炎调方治疗脓毒症致急性胃肠损伤的可行性探讨
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摘要
脓毒症易并发急性胃肠损伤,其主要病理生理为脓毒症导致的炎症反应。笔者认为其中医病因为腑实营热,通腑清营法切中病机。炎调方具有通腑清营功能,前期研究发现,炎调方能缓解脓毒症炎症反应。基于以上认识,本文拟从"缓解炎症反应——通腑清营"角度探讨炎调方治疗脓毒症致急性胃肠损伤的可行性。
Patients with sepsis are prone to develop acute gastrointestinal injury. The main pathophysiology is inflammation caused by sepsis. From the perspective of traditional Chinese medicine, the disease is due to fu organ constipation and heat of yingfen, so the treatment relies on clearing the fu organ and cooling the yingfen. Yantiaofang has the function of clearing the fu organ and cooling the yingfen. Our previous research found Yantiaofang could relieve the inflammatory response caused by sepsis. This article is to discuss the feasibility of Yantiaofang in treating acute gastrointestinal injury caused by sepsis by relieving the inflammation, clearing the fu organ and cooling the yingfen.
Patients with sepsis are prone to develop acute gastrointestinal injury. The main pathophysiology is inflammation caused by sepsis. From the perspective of traditional Chinese medicine, the disease is due to fu organ constipation and heat of yingfen, so the treatment relies on clearing the fu organ and cooling the yingfen. Yantiaofang has the function of clearing the fu organ and cooling the yingfen. Our previous research found Yantiaofang could relieve the inflammatory response caused by sepsis. This article is to discuss the feasibility of Yantiaofang in treating acute gastrointestinal injury caused by sepsis by relieving the inflammation, clearing the fu organ and cooling the yingfen.
引文
[1]Rhodes A,Evans LE,Alhazzani W,et al.Surviving sepsis campaign:international guidelines for management of sepsis and septic shock:2016[J].Intensive Care Med,2017,43(3):304-377.
[2]Piton G,Capellier G.Biomarkers of gut barrier failure in the ICU[J].Curr Opin Crit Care,2016,22(2):152-160.
[3]Sertaridou E,Papaioannou V,Kolios G,et al.Gut failure in critical care:old school versus new school[J].Ann Gastroenterol,2015,28(3):309-322.
[4]王玉玉,周大勇.脓毒症患者胃肠功能衰竭的中西医治疗研究进展[J].内蒙古中医药,2014,33(4):111-112.
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[6]Klingensmith NJ,Coopersmith CM.The gut as the motor of multiple organ dysfunction in critical illness[J].Crit Care Clin,2016,32(2):203-212.
[7]Carrico CJ,Meakins JL,Marshall JC,et al.Multiple-organfailure syndrome[J].Arch Surg,1986,121(2):196-208.
[8]Li B,Tang S,Ma YL,et al.Analysis of bowel sounds application status for gastrointestinal function monitoring in the intensive care unit[J].Crit Care Nurs Q,2014,37(2):199-206.
[9]Chen H,Zhang H,Li W,et al.Acute gastrointestinal injury in the intensive care unit:a retrospective study[J].Ther Clin Risk Manag,2015,11:1523-1529.
[10]Reintam Blaser A,Malbrain ML,Starkopf J,et al.Gastrointestinal function in intensive care patients:terminology,definitions and management.Recommendations of the ESICM Working Group on Abdominal Problems[J].Intensive Care Med,2012,38(3):384-394.
[11]Piton G,Belon F,Cypriani B,et al.Enterocyte damage in critically ill patients is associated with shock condition and28-day mortality[J].Crit Care Med,2013,41(9):2169-2176.
[12]刘宁,苏立杰,许树长,等.脓毒症合并急性胃肠损伤的危险因素与预后调查分析[J].同济大学学报:医学版,2015,36(2):53-58.
[13]北京市科委重大项目MODS课题组.1087例多器官功能障碍综合征临床流行病学调查[J].中国危重病急救医学,2007,19(1):2-6.
[14]肖武强,何再明,党宗彦,等.脓毒症合并急性胃肠损伤的危险因素分析[J].中国急救医学,2016,36(1):35-38.
[15]朱承睿,栾正刚,尹晓晗,等.急性胃肠损伤分级对疾病严重程度及预后评估价值研究(附296例报告)[J].中国实用外科杂志,2015,35(5):531-533.
[16]Li H,Zhang D,Wang Y,et al.Association between acute gastrointestinal injury grading system and disease severity and prognosis in critically ill patients:a multicenter,prospective,observational study in China[J].J Crit Care,2016,36:24-28.
[17]Landahl P,Ansari D,Andersson R.Severe acute pancreatitis:gut barrier failure,systemic inflammatory response,acute lung injury,and the role of the mesenteric lymph[J].Surg Infect(Larchmt),2015,16(6):651-656.
[18]Gao H,Yao J,Lu L,et al.Clinical study of acute gastrointestinal injury classification in early enteral nutrition in patients under intensive care[J].Chin Crit Care Med,2014,26(4):214-218.
[19]张浩,崔乃强.肠屏障与多器官功能障碍综合征[J].中国中西医结合外科杂志,2007,13(3):316-318.
[20]李闪闪,江荣林.中西医结合防治脓毒症胃肠功能障碍研究进展[J].浙江中西医结合杂志,2015,25(7):705-710.
[21]Coopersmith CM,Stromberg PE,Dunne WM,et al.Inhibition of intestinal epithelial apoptosis and survival in a murine model of pneumonia-induced sepsis[J].JAMA,2002,287(13):1716-1721.
[22]Gordeeva AE,Sharapov MG,Tikhonova IV,et al.Vascular pathology of ischemia/reperfusion injury of rat small intestine[J].Cells Tissues Organs,2017,203(6):353-364.
[23]Tuboly E,Futakuchi M,Varga G,et al.C5a inhibitor protects against ischemia/reperfusion injury in rat small intestine[J].Microbiol Immunol,2016,60(1):35-46.
[24]Li MX,Liu JF,Lu JD,et al.Plasmadiafiltration ameliorating gut mucosal barrier dysfunction and improving survival in porcine sepsis models[J].Intensive Care Med Exp,2016,4(1):31.
[25]Bondarenko VM,Likhoded VG,Fialkina SV.Commensal microflora and endogenous inductors of pathophysiological reactions of innate immunity[J].Zh Mikrobiol Epidemiol Immunobiol,2015(1):81-85.
[26]王晶晶,孔祥照,张晓璇.针刺足三里对脓毒症胃肠功能障碍患者腹内压的影响[J].中国中医急症,2012,21(11):1834-1835.
[27]Yu HJ,Zhu JG,Shen P,et al.Electroacupuncture decreases the urinary bladder pressure in patients with acute gastrointestinal injury[J].Genet Mol Res,2015,14(1):34-39.
[28]王益斐,江荣林,张赟华,等.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[J].中国现代医生,2016,54(9):20-24.
[29]陈贞羽,张织雯,周杰.大承气汤灌肠治疗急性胃肠损伤的随机对照研究[J].辽宁中医杂志,2015,42(6):1248-1250.
[30]李凤舞,王红.急性胰腺炎伴胃肠功能障碍的中西医结合研究进展[J].北京中医药,2015,34(3):253-256.
[31]施荣,熊旭东.通腑清营法治疗脓毒症热毒内盛证临床观察[J].中国中医急症,2011,20(4):521-522.
[32]张涛,熊旭东,李淑芳.通腑泻肺方治疗肺系脓毒症(痰热壅肺证)的临床研究[J].中国中医急症,2014,23(10):1788-1790,1805.
[33]何淼,熊旭东,沈晓红.炎调方对脓毒症急性呼吸窘迫综合征(热炽营血证)患者血细胞因子的影响[J].中国中医急症,2013,22(7):1097-1099.
[34]施荣,熊旭东.NF-κB在脓毒症大鼠肺组织中的活性变化及炎调方对其活性的影响[J].时珍国医国药,2014,25(4):1016-1018.
[35]沈晓红,何淼,熊旭东,等.炎调方对脓毒症大鼠肺热休克蛋白70和核因子-κB的调控作用[J].上海中医药大学学报,2013,27(3):69-72.
[36]施荣,熊旭东,李淑芳,等.炎调方对脓毒症大鼠血清炎症因子的调控作用[J].中国中医急症,2012,21(3):397-398.
[2]Piton G,Capellier G.Biomarkers of gut barrier failure in the ICU[J].Curr Opin Crit Care,2016,22(2):152-160.
[3]Sertaridou E,Papaioannou V,Kolios G,et al.Gut failure in critical care:old school versus new school[J].Ann Gastroenterol,2015,28(3):309-322.
[4]王玉玉,周大勇.脓毒症患者胃肠功能衰竭的中西医治疗研究进展[J].内蒙古中医药,2014,33(4):111-112.
[5]Meng M,Klingensmith NJ,Coopersmith CM.New insights into the gut as the driver of critical illness and organ failure[J].Curr Opin Crit Care,2017,23(2):143-148.
[6]Klingensmith NJ,Coopersmith CM.The gut as the motor of multiple organ dysfunction in critical illness[J].Crit Care Clin,2016,32(2):203-212.
[7]Carrico CJ,Meakins JL,Marshall JC,et al.Multiple-organfailure syndrome[J].Arch Surg,1986,121(2):196-208.
[8]Li B,Tang S,Ma YL,et al.Analysis of bowel sounds application status for gastrointestinal function monitoring in the intensive care unit[J].Crit Care Nurs Q,2014,37(2):199-206.
[9]Chen H,Zhang H,Li W,et al.Acute gastrointestinal injury in the intensive care unit:a retrospective study[J].Ther Clin Risk Manag,2015,11:1523-1529.
[10]Reintam Blaser A,Malbrain ML,Starkopf J,et al.Gastrointestinal function in intensive care patients:terminology,definitions and management.Recommendations of the ESICM Working Group on Abdominal Problems[J].Intensive Care Med,2012,38(3):384-394.
[11]Piton G,Belon F,Cypriani B,et al.Enterocyte damage in critically ill patients is associated with shock condition and28-day mortality[J].Crit Care Med,2013,41(9):2169-2176.
[12]刘宁,苏立杰,许树长,等.脓毒症合并急性胃肠损伤的危险因素与预后调查分析[J].同济大学学报:医学版,2015,36(2):53-58.
[13]北京市科委重大项目MODS课题组.1087例多器官功能障碍综合征临床流行病学调查[J].中国危重病急救医学,2007,19(1):2-6.
[14]肖武强,何再明,党宗彦,等.脓毒症合并急性胃肠损伤的危险因素分析[J].中国急救医学,2016,36(1):35-38.
[15]朱承睿,栾正刚,尹晓晗,等.急性胃肠损伤分级对疾病严重程度及预后评估价值研究(附296例报告)[J].中国实用外科杂志,2015,35(5):531-533.
[16]Li H,Zhang D,Wang Y,et al.Association between acute gastrointestinal injury grading system and disease severity and prognosis in critically ill patients:a multicenter,prospective,observational study in China[J].J Crit Care,2016,36:24-28.
[17]Landahl P,Ansari D,Andersson R.Severe acute pancreatitis:gut barrier failure,systemic inflammatory response,acute lung injury,and the role of the mesenteric lymph[J].Surg Infect(Larchmt),2015,16(6):651-656.
[18]Gao H,Yao J,Lu L,et al.Clinical study of acute gastrointestinal injury classification in early enteral nutrition in patients under intensive care[J].Chin Crit Care Med,2014,26(4):214-218.
[19]张浩,崔乃强.肠屏障与多器官功能障碍综合征[J].中国中西医结合外科杂志,2007,13(3):316-318.
[20]李闪闪,江荣林.中西医结合防治脓毒症胃肠功能障碍研究进展[J].浙江中西医结合杂志,2015,25(7):705-710.
[21]Coopersmith CM,Stromberg PE,Dunne WM,et al.Inhibition of intestinal epithelial apoptosis and survival in a murine model of pneumonia-induced sepsis[J].JAMA,2002,287(13):1716-1721.
[22]Gordeeva AE,Sharapov MG,Tikhonova IV,et al.Vascular pathology of ischemia/reperfusion injury of rat small intestine[J].Cells Tissues Organs,2017,203(6):353-364.
[23]Tuboly E,Futakuchi M,Varga G,et al.C5a inhibitor protects against ischemia/reperfusion injury in rat small intestine[J].Microbiol Immunol,2016,60(1):35-46.
[24]Li MX,Liu JF,Lu JD,et al.Plasmadiafiltration ameliorating gut mucosal barrier dysfunction and improving survival in porcine sepsis models[J].Intensive Care Med Exp,2016,4(1):31.
[25]Bondarenko VM,Likhoded VG,Fialkina SV.Commensal microflora and endogenous inductors of pathophysiological reactions of innate immunity[J].Zh Mikrobiol Epidemiol Immunobiol,2015(1):81-85.
[26]王晶晶,孔祥照,张晓璇.针刺足三里对脓毒症胃肠功能障碍患者腹内压的影响[J].中国中医急症,2012,21(11):1834-1835.
[27]Yu HJ,Zhu JG,Shen P,et al.Electroacupuncture decreases the urinary bladder pressure in patients with acute gastrointestinal injury[J].Genet Mol Res,2015,14(1):34-39.
[28]王益斐,江荣林,张赟华,等.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[J].中国现代医生,2016,54(9):20-24.
[29]陈贞羽,张织雯,周杰.大承气汤灌肠治疗急性胃肠损伤的随机对照研究[J].辽宁中医杂志,2015,42(6):1248-1250.
[30]李凤舞,王红.急性胰腺炎伴胃肠功能障碍的中西医结合研究进展[J].北京中医药,2015,34(3):253-256.
[31]施荣,熊旭东.通腑清营法治疗脓毒症热毒内盛证临床观察[J].中国中医急症,2011,20(4):521-522.
[32]张涛,熊旭东,李淑芳.通腑泻肺方治疗肺系脓毒症(痰热壅肺证)的临床研究[J].中国中医急症,2014,23(10):1788-1790,1805.
[33]何淼,熊旭东,沈晓红.炎调方对脓毒症急性呼吸窘迫综合征(热炽营血证)患者血细胞因子的影响[J].中国中医急症,2013,22(7):1097-1099.
[34]施荣,熊旭东.NF-κB在脓毒症大鼠肺组织中的活性变化及炎调方对其活性的影响[J].时珍国医国药,2014,25(4):1016-1018.
[35]沈晓红,何淼,熊旭东,等.炎调方对脓毒症大鼠肺热休克蛋白70和核因子-κB的调控作用[J].上海中医药大学学报,2013,27(3):69-72.
[36]施荣,熊旭东,李淑芳,等.炎调方对脓毒症大鼠血清炎症因子的调控作用[J].中国中医急症,2012,21(3):397-398.