traditional chinese medicine and western medicine treatment of acute gastrointestinal injury（AGI） patients in different traditional chinese medicine（TCM） types of the severe sepsis. Methods The cases in the control group（30 cases） were treated by western medicine. The cases in the treatment group（136 cases） were divided into different TCM syndrome types：Qi activity stagnation， Qi stagnation and blood stasis， asthenia of spleen and stomach， dampness and heat from interior，and were treated by western medicine and traditional chinese medicine. The cases were given different chinese medicine decoction by nasal feeding in difference TCM syndrome types， and mirabilite by applying navel. The treatment cycle was 7 days. Results （1）APACHE-Ⅱ score and AGI grading of day1 was no significantly different（P0.05）. Comparison of GAS and MTL contents：Asthenia of spleen and stomach was lower than those of other three types. There was statistical difference（P 　　[Key words] Severe sepsis； Acute gastrointestinal injury； TCM syndrome types； Gastrointestinal hormone； APACHE-Ⅱ 　　严重脓毒症是临床的常见危重病，病情凶险，病死率高。脓毒症导致多器官功能障碍综合征（multiple organ dysfunction syndrome， MODS），最常累及的器官为胃肠道[1]，AGI是MODS的局部器官表现，但它又通过肠道内细菌和毒素的易位，形成肠源性感染，进而促进MODS的病理生理进程，造成恶性循环，影响预