摘要
目的分析随机对照研究文献关于中医药治疗脓毒症胃肠功能障碍用药特点和规律。方法检索CNKI、维普、万方(2000年1月至2017年10月)获取中医药治疗脓毒症胃肠功能障碍的研究文献,根据纳入、排除标准筛选文献。采用文献逻辑学及信息定量统计法建立用药数据库,对中药治疗脓毒症胃肠功能障碍患者用药频次、功效、四气五味及归经进行统计分析。结果口服或鼻饲给药出现频次前6位常用中药是大黄,人参类,炙甘草,枳实,白术,厚朴;前6类中药是补虚药(补气药为主),清热药,理气药,泻下药,化湿药,温里药;前3位归经是脾经、胃经和肺经;温性药物多于寒性药物。灌肠给药出现频次前5位中药分别是大黄、芒硝、枳实、厚朴、生黄芪;前5类中药是泻下药、化湿药、理气药、补气药、温里药;前3位归经为脾经、胃经和大肠经;寒性药物多于温性药物。结论口服或鼻饲给药与灌肠给药治疗脓毒症胃肠功能障碍用药特点不同,大黄是最常用中药,攻下法是在治疗脓毒症胃肠功能障碍中发挥了重要作用;同时务必顾护脾胃,辨证使用健脾益气、清热、理气化湿及温里等治法。
Objective: To systematically analyze the characteristics of Chinese herbs on sepsis with gastroenteric dysfunction based on literature analysis. Methods: Medical journals from January,2000 to October,2017 in CQVIP,Wanfang data and CNKI were searched and screenedby inclusion and exclusion criteria. With literature logics and quantitative information statistical method,the frequency and different effects of Chinese herbs,four properties and five tastes and channel tropism in the treatment of sepsis with gastroenteric dysfunction were found out. Results: The top 6 commonly single herb by oral or nasal feeding were Rhubarb,Ginseng class,Grilled liquorice,Immature Bitter Orange,Rhizoma Atractylodis Macrocephalae and Mangnolia officinalis. The top 6 kinds of traditional Chinese medicine were supplementing the asthenia drugs(mainly for supplementing qi),clearing away heat,regulating qi,reducing diarrhea,dampness,and warming the interior. The top 3 channel tropism were spleen channel,stomach channel and lung channel. There were more cold property of drug than warm ones. The top 5 commonly single herb by enema therapy were Rhubarb,Mirabilite,Immature Bitter Orange,Mangnolia officinalis and Astragalus membranaceus. The top five types of traditional Chinese medicine by enema therapy were purgating drugs,resolving dampness drugs,Qi-regulating drugs and restoring qi drugs. The top 3 types of herb channel tropism were the spleen channel,stomach channel and large intestine channel. There were less cold property of drug than warm ones. Conclusion: There are different characteristics between the drugs by oral or nasal feeding and enema therapy for sepsis with gastroenteric dysfunction. Rhubarb is the most commonly used drug. Purgating method plays an important role in the treatment of gastroenteric dysfunction of sepsis. And it is necessary to protect the spleen and stomach that rationally uses the methods of invigorating spleen,supplementing Qi,clearing heat,regulating Qi,resolving dampness and interior-warming.
引文
[1]Mervyn Singer,MD,Clifford S.Deutschman,MD,Christopher Warren Seymour,MD,et al.The third international consensus definitions for sepsis and septic shock(Sepsis-3)[J].JAMA,2016,315(8):801-810.
[2]赵国桢,郭玉红,李博,等.中医药防治脓毒症的研究进展[J].中国中药杂志,2017,42(8):1423-1429.
[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]冯文涛,蔡文君,沙圆圆,等.脓毒症胃肠道功能紊乱的中西医治疗概况[J].中国中医急症,2015,24(9):1583-1586.
[5]边金泂,周祖模,张苏江.头孢曲松和亚胺培南对脓毒症大鼠肠道菌群及细菌耐药性的影响[J].中国生化药物杂志,2014,34(3):34-36.
[6]高学敏.中药学[M].北京:中国中医药出版社,2002.
[7]张飞虎,孙雨菡,孔立,等.半夏泻心汤加减治疗脓毒症胃肠功能障碍的临床观察[J].中国中医急症,2016,25(7):1367-1369.
[8]李雄辉,张东山.大黄附子汤治疗脓毒症胃肠功能障碍临床研究[J].河北中医,2017,39(3):356-360.
[9]张艳,蔡莉娟,刘文兵,等.清营汤加味对老年脓毒症患者胃肠道功能保护作用的临床观察[J].上海中医药杂志,2016,50(7):53-55.
[10]张少言,刘小路,陈浩.祛瘀解毒益气方对脓毒症胃肠功能障碍患者降钙素原和二胺氧化酶的影响[J].上海中医药杂志,2016,50(1):51-52.
[11]田正云,赵浩,孔立,等.调气通腑泄热法治疗脓毒症胃肠功能障碍的临床研究[J].中国中医急症,2015,24(9):1528-1529,1552.
[12]王旭升,范文君,吴志松,等.通腑解毒方改善严重脓毒症胃肠功能障碍评分及短期预后的临床研究[J].中国中医基础医学杂志,2017,23(4):512-513,520.
[13]陈银结,张云海,苏懿,等.温下健脾法改善重度脓毒症患者胃肠功能障碍的临床研究[J].陕西中医,2016,37(8):939-941.
[14]张秋峰.液体复苏后24 h胃管注入大黄附子汤联合西医基础治疗对急诊ICU脓毒症患者胃肠功能改善的作用[J].中国全科医学,2017,20(S1):226-228.
[15]姜春燕,徐艳霞,郝瑞瑞,等.中药复方通腑颗粒对老年脓毒症患者肠屏障功能的影响[J].中国中西医结合杂志,2015,35(7):787-791.
[16]王珊珊,赵浩,孔立,等.益气清热化湿法治疗脓毒症胃肠功能障碍的临床研究[J].中国中医急症,2016,25(1):20-21,105.
[17]通晴,胡苏.足三里穴位注射新斯的明联合大承气汤对脓毒症患者胃肠功能的影响及其机制探讨[J].中国中医急症,2017,26(6):1052-1055.
[18]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.
[19]方雪玲,方强,崔巍,等.生大黄对脓毒症患者肠道屏障功能的影响[J].中华急诊医学杂志,2006,17(10):927-929.
[20]张翔炜,张敏州,翁燕娜,等.通腑泻下法干预危重症患者胃肠功能障碍的临床研究[J].北京中医药大学学报,2011,34(10):707-710.
[21]周玲霞,章琳,钱雅萍.健脾理气方联合穴位按揉对肠源性脓毒症的疗效观察[J].中华中医药学刊,2012,30(6):1438-1440.
[22]陈贞羽,陆军,张织雯.大承气汤灌肠治疗重症患者胃肠功能障碍疗效观察[J].中国中西医结合消化杂志,2014,22(1):22-24.
[23]陈晓勤,秦兵.通腑泻下法对危重患者胃肠功能障碍的治疗效果评价[J].时珍国医国药,2014,25(5):1163-1165.
[24]高锡坤.健脾益胃治疗脓毒症胃虚弱型胃肠功能障碍脾的临床研究[D].南京:南京中医药大学,2015.
[25]陈冉.沙参麦冬汤治疗脓毒症胃阴虚型胃肠功能障碍的临床研究[D].济南:山东中医药大学,2013.
[26]刘金鹏.四君子汤加减配合常规疗法治疗脓毒症脾胃虚弱型胃肠功能障碍的疗效及预后评价[D].济南:山东中医药大学,2012.
[27]李文静.调气和胃法治疗脓毒症气机壅滞型胃肠功能障碍的临床研究[D].济南:山东中医药大学,2012.
[28]魏金玲.调气通腑法治疗脓毒症胃肠功能障碍胃热腑实证的临床研究[D].济南:山东中医药大学,2012.
[29]王倩影.通里攻下法治疗急性胃肠损伤的临床研究[D].成都:成都中医药大学,2015.
[30]冯祥兴.温脾汤加味治疗脓毒症患者急性胃肠损伤的临床观察[D].广州:广州中医药大学,2015.
[31]刁闽俐.温阳健脾法干预治疗严重脓毒症胃肠功能障碍脾阳虚证的临床研究[D].济南:山东中医药大学,2013.
[32]刘洋.益气健脾法治疗脓毒症胃肠功能障碍脾气虚证的临床研究[D].济南:山东中医药大学,2013.
[33]李泉.益气清热化湿法治疗脾胃湿热型脓毒症胃肠功能的临床疗效观察[D].济南:山东中医药大学,2013.
[34]崔琪.燥湿泄热法治疗脓毒症湿热蕴脾型胃肠功能障碍的临床研究[D].济南:山东中医药大学,2012.
[35]赵丽芸,刘秋江.温脾理气通腑法干预脓毒症胃肠功能障碍的效果[J].热带医学杂志,2017,17(6):747-750.
[36]李岩涛,陈分乔.中医集束化调肠方案治疗脓毒症肠功能障碍的疗效及其对胃肠功能的影响[J].实用临床护理学电子杂志,2016,1(8):49-50.
[37]谢东平,韩云,李芳,等.集束化调肠方案对脓毒症肠功能障碍患者肠道功能及炎症反应的影响[J].中国中医急症,2011,20(7):1050-1051,1130.
[38]王桐,王东强,李志军.大承气汤灌肠治疗脓毒症合并肠麻痹的临床疗效观察[J].四川中医,2015,33(2):114-115.
[39]张丽.大黄保留灌肠辅助谷氨酰胺对脓毒血症患者胃肠功能障碍的疗效[J].陕西中医,2017,38(7):912-913.
[40]伏添.大黄联合谷氨酰胺对脓毒血症患者胃肠功能障碍的影响[J].河南中医,2016,36(3):504-506.
[41]姚克宇.大黄甘草汤类方辨证灌肠治疗脓毒症胃肠功能障碍疗效观察[D].北京:北京中医药大学,2008.
[42]姚坤.大承气汤灌肠疗法对脓毒症肠功能障碍患者的临床疗效[D].济南:山东中医药大学,2012.
[43]付征.大黄甘草汤类方保留灌肠治疗SIRS患者胃肠功能障碍的疗效观察[D].北京:中国中医科学院,2007.
[44]林瑾,王海曼,李昂,等.多器官功能障碍综合征患者胃肠功能损伤流行病学调查[J].中国临床医学,2009,16(6):863-864.
[45]金华,张蕾蕾,金钊.从危重症胃肠保护看中医保胃气的意义[J].医学与哲学:临床决策论坛版,2009,30(12):37-38,41.
[46]中华医学会重症医学分会.中国严重脓毒症/脓毒性休克治疗指南(2014)[J].中华内科杂志,2015,54(6):557-581.
[47]刘福生,方晓磊,刘陟,等.大黄类制剂治疗脓毒症急性胃肠损伤的疗效:基于随机对照临床试验的Meta分析[J].中国中西医结合急救杂志,2016,23(5):484-489.
[48]赵国桢,赵京霞,陈腾飞,等.近年中医文献中药治疗脓毒症的用药情况分析[J].中国中医急症,2017,26(5):764-767.
[49]蔡阳平,王兰,江其敏,等.温阳益气、通腑降浊法治疗严重脓毒症急性胃肠损伤临床应用的探讨[J].现代中医临床,2014,21(4):7-8.
[50]方晓磊,王苏妹,李金霞.危重症急性胃肠损伤与温下法研究[J].中国医药导报,2014,11(23):87-89.