大承气汤脐部湿热敷治疗AECOPD合并Ⅱ型呼吸衰竭NIV并发腹胀患者胃肠动力的影响
|
摘要
目的:观察大承气汤加味脐部湿热敷治疗慢性阻塞性肺疾病急性加重期(AECOPD)合并Ⅱ型呼吸衰竭,采用无创通气(NIV)并发腹胀的疗效及对胃肠动力激素水平的调节作用。方法:将160例符合要求的患者随机按数字表法分为对照组和观察组各80例。对照组口服枸橼酸莫沙必利片,5 mg/次,3次/d;观察组在对照组治疗的基础上给予大承气汤加味脐部湿热敷,30 min/次,2次/d。两组疗程均为连续治疗7 d。腹胀程度分别采用卷尺测量和患者主观评价,治疗前后各评价1次;记录肠鸣音恢复、腹胀缓解、排气、排便时间;记录每日呼吸机使用总时间、每日记录呼吸机使用压力,呼吸机使用总天数;记录治疗前后动脉血氧饱和度(Sa O2),动脉血氧分压(Pa O2)和二氧化碳分压(Pa CO2)变化情况;检测治疗前后胃泌素(GAS),胃动素(MTL),血管活性肠肽(VIP)和生长抑素(SS)水平。结果:经秩和检验,观察组临床疗效优于对照组(Z=2. 484,P <0. 05);治疗后观察组患者腹胀程度轻于对照组(Z=2. 456,P <0. 05);对照组治疗前后腹围差值(14. 63±3. 76) cm,观察组为(16. 33±4. 11) cm,观察组治疗前后腹围差值多于对照组(P <0. 05);观察组平均呼吸机使用时间短于对照组(P <0. 05),呼吸机使用压力低于对照组(P <0. 05),呼吸机使用总天数少于对照组(P <0. 05);治疗后,观察组患者Sa O2和Pa O2水平均高于对照组,Pa CO2低于对照组(P <0. 05);治疗后观察组患者GAS和MTL水平均高于对照组,VIP和SS水平均低于对照组(P <0. 01)。结论:大承气汤加味脐部湿热敷用于AECOPD合并Ⅱ型呼吸衰竭NIV并发腹胀患者的治疗,可明显减轻腹胀,降低腹内压,减轻呼吸困难,促进胃肠功能恢复,并具有调节胃肠激素水平的作用。
Objective: To observe the efficacy of umbilical moist-heat application of modified Da Chengqitang in treating ventosity after noninvasive ventilation,and the regulatory effect on level of gastrointestinal motility hormone. Method: One hundred and sixty patients were randomly divided into control group and observation group by random number table. Patients in control group got mosapride citrate tablets,5 mg/time,3 times/days. In addition tothe therapy in control group,patients in observation group was also given mbilical moistheat application of modified Da Chengqitang,30 min/time,2 times/day. And a course of treatment was 7 days.Before and after treatment,degree of abdominal distention was measured by a tape and subjective evaluation. Time of recovery of bowel sounds,remission of abdominal distention,exhausting and defecation,and the total time of using respirator,pressure of using respirator,and the total days of using respirator were recorded. And levels of gastrin(GAS),motilin(MTL),vasoactive intestinal peptide(VIP) and somatostatin(SS) were detected.Result: According to the rank sum test,the clinical effect in observation group was superior to that in control group(Z = 2. 484,P < 0. 05). Degree of abdominal distention was lower than that in control group(Z = 2. 456,P < 0. 05). Difference of abdominal circumference in control group before and after treatment was(14. 63 ±3. 76) cm,the observation group is(16. 33 ± 4. 11) cm,the observation group was more than the control group(P < 0. 05). The mean time and the total time of using respirator were shorter than those in control group(P <0. 05),and pressure was lower than that in control group(P < 0. 05,P < 0. 01). And SaO_2,PaCO_2,GAS,MTL were higher than those in control group,whereas PaCO_2,VIP and SS were lower than those in control group(P <0. 05,P < 0. 01). Conclusion: Umbilical moist-heat application of modified Da Chengqitang can relieve abdominal distention and dyspnea, reduce intraperitoneal pressure, improve the recovery of gastrointestinal function,and regulate gastrointestinal hormone level.
Objective: To observe the efficacy of umbilical moist-heat application of modified Da Chengqitang in treating ventosity after noninvasive ventilation,and the regulatory effect on level of gastrointestinal motility hormone. Method: One hundred and sixty patients were randomly divided into control group and observation group by random number table. Patients in control group got mosapride citrate tablets,5 mg/time,3 times/days. In addition tothe therapy in control group,patients in observation group was also given mbilical moistheat application of modified Da Chengqitang,30 min/time,2 times/day. And a course of treatment was 7 days.Before and after treatment,degree of abdominal distention was measured by a tape and subjective evaluation. Time of recovery of bowel sounds,remission of abdominal distention,exhausting and defecation,and the total time of using respirator,pressure of using respirator,and the total days of using respirator were recorded. And levels of gastrin(GAS),motilin(MTL),vasoactive intestinal peptide(VIP) and somatostatin(SS) were detected.Result: According to the rank sum test,the clinical effect in observation group was superior to that in control group(Z = 2. 484,P < 0. 05). Degree of abdominal distention was lower than that in control group(Z = 2. 456,P < 0. 05). Difference of abdominal circumference in control group before and after treatment was(14. 63 ±3. 76) cm,the observation group is(16. 33 ± 4. 11) cm,the observation group was more than the control group(P < 0. 05). The mean time and the total time of using respirator were shorter than those in control group(P <0. 05),and pressure was lower than that in control group(P < 0. 05,P < 0. 01). And SaO_2,PaCO_2,GAS,MTL were higher than those in control group,whereas PaCO_2,VIP and SS were lower than those in control group(P <0. 05,P < 0. 01). Conclusion: Umbilical moist-heat application of modified Da Chengqitang can relieve abdominal distention and dyspnea, reduce intraperitoneal pressure, improve the recovery of gastrointestinal function,and regulate gastrointestinal hormone level.
引文
[1]杜丽娟,尚磊.双水平气道内正压无创呼吸机治疗Ⅱ型呼吸衰竭患者发生腹胀的影响因素分析[J].广西医学,2017,39(11):1767-1769.
[2]李盼盼,徐艳,吴晶.厚朴排气合剂治疗无创通气并发腹胀患者疗效观察[J].贵阳中医学院学报,2016,38(2):53-55.
[3]谢礼翔,梁群.针刺治疗无创呼吸机辅助呼吸致胃肠道胀气临床观察[J].辽宁中医药大学学报,2017,19(8):80-82.
[4]张玲.五磨饮子联合灸法治疗无创呼吸机致腹胀疗效观察[J].山西中医,2016,32(7):15-17.
[5]魏江存,陈勇,谢臻,等.大承气汤的药理作用研究概况[J].中国民族民间医药,2017,26(21):70-74.
[6]朱丽娜,朱京慈.大承气汤防治胃肠动力不足作用机制的研究进展[J].中成药,2014,36(12):2591-2594.
[7]傅志泉,粜鹏翀,李清林,等.大承气汤治疗胃肠功能障碍的Meta分析[J].中华中医药学刊,2017,35(1):169-172.
[8]慢性阻塞性肺疾病急性加重诊治专家组.慢性阻塞性肺疾病急性加重(AECOPD)诊治中国专家共识(2014年修订版)[J].国际呼吸杂志,2014,34(1):1-11.
[9]刘新光.解读功能性肠病罗马Ⅲ诊断标准[J].中国实用内科杂志,2006,26(21):1691-1693.
[10]黄吉强.腹部外科学理论与实践[M].北京:科学出版社,2003:64-66.
[11]聂万水,陈晨松,王韧.厚朴排气合剂治疗重症监护室机械通气后腹胀、便秘疗效观察[J].新中医,2017,49(4):36-38.
[12]倪猛,高改云.莫沙必利与多潘立酮治疗功能性消化不良的临床疗效比较[J].重庆医学,2014,43(7):856-857.
[13]刘慧敏,刘莉,肖炜,等.中药胃肠动力学研究概况[J].时珍国医国药,2013,24(12):2983-2985.
[14]赵冬雨,成丽娅,沈宏,等.大承气汤治疗术后粘连性肠梗阻58例[J].中国实验方剂学杂志,2013,19(9):342-344.
[15]李颖,田如玉,马仲丽,等.大承气汤对胃肠激素的分泌及其促胃肠运动关系的研究[J].中医学报,2008,23(5):19-19.
[16]张启荣,朱克刚,彭吉霞,等.大承气汤对兔离体十二指肠平滑肌活动的影响[J].中国中医药科技,2011,18(1):24-25.
[17]李敏,吴向东,万献尧.大承气汤对危重症患者胃肠功能影响的研究进展[J].医学与哲学,2014,35(4B):56-58.
[18]李志祥,钟丽华.自拟消胀汤治疗AECOPD机械通气患者腹胀的疗效观察[J].河北医科大学学报,2014,35(10):1172-1174.
[19]杨国红,张翠,王晓,等.大承气汤、大柴胡汤四联辨证治疗胃肠实热和肝胆湿热证早期急性胰腺炎及对血清炎症因子的影响[J].中国实验方剂学杂志,2018,24(8):165-170.
[20]税典奎,谢胜.胃肠动力障碍性疾病的发病机制认识及诊治进展[J].中国中西医结合消化杂志,2013,21(1):47-51.
[21]王欢.胃肠激素与胃肠道功能及疾病的关系[J].医学综述,2013,19(15):2735-2738.
[2]李盼盼,徐艳,吴晶.厚朴排气合剂治疗无创通气并发腹胀患者疗效观察[J].贵阳中医学院学报,2016,38(2):53-55.
[3]谢礼翔,梁群.针刺治疗无创呼吸机辅助呼吸致胃肠道胀气临床观察[J].辽宁中医药大学学报,2017,19(8):80-82.
[4]张玲.五磨饮子联合灸法治疗无创呼吸机致腹胀疗效观察[J].山西中医,2016,32(7):15-17.
[5]魏江存,陈勇,谢臻,等.大承气汤的药理作用研究概况[J].中国民族民间医药,2017,26(21):70-74.
[6]朱丽娜,朱京慈.大承气汤防治胃肠动力不足作用机制的研究进展[J].中成药,2014,36(12):2591-2594.
[7]傅志泉,粜鹏翀,李清林,等.大承气汤治疗胃肠功能障碍的Meta分析[J].中华中医药学刊,2017,35(1):169-172.
[8]慢性阻塞性肺疾病急性加重诊治专家组.慢性阻塞性肺疾病急性加重(AECOPD)诊治中国专家共识(2014年修订版)[J].国际呼吸杂志,2014,34(1):1-11.
[9]刘新光.解读功能性肠病罗马Ⅲ诊断标准[J].中国实用内科杂志,2006,26(21):1691-1693.
[10]黄吉强.腹部外科学理论与实践[M].北京:科学出版社,2003:64-66.
[11]聂万水,陈晨松,王韧.厚朴排气合剂治疗重症监护室机械通气后腹胀、便秘疗效观察[J].新中医,2017,49(4):36-38.
[12]倪猛,高改云.莫沙必利与多潘立酮治疗功能性消化不良的临床疗效比较[J].重庆医学,2014,43(7):856-857.
[13]刘慧敏,刘莉,肖炜,等.中药胃肠动力学研究概况[J].时珍国医国药,2013,24(12):2983-2985.
[14]赵冬雨,成丽娅,沈宏,等.大承气汤治疗术后粘连性肠梗阻58例[J].中国实验方剂学杂志,2013,19(9):342-344.
[15]李颖,田如玉,马仲丽,等.大承气汤对胃肠激素的分泌及其促胃肠运动关系的研究[J].中医学报,2008,23(5):19-19.
[16]张启荣,朱克刚,彭吉霞,等.大承气汤对兔离体十二指肠平滑肌活动的影响[J].中国中医药科技,2011,18(1):24-25.
[17]李敏,吴向东,万献尧.大承气汤对危重症患者胃肠功能影响的研究进展[J].医学与哲学,2014,35(4B):56-58.
[18]李志祥,钟丽华.自拟消胀汤治疗AECOPD机械通气患者腹胀的疗效观察[J].河北医科大学学报,2014,35(10):1172-1174.
[19]杨国红,张翠,王晓,等.大承气汤、大柴胡汤四联辨证治疗胃肠实热和肝胆湿热证早期急性胰腺炎及对血清炎症因子的影响[J].中国实验方剂学杂志,2018,24(8):165-170.
[20]税典奎,谢胜.胃肠动力障碍性疾病的发病机制认识及诊治进展[J].中国中西医结合消化杂志,2013,21(1):47-51.
[21]王欢.胃肠激素与胃肠道功能及疾病的关系[J].医学综述,2013,19(15):2735-2738.