益气通腑逐瘀方灌肠疗法对脓毒症患者肠道黏膜屏障功能的影响
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摘要
目的：研究益气通腑逐瘀方灌肠疗法对脓毒症患者的治疗作用及其可能的机制。
方法：按照脓毒症诊断标准,选择40例脓毒症患者,采用随机数字表法,随机分为两组。两组在采用西医综合治疗基础上,治疗组加用益气通腑逐瘀方灌肠,对照组以等量生理盐水灌肠,均为每日2次,7天为1疗程,观察期为14天。治疗前后对两组所有患者进行中医证侯积分、APACHEⅡ评分,以此计算并比较两组的治疗效果。同时检测所有入选病例的静脉血D-乳酸、尿乳果糖／甘露醇(L/M)值,比较两组患者治疗开始、3d、7d、14d各指标的变化,观察急性呼吸窘迫综合征、多器官功能障碍综合征的发生率及28天死亡率。
结果：治疗前两组的中医证侯积分、APACHEⅡ评分无明显差异(P>0.05),病情严重程度相似。治疗后两组的中医证侯积分均下降(P<0.05),治疗组较对照组下降更显著(P<0.05)。治疗组治疗愈显率35.3%,对照组治疗愈显率5.6%,两者差异有显著性意义(P<0.05)。治疗组治疗7d及14d后,较对照组D-乳酸水平均有显著统计学差异(p<0.05)；治疗14d后,较对照组尿L/M水平有明显统计学差异(p<0.05)；治疗结束后,治疗组急性呼吸窘迫综合征发生率及多器官功能障碍综合征发生率较对照组均有明显统计学差异(p<0.05)；治疗组28天死亡率较对照组无明显统计学差异。
结论：益气通腑逐瘀方灌肠疗法能显著改善脓毒症患者的症状,提高其临床治疗有效率,降低临床急性呼吸窘迫综合征、多器官功能障碍综合征的发生率。其机制可能与其保护肠道黏膜屏障功能及预防细菌内毒素移位有关。
Objective:To study Yiqi Tongfu Zhuyu decoction enema therapy for treatment of patients with sepsis and its possible mechanism.
Methods:In accordance with sepsis diagnostic criteria, select 40 cases of septic patients, using random number table, randomly divided into two groups.On The basis of Western medicine treatment of two groups,the treatment group with Yiqi Tongfu Zhuyu decoction enema therapy, the control group with normal saline enema therapy, both 2 times a day,7 days a course of treatment, observation period of 14 days.In two groups before and after treatment to all patients TCM syndrome score, APACHE II score,as calculated and compared between two groups of treatment efficiency. Test their blood of D-lactic acid, urinary lactulose/mannitol (L/M) values,then compare them when treatment started, after treated 3days,7days,14days,for each index changes.Also compare acute respiratory distress syndrome, multiple organ dysfunction syndrome incidence and mortality in 28 days of two groups.
Results:Before treatment TCM syndrome score and APACHEⅡscore of two groups were no significant difference (p>0.05), similar severity of the disease. The two groups after treatment decreased TCM syndrome score (p<0.05), the treatment group than in the control group decreased more significantly (p<0.05). Treatment group's complete recover and effective rate was 35.3%, the complete recover and effective rate in the control group was 5.6%.Their difference was significantly statistical (p<0.05). Treatment group after 7 days and 14 days, compared with the control group D-lactate levels, Their difference was significantly statistical difference (p<0.05); therapy after 14d than the control group, urinary L/M level has significantly statistical difference (p<0.05);After treatment, acute respiratory distress syndrome and multiple organ dysfunction syndrome incidence of the treatment group have statistically significant differences with the control group (p<0.05); mortality in 28 days of two groups have no statistically significant differences (p>0.05).
Conclusion:Yiqi Tongfu Zhuyu decoction enema therapy can significantly improve the symptoms of septic patients,improve their clinical treatment efficiency,reduce the clinical acute respiratory distress syndrome and multiple organ dysfunction syndrome incidence. The mechanism may be related to protection of intestinal mucosa barrier function and prevention of bacterial endotoxin translocation relevant.
方法：按照脓毒症诊断标准,选择40例脓毒症患者,采用随机数字表法,随机分为两组。两组在采用西医综合治疗基础上,治疗组加用益气通腑逐瘀方灌肠,对照组以等量生理盐水灌肠,均为每日2次,7天为1疗程,观察期为14天。治疗前后对两组所有患者进行中医证侯积分、APACHEⅡ评分,以此计算并比较两组的治疗效果。同时检测所有入选病例的静脉血D-乳酸、尿乳果糖／甘露醇(L/M)值,比较两组患者治疗开始、3d、7d、14d各指标的变化,观察急性呼吸窘迫综合征、多器官功能障碍综合征的发生率及28天死亡率。
结果：治疗前两组的中医证侯积分、APACHEⅡ评分无明显差异(P>0.05),病情严重程度相似。治疗后两组的中医证侯积分均下降(P<0.05),治疗组较对照组下降更显著(P<0.05)。治疗组治疗愈显率35.3%,对照组治疗愈显率5.6%,两者差异有显著性意义(P<0.05)。治疗组治疗7d及14d后,较对照组D-乳酸水平均有显著统计学差异(p<0.05)；治疗14d后,较对照组尿L/M水平有明显统计学差异(p<0.05)；治疗结束后,治疗组急性呼吸窘迫综合征发生率及多器官功能障碍综合征发生率较对照组均有明显统计学差异(p<0.05)；治疗组28天死亡率较对照组无明显统计学差异。
结论：益气通腑逐瘀方灌肠疗法能显著改善脓毒症患者的症状,提高其临床治疗有效率,降低临床急性呼吸窘迫综合征、多器官功能障碍综合征的发生率。其机制可能与其保护肠道黏膜屏障功能及预防细菌内毒素移位有关。
Objective:To study Yiqi Tongfu Zhuyu decoction enema therapy for treatment of patients with sepsis and its possible mechanism.
Methods:In accordance with sepsis diagnostic criteria, select 40 cases of septic patients, using random number table, randomly divided into two groups.On The basis of Western medicine treatment of two groups,the treatment group with Yiqi Tongfu Zhuyu decoction enema therapy, the control group with normal saline enema therapy, both 2 times a day,7 days a course of treatment, observation period of 14 days.In two groups before and after treatment to all patients TCM syndrome score, APACHE II score,as calculated and compared between two groups of treatment efficiency. Test their blood of D-lactic acid, urinary lactulose/mannitol (L/M) values,then compare them when treatment started, after treated 3days,7days,14days,for each index changes.Also compare acute respiratory distress syndrome, multiple organ dysfunction syndrome incidence and mortality in 28 days of two groups.
Results:Before treatment TCM syndrome score and APACHEⅡscore of two groups were no significant difference (p>0.05), similar severity of the disease. The two groups after treatment decreased TCM syndrome score (p<0.05), the treatment group than in the control group decreased more significantly (p<0.05). Treatment group's complete recover and effective rate was 35.3%, the complete recover and effective rate in the control group was 5.6%.Their difference was significantly statistical (p<0.05). Treatment group after 7 days and 14 days, compared with the control group D-lactate levels, Their difference was significantly statistical difference (p<0.05); therapy after 14d than the control group, urinary L/M level has significantly statistical difference (p<0.05);After treatment, acute respiratory distress syndrome and multiple organ dysfunction syndrome incidence of the treatment group have statistically significant differences with the control group (p<0.05); mortality in 28 days of two groups have no statistically significant differences (p>0.05).
Conclusion:Yiqi Tongfu Zhuyu decoction enema therapy can significantly improve the symptoms of septic patients,improve their clinical treatment efficiency,reduce the clinical acute respiratory distress syndrome and multiple organ dysfunction syndrome incidence. The mechanism may be related to protection of intestinal mucosa barrier function and prevention of bacterial endotoxin translocation relevant.
引文
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[7]北京市科委重大项目“MODS中西医结合诊治／降低病死率研究”课题组：多器官功能障碍综合征诊断标准、病情严重度评分及预后评估系统和中西医结合证型诊断.中国危重病急救医学,2008；20(1)：1-3.
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[2]姚咏明,盛志勇.我国创伤脓毒症基础研究新进展.中华创伤杂志,2003；19：9-12.
[3]Martin GS, Mannino DM, Eaton S, et al.The epidemiolog of sepsis in the United State from 1979 thorugh 2000.N Engl J Med,2003;348:1546-1554.
[4].Dellinger RP, Levy MM, Carlet JM, et al.Surviving sepsis campaign:international guidelines for management of severe sepsis and se ptic shock:2008.Crit Care Med, 2008;36(1):296-327.
[5]Levy MM,Fink MP,Marshall JC,et al.2001 SCCM/ESICM/ACCP/ATS/SIS Internati-onal Sepsis Definitions conference.Crit Care Med,2003;31(4):1250-1256.
[6]急性肺损伤／急性呼吸窘迫综合征诊断和治疗指南(2006).中国危重病急救医学,2006；18(12)：706-710.
[7]北京市科委重大项目“MODS中西医结合诊治／降低病死率研究”课题组：多器官功能障碍综合征诊断标准、病情严重度评分及预后评估系统和中西医结合证型诊断.中国危重病急救医学,2008；20(1)：1-3.
[8]王今达,李建国,程津新.脓毒症的诊断标准及中西医结合治疗指南的研究(讨论稿).李建国,程津新.成就卓越六十载光辉业绩誉全球.天津：天津科技翻译出版公司,2005：1：406-409.
[9]袁海兰,陈玲,房静.中药灌肠器的制作与应用.现代护理,2003；9(7)：566.
[10]Unno N,Fi nk MP.Intestinal epithelial hyperpermeability.Mechanisms and relevance to disease.Gastroenterol Clin North Am,1998;27(2):289-307.
[11]Baumgart DC,Dignass AU.Intestinal barrier function.Curr Opin Clin Nutr Metab Care. 2002;5(6):685-94.
[12]Rombeau JL,Takala J.Summary of round table conference:gut dysfunction in critical illness.Intens Care Med,1997;23(4):476-9.
[13]曾祥国.从黏液组织化学试论肺与大肠阴阳表里关系.四川医学,1982；43(3)： 129-132.
[14]王今达,高天元,崔乃杰,等.祖国医学“肺与大肠相表里”学说的临床意义及其本质探讨.中西医结合杂志,1982；2(2)：77.
[15]周东浩,张蕾,周明爱.肺与大肠相表里今释.中国中医基础医学杂志,2003；8(9)：567-569.
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