结肠镜减压及大黄肠道去污对合并胃肠功能障碍脓毒症患者临床疗效及预后的影响
|
摘要
目的探讨结肠镜减压联合大黄进行肠道去污对合并胃肠功能损伤的脓毒症患者临床疗效及预后的影响。方法选取2014年1月—2017年12月河南大学第一附属医院重症医学科住院接受治疗的合并胃肠功能损伤的脓血症患者72例,随机分为对照组和治疗组,每组36例。检测患者的血清降钙素原(PCT)、C反应蛋白(CRP)、尿素氮(BUN)、血清肌酐(Scr)等生化指标。同时评估患者的APACHEⅡ评分、胃肠功能评分和临床疗效以及多器官功能障碍综合征(MODS)发生率以及病死率。结果经治疗后,治疗组患者血清PCT、CRP、BUN、SCr水平低于治疗前和对照组(P <0.05)。另外,治疗组患者APACHEⅡ评分、胃肠功能障碍评分、肠鸣音恢复时间、肛门排气时间、腹痛腹胀缓解时间、使用血管活性药物的时间、机械通气时间、ICU住院时间均低于对照组患者(P <0.05)。治疗组患者胃肠功能障碍治疗总有效率为80.56%,高于对照组患者(P <0.05),而继发性MODS发生率和病死率分别为25.0%和13.89%,低于对照组患者(P <0.05)。结论结肠镜减压及大黄肠道去污治疗合并胃肠功能障碍的脓毒症患者疗效确切,值得临床推广。
Objective To investigate the clinical effect and prognosis of colonoscopy decompression combined with rhubarb decontamination of the digestive tract in sepsis patients with gastrointestinal dysfunction.Methods A total of 72 sepsis patients with AGI Ⅱ-Ⅱ gastrointestinal dysfunction admitted in our hospital during January 2014 to December 2017 were enrolled in this study.Patients were divided into control group(n = 36) and treatment group(n = 36).The procalcitonin(PCT),C-reactive protein(CRP),urea nitrogen(BUN),serum creatinine(SCr),APACHE Ⅱ score,gastrointestinal function score,and incidence of multiple organ dysfunction syndrome(MODS) were recorded.Results Serum levels of PCT,CRP,BUN,and Scr in treatment group were lowered than those in control group(P<0.05).Further,the APACHE Ⅱ score,gastrointestinal function score,the recovery time of bowel sounds,the anus exhaust time,the relief time of abdominal pain abdominal distension,the usage time of vasoactive agent and mechanical ventilation,ICU stay time were decreased when compared with those in control group(P<0.05).The total effective rate in treatment group was 80.56%,which was significantly higher than that in control group(P<0.05).The incidence of MODS and death in treatment group were 25.0% and 13.89%,which were higher than that in control group(P<0.05).Conclusions The application of colonoscopy decompression combined with rhubarb decontamination of the digestive tract in sepsis patients with gastrointestinal dysfunction effectively improves the gastrointestinal function,which would be recommended for the clinical use.
Objective To investigate the clinical effect and prognosis of colonoscopy decompression combined with rhubarb decontamination of the digestive tract in sepsis patients with gastrointestinal dysfunction.Methods A total of 72 sepsis patients with AGI Ⅱ-Ⅱ gastrointestinal dysfunction admitted in our hospital during January 2014 to December 2017 were enrolled in this study.Patients were divided into control group(n = 36) and treatment group(n = 36).The procalcitonin(PCT),C-reactive protein(CRP),urea nitrogen(BUN),serum creatinine(SCr),APACHE Ⅱ score,gastrointestinal function score,and incidence of multiple organ dysfunction syndrome(MODS) were recorded.Results Serum levels of PCT,CRP,BUN,and Scr in treatment group were lowered than those in control group(P<0.05).Further,the APACHE Ⅱ score,gastrointestinal function score,the recovery time of bowel sounds,the anus exhaust time,the relief time of abdominal pain abdominal distension,the usage time of vasoactive agent and mechanical ventilation,ICU stay time were decreased when compared with those in control group(P<0.05).The total effective rate in treatment group was 80.56%,which was significantly higher than that in control group(P<0.05).The incidence of MODS and death in treatment group were 25.0% and 13.89%,which were higher than that in control group(P<0.05).Conclusions The application of colonoscopy decompression combined with rhubarb decontamination of the digestive tract in sepsis patients with gastrointestinal dysfunction effectively improves the gastrointestinal function,which would be recommended for the clinical use.
引文
[1]SEYMOUR C W,LIU V X,IWASHYNA T J,et al.Assessment of clinical criteria for sepsis:for the third international consensus definitions for sepsis and septic shock(Sepsis-3)[J].JAMA,2016,315(8):762-774.
[2]ISKANDER K N,OSUCHOWSKI M F,STEARNS-KUROSAWAD J,et al.Sepsis:multiple abnormalities,heterogeneous responses,and evolving Understanding[J].Physiol Rev,2013,93(3):1247-1288.
[3]INADA-KIM M,PAGE B,MAQSOOD I,et al.Defining and measuring suspicion of sepsis:an analysis of routine data[J].BMJOpen,2017,7(6):e014885.
[4]MATTHEW J.DELANO,PETER A.WARD.The immune system’s role in sepsis progression,resolution and long-term outcome[J].Immunol Rev,2016,274(1):330-353.
[5]NULLENS S,STAESSENS M I,PELEMAN C,et al.Beneficial effects of Anti-interleukin-6 antibodies on impaired gastrointestinal motility,inflammation and increased colonic permeability in a murine model of sepsis are most pronounced when administered in a preventive setup[J].PLoS One,2016,11(4):e0152914.
[6]ELLIOTT CROUSER,MATTHEW EXLINE,DAREN KNOELL,et al.Sepsis:links between pathogen sensing and organ damage[J].Curr Pharm Des,2008,14(19):1840-1852.
[7]SILVESTRI L,van SAENE H K F.Selective decontamination of the digestive tract:an update of the evidence[J].HSR Proc Intensive Care Cardiovasc Anesth,2012,4(1):21-29.
[8]MERVYN SINGER,CLIFFORD S.DEUTSCHMAN,CHRISTOPHER WARREN SEYMOUR,et al.The third international consensus definitions for sepsis and septic shock(Sepsis-3)[J].JAMA,2016,315(8):801-810.
[9]ANNIKA R B,MALBRAIN M L N G,JOEL S,et al.Gastrointestinal function in intensive care patients:terminology,definitions and management.Recommendations of the ESICMworking group on abdominal problems[J].Intensive Care Medicine,2012,38(3):384-394.
[10]MATTHIAS FR?HLICH,ARASCH WAFAISADE,ANASTASIOS MANSURI,et al.Which score should be used for posttraumatic multiple organ failure-comparison of the MODS,denver-and SOFA-scores[J].Scand J Trauma Resusc Emerg Med,2016,24:130.
[11]中国中西医结合学会急救医学专业委员会.重修“95庐山会议”多器官功能障碍综合征病情分期诊断及严重程度评分标准(2015)[J].中医危重病急救医学,2016,28(2):99-101.
[12]PRASHANT SHUKLA,G MADHAVA RAO,GITU PANDEY,et al.Therapeutic interventions in sepsis:current and anticipated pharmacological agents[J].Br J Pharmacol,2014,171(22):5011-5031.
[13]SCOTT B,ARMEN,CAROL V,FREER,JOHN W,SHOWALTER,et al.Improving outcomes in patients with sepsis[J].Am J Med Qual,2016,31(1):56-63.
[14]中国中西医结合学会急救医学专业委员会.脓毒症中西医结合诊疗专家共识[J].中华危重病急救医学,2013,25(4):194-197.
[15]李书清,沈宇清.大黄防治危重症急性肠功能衰竭的临床研究[J].现代中西医结合杂志,2008,17(13):1972-1973.
[2]ISKANDER K N,OSUCHOWSKI M F,STEARNS-KUROSAWAD J,et al.Sepsis:multiple abnormalities,heterogeneous responses,and evolving Understanding[J].Physiol Rev,2013,93(3):1247-1288.
[3]INADA-KIM M,PAGE B,MAQSOOD I,et al.Defining and measuring suspicion of sepsis:an analysis of routine data[J].BMJOpen,2017,7(6):e014885.
[4]MATTHEW J.DELANO,PETER A.WARD.The immune system’s role in sepsis progression,resolution and long-term outcome[J].Immunol Rev,2016,274(1):330-353.
[5]NULLENS S,STAESSENS M I,PELEMAN C,et al.Beneficial effects of Anti-interleukin-6 antibodies on impaired gastrointestinal motility,inflammation and increased colonic permeability in a murine model of sepsis are most pronounced when administered in a preventive setup[J].PLoS One,2016,11(4):e0152914.
[6]ELLIOTT CROUSER,MATTHEW EXLINE,DAREN KNOELL,et al.Sepsis:links between pathogen sensing and organ damage[J].Curr Pharm Des,2008,14(19):1840-1852.
[7]SILVESTRI L,van SAENE H K F.Selective decontamination of the digestive tract:an update of the evidence[J].HSR Proc Intensive Care Cardiovasc Anesth,2012,4(1):21-29.
[8]MERVYN SINGER,CLIFFORD S.DEUTSCHMAN,CHRISTOPHER WARREN SEYMOUR,et al.The third international consensus definitions for sepsis and septic shock(Sepsis-3)[J].JAMA,2016,315(8):801-810.
[9]ANNIKA R B,MALBRAIN M L N G,JOEL S,et al.Gastrointestinal function in intensive care patients:terminology,definitions and management.Recommendations of the ESICMworking group on abdominal problems[J].Intensive Care Medicine,2012,38(3):384-394.
[10]MATTHIAS FR?HLICH,ARASCH WAFAISADE,ANASTASIOS MANSURI,et al.Which score should be used for posttraumatic multiple organ failure-comparison of the MODS,denver-and SOFA-scores[J].Scand J Trauma Resusc Emerg Med,2016,24:130.
[11]中国中西医结合学会急救医学专业委员会.重修“95庐山会议”多器官功能障碍综合征病情分期诊断及严重程度评分标准(2015)[J].中医危重病急救医学,2016,28(2):99-101.
[12]PRASHANT SHUKLA,G MADHAVA RAO,GITU PANDEY,et al.Therapeutic interventions in sepsis:current and anticipated pharmacological agents[J].Br J Pharmacol,2014,171(22):5011-5031.
[13]SCOTT B,ARMEN,CAROL V,FREER,JOHN W,SHOWALTER,et al.Improving outcomes in patients with sepsis[J].Am J Med Qual,2016,31(1):56-63.
[14]中国中西医结合学会急救医学专业委员会.脓毒症中西医结合诊疗专家共识[J].中华危重病急救医学,2013,25(4):194-197.
[15]李书清,沈宇清.大黄防治危重症急性肠功能衰竭的临床研究[J].现代中西医结合杂志,2008,17(13):1972-1973.