摘要
目的 观察针药结合协同治疗脓毒症胃肠功能障碍(湿热壅滞证)患者的临床疗效.方法 患者64例随机分为两组,对照组予西医常规处理,治疗组在此基础上予大承气汤口服、电针(上脘、中脘、双侧天枢、双侧足三里).治疗7 d后,对比两组疗效及肠道黏膜屏障功能指标、炎症反应水平、胃肠道症状评分、急性生理与慢性健康评分(APACHEⅡ)、序贯器官衰竭估计评分(SOFA)的变化.结果 治疗组临床总有效率为93.75％,明显高于对照组75.00％(P＜0.05).治疗后两组患者APACHE Ⅱ评分、SOFA评分、胃肠道症状评分较治疗前明显降低(P＜0.05),且治疗组较对照组明显降低(P＜0.05).治疗后两组患者炎性反应指标C反应蛋白(CRP)、白细胞计数(WBC)、白细胞介素-6(IL-6)、乳酸(Lac)水平均较治疗前降低(P＜0.05),且治疗组炎性指标水平均较对照组明显降低(P＜0.05).对照组治疗后肠屏障功能指标肠脂肪酸结合蛋白(IFABP)、二胺氧化酶(DAO)水平较治疗前减少,瓜氨酸(Cit)水平较治疗前升高,但差异无统计学意义(P＞0.05).治疗组治疗后肠屏障功能指标均有改善(P＜0.05).结论 在西医常规治疗基础上,针药结合法能够协同促进湿热壅滞型脓毒症胃肠功能障碍患者胃肠动力的恢复,对肠屏障功能具有保护作用,同时可减轻机体炎症反应,改善血清Cit、IFABP、DAO的水平,减轻病情危重程度,避免恶性循环.
Abstract
Objective:To observe the clinical efficacy of synergistic treatment of patients with gastrointestinal dysfunction of sepsis(syndrome of stagnant and jamming dampness-heat)by combining acupuncture and medi-cine.Methods:64 patients were randomly and equally divided into two groups.The control group was treated with conventional western medicine,and the treatment group was given Dachengqi Decoction orally and electroacu-puncture(Shangwan,Zhongwan,bilateral Tianshu,and bilateral Zusanli acupoints).After 7 days of treatment,the two groups were compared in terms of efficacy,changes in intestinal mucosal barrier function indexes,inflammato-ry response level,gastrointestinal symptom score,acute physiological and chronic health score(APACHE Ⅱ),and sequential organ failure estimation score(SOFA).Results:After 7 days of treatment,the total clinical effective-ness rate of the treatment group was 93.75％,which was significantly higher than 75.00％of the control group,and the difference was statistically significant(P＜0.05).After treatment,the APACHE Ⅱ score,SOFA score and gastro-intestinal symptom score of the two groups were significantly lower than those before treatment,and the difference was statistically significant(P＜0.05).The treatment group was significantly lower than the control group,and the difference was statistically significant(P＜0.05).After treatment,the levels of C-reactive protein(CRP),white blood cells(WBC),interleukin-6(IL-6)and lactate(Lac)in the two groups were significantly lower than those be-fore treatment(P＜0.05),and the inflammatory index levels in the treatment group were significantly lower than those in the control group(P＜0.05).After treatment,the levels of intestinal fatty acid binding protein(IFABP)and diamine oxidase(DAO)decreased compared with those before treatment,and the levels of citrulline(Cit)in-creased compared with those before treatment,but there was no statistical significance(P＞0.05).The intestinal barrier function indexes in the treatment group were improved after treatment,and the difference was statistically significant(P＜0.05).The improvement in the treatment group was more significant,and the difference was statisti-cally significant(P＜0.05).Conclusion:On the basis of conventional western medical treatment,the combination of acupuncture and medicine can synergistically promote the recovery of gastrointestinal dynamics in patients with sepsis gastrointestinal dysfunction(syndrome of stagnant and jamming dampness-heat),which has a protective ef-fect on the intestinal barrier function;at the same time,it can reduce inflammatory reactions of the body,improve the level of serum Cit,IFABP and DAO,reduce the critical degree of the patients'condition,and avoid the vicious circle.
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