發(fā)布時間：2018-10-13 12:21

【摘要】：背景:胃腸功能障礙是ICU患者常見的并發(fā)癥,若出現(xiàn)胃腸功能損傷的臨床癥狀則提示預(yù)后不良或病情加重�，F(xiàn)代醫(yī)學對重癥胃腸功能障礙的發(fā)病機制仍不明確,治療亦缺乏相關(guān)特異性。而中醫(yī)的治療模式是多靶點、多途徑,具有整體觀念和辨證論治的特色。中醫(yī)認為胃腸功能障礙的基本病機是胃失和降、腑氣不通,故基本治療原則是和胃通降、行氣通腑。調(diào)胃承氣湯出自《傷寒論》辨陽明病脈證并治陽明病證篇,具有瀉熱和胃、潤燥軟堅的功效,常用于陽明病胃腸燥熱證。目前臨床上關(guān)于調(diào)胃承氣湯治療重癥胃腸功能障礙的研究相對較少。本研究旨在評估加用調(diào)胃承氣湯的中西醫(yī)結(jié)合治療對于重癥患者胃腸功能障礙的臨床療效。目的:通過觀察在西醫(yī)治療基礎(chǔ)上加用調(diào)胃承氣湯對合并有重癥胃腸功能障礙的患者的影響,證明調(diào)胃承氣湯能有效的降低患者腹內(nèi)壓、促進胃腸蠕動、改善氧合及疾病預(yù)后,進而為調(diào)胃承氣湯在臨床的廣泛運用提供一定的科學依據(jù)。方法:采用隨機、對照、前瞻性設(shè)計方案。選擇入住廣州中醫(yī)藥大學第一附屬醫(yī)院重癥醫(yī)學科符合實驗標準的患者50例,按照隨機分組的方法將納入患者分為治療組和對照組,治療組與對照組各自25例。所有入選的患者均給予常規(guī)基礎(chǔ)治療。治療組在常規(guī)治療的基礎(chǔ)上加用調(diào)胃承氣湯加減,療程5天,觀察腹內(nèi)壓、腹圍、腸鳴音、氧合指數(shù)及APACHEⅡ評分治療前后的變化情況,采用SPSS20.0統(tǒng)計軟件對數(shù)據(jù)進行統(tǒng)計處理。結(jié)果:1.治療組與對照組入組前的性別、年齡、腹內(nèi)壓、腹圍、腸鳴音、氧合指數(shù)及APACHEⅡ評分都是P0.05,說明兩組具有可比性。2.調(diào)胃承氣湯能改善重癥患者的胃腸功能障礙。治療組治療后的腹內(nèi)壓、腹圍及腸鳴音與對照組相比明顯好轉(zhuǎn),PO.05,兩組具有統(tǒng)計學差異。3.調(diào)胃承氣湯能改善重癥患者的氧合情況。治療組氧合指數(shù)升高的程度大于對照組,P0.05,兩組具有統(tǒng)計學差異。4.調(diào)胃承氣湯能改善重癥患者病情的嚴重程度。治療組與對照組相比APACHEⅡ評分明顯下降,P0.05,兩組具有統(tǒng)計學差異。結(jié)論:調(diào)胃承氣湯可以促進胃腸蠕動,降低腹腔壓,縮減腹圍,增加腸鳴音次數(shù),改善全身氧合狀態(tài)及病情危重程度,對重癥胃腸功能障礙的治療效果理想。
[Abstract]:Background: gastrointestinal dysfunction is a common complication in patients with ICU. The pathogenesis of severe gastrointestinal dysfunction in modern medicine is still unclear and the treatment lacks specificity. The treatment mode of TCM is multi-target and multi-channel with the characteristics of holistic concept and differentiation of symptoms and signs. TCM believes that the basic pathogenesis of gastrointestinal dysfunction is gastric disharmony, entrails and qi impassable, so the basic principle of treatment is to make the stomach go down, and carry out qi to clear the Fu organs. The decoction of regulating stomach and Chengqi comes from the syndrome of differentiating Yangming disease and treating Yangming disease, it has the effect of purging heat and stomach, moistening dryness, and is often used in Yangming disease of gastrointestinal dryness and heat syndrome. At present, there are few clinical studies on the treatment of severe gastrointestinal dysfunction with Tiaowei Chengqi decoction. The purpose of this study was to evaluate the clinical efficacy of combined Chinese and western medicine with TWTD in the treatment of gastrointestinal dysfunction in severe patients. Objective: to observe the effect of Tiaowei Chengqi decoction on patients with severe gastrointestinal dysfunction on the basis of western medicine treatment, and to prove that Tiaowei Chengqi decoction can effectively reduce the abdominal pressure, promote gastrointestinal peristalsis, improve oxygenation and disease prognosis. It provides a scientific basis for the wide application of Tiaowei Chengqi decoction in clinical practice. Methods: a randomized, controlled and prospective design was used. Fifty patients admitted to the Department of intensive Medicine of the first affiliated Hospital of Guangzhou University of traditional Chinese Medicine were selected and divided into treatment group and control group according to the method of random grouping. There were 25 cases in treatment group and control group respectively. All selected patients were given routine basic treatment. On the basis of routine treatment, the treatment group was treated with taiwei Chengqi decoction for 5 days. The changes of abdominal pressure, abdominal circumference, bowel sound, oxygenation index and APACHE 鈪，

本文編號：2268606