基于床旁JY-DLT肠道屏障功能检测系统分析参苓白术散对脓毒症胃肠功能障碍患者肠黏膜屏障的影响
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摘要
目的:基于JY-DLT肠道屏障功能检测分析系统观察参苓白术散对于脓毒症患者肠黏膜屏障的影响。方法:将脓毒症胃肠功能障碍的80例患者按随机数字表进行分组。治疗组40例给予西医常规治疗加参苓白术散,对照组40例给予西医常规治疗加等量温开水,14d为1个疗程。治疗前后予JY-DLT肠道屏障功能系统床旁检测分析两组患者肠黏膜屏障功能指标。结果:治疗前两组各指标无明显差异,治疗后两组患者APACHEⅡ评分、胃肠功能障碍评分、炎症指标(白细胞计数、C反应蛋白、降钙素原)均显著下降(P<0.05)。治疗组治疗后的肠黏膜屏障功能指标(二胺氧化酶、D-乳酸及内毒素)的水平较治疗前显著下降(P<0.05)。治疗组总体疗效优于对照组(P<0.05),且治疗组中医证候治疗的总有效率显著高于对照组(P<0.05)。结论:床旁JY-DLT肠道屏障功能系统能快捷地检测肠黏膜屏障功能指标,建立有效实用的肠屏障功能评估监测体系,基于该系统发现参苓白术散能改善脓毒症患者的胃肠功能,降低炎性反应,改善患者肠黏膜屏障功能,提高临床疗效,降低病死率,具有较高的临床价值。
Objective: To study the effects of Shenling Baizhu Powder on intestinal mucosal barrier in sepsis patient with gastrointestinal dysfunction based on bedside JY-DLT intestinal barrier function detection system. Methods: Eighty patients with sepsis gastrointestinal dysfunction were divided into groups according to random number table. Forty cases in the treatment group were treated with routine western medicine plus Shenling Baizhu Powder; 40 cases in control group were treated with routine western medicine plus lukewarm boiled water of equal volume, 14 d was one course of treatment. Before and after treatment,JY-DLT intestinal barrier function system was used to detect and analyze the intestinal mucosal barrier function indexes in two groups. Results: According to the statistical data analysis, there was no significant difference between the two groups before treatment. After treatment, the APACHEⅡ score, gastrointestinal dysfunction scores, the inflammatory indexes(WBC, CRP,serum procalcitonin) were significantly decreased in both groups(P<0.05). The indexes of intestinal mucosal barrier function(DAO,D-lac, endotoxin) in treatment group were significantly decreased than those before treatment in the treatment group(P<0.05).The total curative effect of the treatment group was better than that of the control group(P<0.05), and the effective rate of TCM syndrome in the treatment group was significantly higher than that in the control group(P<0.05). Conclusion: The bedside JYDLT intestinal barrier system can detect quickly the indexes of intestinal mucosal barrier function and help establish an effective and practical system of intestinal barrier function evaluation and monitoring for hospital. Based on the system, it is found that Shenling Baizhu Powder can improve the gastrointestinal function in the patients of sepsis, reduce inflammation, improve intestinal mucosal barrier function of patients, improve clinical efficacy, decrease the mortality rate, and it has high clinical value for the treatment of sepsis.
Objective: To study the effects of Shenling Baizhu Powder on intestinal mucosal barrier in sepsis patient with gastrointestinal dysfunction based on bedside JY-DLT intestinal barrier function detection system. Methods: Eighty patients with sepsis gastrointestinal dysfunction were divided into groups according to random number table. Forty cases in the treatment group were treated with routine western medicine plus Shenling Baizhu Powder; 40 cases in control group were treated with routine western medicine plus lukewarm boiled water of equal volume, 14 d was one course of treatment. Before and after treatment,JY-DLT intestinal barrier function system was used to detect and analyze the intestinal mucosal barrier function indexes in two groups. Results: According to the statistical data analysis, there was no significant difference between the two groups before treatment. After treatment, the APACHEⅡ score, gastrointestinal dysfunction scores, the inflammatory indexes(WBC, CRP,serum procalcitonin) were significantly decreased in both groups(P<0.05). The indexes of intestinal mucosal barrier function(DAO,D-lac, endotoxin) in treatment group were significantly decreased than those before treatment in the treatment group(P<0.05).The total curative effect of the treatment group was better than that of the control group(P<0.05), and the effective rate of TCM syndrome in the treatment group was significantly higher than that in the control group(P<0.05). Conclusion: The bedside JYDLT intestinal barrier system can detect quickly the indexes of intestinal mucosal barrier function and help establish an effective and practical system of intestinal barrier function evaluation and monitoring for hospital. Based on the system, it is found that Shenling Baizhu Powder can improve the gastrointestinal function in the patients of sepsis, reduce inflammation, improve intestinal mucosal barrier function of patients, improve clinical efficacy, decrease the mortality rate, and it has high clinical value for the treatment of sepsis.
引文
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[14]姚卫海,李云虎,孟宪文.中医药防治危重症胃肠功能障碍的研究进展.北京中医药,2010,29(2):148-150
[15]Wang Y,Zhang Y,Jiang R.Early traditional Chinese medicinebundle therapy for the prevention of sepsis acute gastrointestinalinjury in elderly patients with severe sepsis.Sci Rep,2017,7:46015
[16]陆红.参苓白术散治疗危重病患者胃肠功能障碍40例观察.浙江中医杂志,2011,46(2):107
[17]丁维俊,周邦靖.参苓白术散对小鼠脾虚模型肠道菌群的影响.北京中医药大学学报,2006,29(8):530-532
[2]Mayr F B,Sachin Y,Angus D C.Epidemiology of severe sepsis.Virulence,2014,5(1):4-11
[3]Puleo F,Arvanitakis M,Gossum A V,et al.Gut failure in the ICU.Semin Respir Crit Care Med,2011,32(5):626-638
[4]Rodríguez-Berna G,Mangas-Sanjuán V,Gonzalez-Alvarez M,et al.Apromising camptothecin derivative:Semisynthesis,antitumor activityand intestinal permeability.Eur J Med Chem,2014,18(83):366-373
[5]Xiao G,Yuan F,Geng Y,et al.Eicosapentaenoic acid enhancesheatstroke-impaired intestinal epithelial barrierf unction in rats.Shock,2015,44(4):348-356
[6]王今达,王宝恩.多脏器功能失常综合征(MODS)病情分期诊断及严重程度评分标准.中国危重病急救医学,1995,7(6):346-347
[7]CFDA.中药新药临床研究指导原则(试行).北京:中国医药科技出版社,2002:361-390
[8]Rhodes,Evans,Alhazzani,et al.Surviving Sepsis Campaign:International Guidelines for Management of Sepsis and SepticShock:2016.Critical Care Medicine,2017,45(3):486-552
[9]Puleo F,Arvanitakis M,Van Gossum A,et al.Gut failure in the ICU.Semin Respir Crit Care Med,2011,32(5):626-638
[10]Velssco N.Gut barrier in the critically ill patient:facts and trends.Rev Med Chil,2006,134(8):1033-1039
[11]Reintam Blaser A,Malbrain M L,Starkopf J,et al.Gastrointestinalfunction in intensive care patients:terminology,definitions andmanagement.Recommendations of the ESICM Working Group onAbdominal Problems.Intensive Care Med,2012,38(3):384-394
[12]赵国桢,郭玉红,李博,等.中医药防治脓毒症的研究进展.中国中药杂志,2017,42(8):1423-1429
[13]李玲,伍志伟,刘永琦,等.基于胃癌相关微生态变化探讨“脾胃-肠”轴的交互作用.中华中医药杂志,2017,32(4):1567-1569
[14]姚卫海,李云虎,孟宪文.中医药防治危重症胃肠功能障碍的研究进展.北京中医药,2010,29(2):148-150
[15]Wang Y,Zhang Y,Jiang R.Early traditional Chinese medicinebundle therapy for the prevention of sepsis acute gastrointestinalinjury in elderly patients with severe sepsis.Sci Rep,2017,7:46015
[16]陆红.参苓白术散治疗危重病患者胃肠功能障碍40例观察.浙江中医杂志,2011,46(2):107
[17]丁维俊,周邦靖.参苓白术散对小鼠脾虚模型肠道菌群的影响.北京中医药大学学报,2006,29(8):530-532