程玲,高志凌,陈韵

• 1:安徽中医药大学第一附属医院

摘要(Abstract)：

目的中西医结合治疗老年脓毒症继发急性胃肠功能损伤患者的临床观察。方法 40例患者分为治疗组和对照组各20例。对照组予以抗感染、液体复苏、降糖、肠内营养支持等常规治疗。治疗组在对照组治疗基础上加服益气通腑方。观察两组治疗前后中医证候改善、器官功能评分、白细胞、超敏C反应蛋白、肠型脂肪酸结合蛋白、二胺氧化酶、肠三叶因子水平变化情况。结果治疗5 d后,研究组中医证候总有效率90.00%高于对照组的50.00%(P<0.01);两组中医证候改善,器官功能评分(SOFA评分及APACHEⅡ评分)、血浆白细胞、超敏C反应蛋白、肠型脂肪酸结合蛋白、二胺氧化酶、肠三叶因子水平均较治疗前降低(均P<0.05或P<0.01),且治疗组各项指标改善均优于对照组(均P<0.05)。结论益气通腑方合西药治疗治疗脾胃气虚,肠燥热结证的急性胃肠功能损伤脓毒症老年患者疗效优于单纯西医治疗。

关键词(KeyWords)： 急性胃肠功能损伤;脓毒症;益气通腑方;脾胃气虚;肠燥热结

Abstract:

Keywords:

基金项目(Foundation): 安徽中医药大学科研基金项目(2014fy003)

作者(Author): 程玲,高志凌,陈韵

参考文献(References)：

• [1]Wu LM,Sankaran SJ,Plank LD,et al.Meta-analysis of gut barrier dysfunction in patients with acute pancreatitis[J].Br J Surg,2014,101(13):1644-1656.
• [2]沈洪,刘中民.急诊与灾难医学[M].北京:人民卫生出版社,2008:204.
• [3]Reintam BA,Malbrain ML,Tarkopf 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.
• [4]中华人民共和国卫生部.中药新药临床研究指导原则[M].北京:中国医药科技出版社,2002:361-364.
• [5]郭飞,黎蓓蓓,焦常新,等.大承气汤灌肠治疗危重患者胃肠功能障碍临床观察[J].中国中医急症,2012,21(11):1830.
• [6]张晓东.小承气汤治疗慢性不全性粘连性肠梗阻62例[J].中国中医药现代远程教育,2010,8(9):119-120.
• [7]王冰,任乾,黎贵才,等.大黄对多器官功能障碍综合征干预作用的临床研究[J].现代中西医结合杂志,2013,22(1):40-41.
• [8]Yang TC,Zhang SW,Sun LN,et al.Magnolol attenuates sepsis induced astrointestina1 dysmotility in rats by modulating inflammatory mediators[J].World J Gastroenterol,2008,14(48):7353.
• [9]王擂,刘淑丽,田翠,等.ICU住院患者急性胃肠损伤与APACHEⅡ评分的相关性分析[J].山东医药,2015,55(12):82-83.
• [10]Shi H,Wu B,Wan J,et al.The role of serum intestinal fatty acid binding protein levels and D-lactate levels in the diagnosis of acute intestinal ischemia[J].Clin Res Hepatol Gastroenterol,2015,39(3):373-378.
• [11]Timmermans K,Sir O,Kox M,et al.Circulating i FABP Levels as a marker of intestinal damage in trauma patients[J].Shock,2015,43(2):117-120.
• [12]朱承睿,丁仁或,孙旖旎,等.肠脂肪酸结合蛋白与严重脓毒症患者肠道损伤的相关性研究[J].中华危重病急救医学,2014,26(6):420-424.
• [13]Fukudome,Kobayashi M,Dabanaka K,et al.Diamine oxidase as a marker of intestinal mucosal injury and the effect of soluble dietary fiber on gastrointestinal tracttoxicity after intravenous 5-fluorouracil treatment in rats[J].Med Mol Morphol,2014,47(2):100.
• [14]Cakmaz R,Büyüka,slk O,Kahramansoy N,et al.A com-bination of plasma DAO and citrulline levels as a poten-tial marker for acute mesenteric ischemia[J].Libyan J Med,2013,26(8):1-6.
• [15]兰涛,崔乃强.急性出血坏死性胰腺炎大鼠血清二胺氧化酶水平变化及意义[J].山东医药,2016,56(38):37-39.
• [16]Cai C,Li W,Chen J,et al.Diamine oxidase as a marker for diagnosis of superior mesenteric arterial occlusion[J].Hepatogastroenterology,2012,59(113):115-158.
• [17]Zhao L,Luo L,Jia W,et al.Serum diamine oxidase as a hemorrhagic shock biomarker in a rabbit model[J].PLo S One,2014,9(8):e102285.
• [18]林金锋,孙兆瑞,杨志洲,等.肠三叶因子激活ERK1/2信号通路促进胃黏膜上皮细胞增殖和迁移[J].临床急诊杂志,2014,15(11):683-686.
• [19]杨炀,税丕先,陈滟,等.中药大黄在临床应用中的功效以及对其药理作用[J].基因组学与应用生物学,2017,36(3):1226-1231.