文章摘要
杨丽娜;郭永俊;张芮斌.加味黄龙汤联合艾灸治疗脓毒症合并急性胃肠损伤的临床研究[J].中医药信息,2024,41(5):64-68
加味黄龙汤联合艾灸治疗脓毒症合并急性胃肠损伤的临床研究
Clinical Study on the Treatment of Sepsis Complicated with Acute Gastrointestinal Injury by Modified Yellow Dragon Decoction Combined with Moxibustion
投稿时间:2024-04-07  录用日期:2024-05-11
DOI:10.19656/j.cnki.1002-2406.20240511
中文关键词: 脓毒症  急性胃肠损伤  加味黄龙汤  艾灸  胃肠功能
英文关键词: Sepsis  Acute Gastrointestinal Injury  Modified Yellow Dragon Decoction  Moxibustion  Gastrointestinal Function
基金项目:河南省中医药科学研究专项课题(2022ZY1206)
作者单位
杨丽娜;郭永俊;张芮斌  
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中文摘要:
      目的:探讨加味黄龙汤联合艾灸治疗脓毒症合并急性胃肠损伤(AGI)的临床疗效。方法:选择符合纳入标准的脓毒症合并AGI患者60例,依据随机数字表随机分为对照组和研究组,各30例。对照组采用常规西医治疗,研究组在对照组基础上给予加味黄龙汤联合艾灸治疗,共治疗7 d。比较两组患者治疗前后胃黏膜分泌功能(胃蛋白酶原Ⅰ、Ⅱ),胃肠功能相关指标(肠鸣音、腹内压、胃肠功能障碍评分),中医证候积分,急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分,序贯器官衰竭(SOFA)评分的变化情况,并比较临床疗效及ICU住院时间、多器官功能障碍综合征(MODS)发病情况、28 d死亡率。结果:与治疗前比较,两组患者治疗后胃蛋白酶原Ⅰ、Ⅱ(PGⅠ、PGⅡ)含量升高(P <0.05),且研究组治疗后PGⅠ、PGⅡ含量较对照组更高(P <0.01)。与治疗前比较,两组患者治疗后肠鸣音升高(P <0.05),腹内压、胃肠功能障碍评分降低(P <0.05),且研究组治疗后肠鸣音较对照组更高(P <0.01),腹内压、胃肠功能障碍评分较对照组更低(P <0.05,P <0.01)。与治疗前比较,两组治疗后中医证候积分、APACHEⅡ评分、SOFA评分降低(P <0.05),且研究组治疗后中医证候积分、APACHEⅡ评分、SOFA评分较对照组更低(P <0.01)。治疗后,研究组治疗总有效率(96.67%,29/30)高于对照组(76.67%,23/30)(P <0.05)。治疗后,研究组ICU住院时间更短(P <0.01),研究组多器官功能障碍综合征发病率(16.67%,5/30)低于对照组(40%,12/30)(P <0.05),28 d死亡率(13.33%,4/30)低于对照组(36.67%,11/30)(P <0.05)。结论:加味黄龙汤联合艾灸治疗脓毒症合并AGI患者,可提高胃黏膜分泌功能,改善胃肠功能,降低临床评分,提高综合疗效,缩短ICU住院时间,降低MODS发病率和28 d死亡率。
英文摘要:
      Objective: To investigate the clinical efficacy of Modified Yellow Dragon Decoction(MYDD) combined with moxibustion in the treatment of sepsis complicated with acute gastrointestinal injury(AGI).Methods: Sixty patients with sepsis complicated with AGI who met the inclusion criteria were randomly divided into a control group and a study group, with 30 cases in each group. The control group received conventional Western medicine treatment, while the study group received MYDD combined with moxibustion in addition to the treatment for the control group, with a total treatment duration of 7 days. The changes in gastric mucosal secretion function(gastric pepsinogen Ⅰ and Ⅱ), gastrointestinal function-related indicators(intestinal peristalsis, intra-abdominal pressure, gastrointestinal dysfunction score), traditional Chinese medicine syndrome score, Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score, and Sequential Organ Failure Assessment(SOFA) score were compared between the two groups before and after treatment.Clinical efficacy, ICU hospitalization time, incidence of multiple organ dysfunction syndrome(MODS), and 28-day mortality were also compared. Results: Compared with before treatment, the levels of gastric pepsinogen Ⅰ and Ⅱ (PG Ⅰ, PG Ⅱ) increased in both groups after treatment(P < 0. 05), and the levels of PG Ⅰ and PG Ⅱ in the study group were higher than those in the control group after treatment(P < 0. 01).After treatment, intestinal peristalsis increased(P < 0. 05), intra-abdominal pressure and gastrointestinal dysfunction score decreased(P < 0. 05) in both groups. Additionally, the study group had higher intestinal peristalsis(P < 0. 01) and lower intra-abdominal pressure and gastrointestinal dysfunction score(P < 0. 05, P < 0. 01) compared with the control group after treatment. After treatment, traditional Chinese medicine syndrome score, APACHE Ⅱ score, and SOFA score decreased in both groups(P < 0. 05), and the study group had lower traditional Chinese medicine syndrome score, APACHE Ⅱ score, and SOFA score than the control group(P < 0. 01). The total effective rate in the study group(96. 67%, 29/30) was higher than that in the control group(76. 67%, 23/30) after treatment(P < 0. 05). The study group had a shorter ICU hospitalization time(P < 0. 01), lower incidence of MODS(16. 67%, 5/30) compared with the control group(40%, 12/30)(P < 0. 05), and lower 28-day mortality rate(13. 33%, 4/30) compared with the control group(36. 67%, 11/30)(P < 0. 05). Conclusion: Modified Yellow Dragon Decoction combined with moxibustion can improve gastric mucosal secretion function, gastrointestinal function, reduce clinical scores, improve comprehensive efficacy, shorten ICU hospitalization time, and reduce the incidence of MODS and 28-day mortality in patients with sepsis complicated with AGI.
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