加减附子理中汤联合穴位敷贴/中药热奄包治疗对老年脓毒性休克患者疗效影响

Therapeutic effects of modified Fuzi Lizhong decoction combined with acupoint application and traditional Chinese medicine Reyanbao on elderly patients with septic shock

中文关键词: 老年  脓毒性休克  加减附子理中汤  穴位敷贴/中药热奄包  胃肠功能

英文关键词: elderly  septic shock  modified Fuzi Lizhong decoction  acupoint application and traditional Chinese medi-cine Reyanbao  gastrointestinal function

中文摘要:

      目的 探究加减附子理中汤联合穴位敷贴/中药热奄包治疗对老年脓毒性休克胃肠功能障碍的影响,为治疗该病症提供方法.方法 选取2021年3月 2024年5月于四川省第二中医医院诊治的135例老年脓毒性休克并发早期胃肠功能障碍患者为观察对象,采用随机数字表法分为对照组、常规组和汤方组,每组45例.对照组予以常规西医治疗,常规组在对照组相同治疗的基础上予以穴位敷贴/中药热奄包治疗,汤方组在常规组治疗的基础上予以加减附子理中汤治疗.比较3组临床疗效、治疗前后中医症状积分、急性生理和慢性健康量表(APACHE Ⅱ)评分、序贯器官功能衰竭量表(SOFA)评分、胃肠道症状评定量表(GSRS)评分、胃肠功能恢复情况、肠屏障标志物及炎症指标值变化差异,统计并比较3组不良反应发生情况.结果 治疗后,汤方组治疗总有效率均高于对照组和常规组(P＜0.05);3组主症和次症积分均低于同组治疗前(P＜0.05),且汤方组积分最低,常规组次之(P＜0.05),汤方组治疗前后差值大于对照组和常规组(P＜0.05);3组各指标评分均低于同组治疗前(P＜0.05),且汤方组APACHE Ⅱ、SOFA和GSRS评分最低,常规组次之(P＜0.05),汤方组治疗前后差值大于对照组和常规组(P＜0.05);3组患者的腹内压和腹围低于同组治疗前,肠鸣音高于同组治疗前,且汤方组改善程度均优于对照组和常规组,汤方组治疗前后差值大于对照组和常规组,差异均有统计学意义(P＜0.05);3组D-乳酸、胃泌素和DAO水平均降低(P＜0.05),且汤方组降低幅度大于对照组和常规组(P＜0.05),汤方组治疗前后差值大于对照组和常规组(P＜0.05),常规组治疗前后差值大于对照组(P＜0.05);3组患者的CRP、PCT和IL-6水平均低于同组治疗前(P＜0.05),且汤方组最低,常规组次之(P＜0.05),汤方组治疗前后差值大于对照组和常规组(P＜0.05);3组均未见明显不良反应.结论 加减附子理中汤联合穴位敷贴/中药热奄包可明显改善老年脓毒性休克患者早期胃肠功能障碍,减轻患者疾病严重程度,降低炎症反应,具有一定的临床应用价值.

英文摘要:

      Objective To investigate the effects of modified Fuzi Lizhong decoction combined with acupoint application and traditional Chinese medicine Reyanbao on gastrointestinal dysfunction in elderly patients with septic shock,and provide a treatment method for this condition.Methods 135 elderly patients with septic shock complicated with early gastrointestinal dysfunction diagnosed and treated in Second Hospital of Traditional Chinese Medicine(TCM)of Sichuan Province from March 2021 to May 2024 were selected.They were divided into control group,conventional group and decoction group according to random number table method,with 45 cases in each group.The control group was treated with conventional Western medicine.The conventional group was treated with acupoint application and traditional Chinese medicine Reyanbao on the basis of the same treatment as the control group.The decoction group was treated with modified Fuzi Lizhong decoction on the basis of the treatment as the conventional group.The clinical efficacy,TCM symptoms scores,Acute Physiology and Chronic Health Eval-uation Ⅱ(APACHE Ⅱ)score,Sequential Organ Failure Assessment(SOFA)score,Gastrointestinal Symptom Rating Scale(GSRS)score,gastrointestinal function recovery conditions,intestinal barrier markers and inflammatory indicators before and after treatment were compared among the three groups.The occurrence of adverse reactions was statistically analyzed and com-pared among the three groups.Results The total effective rate of treatment in the decoction group was significantly higher than that in the control group and the conventional group(P＜0.05).After treatment,the scores of primary symptoms and secondary symptoms in the three groups decreased significantly(P＜0.05),and the scores in the decoction group were the lowest,followed by the conventional group(P＜0.05),and the differences before and after treatment in the decoction group were larger than those in the control group and the conventional group(P＜0.05).The scores of APACHE Ⅱ,SOFA and GSRS in the three groups decreased significantly after treatment(P＜0.05),and the scores in the decoction group were the lowest,followed by conventional group(P＜0.05),and the differences before and after treatment in the decoction group were larger than those in the control group and the conventional group(P＜0.05).The intra-abdominal pressure and abdominal circ-umference in the three groups were significantly lower than those in the same group before treatment,and the bowel sounds was significantly higher than that in the same group before treatment.Moreover,the improvement degree in the decoction group was better than that in the control group and the conventional group.The difference before and after treatment in the decoction group was greater than that in the control group and the conventional group(P＜0.05).The levels of D-lactic acid,gastrin and DAO decreased significantly in the three groups(P＜0.05),and the reduction amplitude in the decoction group was significantly greater than that in the control group and the conventional group(P＜0.05).The difference before and after treatment in the decoction group was greater than that in the control group and the conventional group(P＜0.05),and the difference before and after treatment in the conventional group was greater than that in the control group(P＜0.05).The levels of CRP,PCT and IL-6 in the three groups were lower than those in the same group before treatment(P＜0.05),and the levels in the decoc-tion group were the lowest,followed by conventional group(P＜0.05),and the decoction group had greater differences before and after treatment compared with the control group and the conventional group(P＜0.05).No obvious adverse reactions were observed in all three groups.Conclusion Modified Fuzi Lizhong decoction combined with acupoint application and traditional Chinese medicine Reyanbao can significantly improve early gastrointestinal dysfunction in elderly patients with septic shock,re-lieve the disease severity and reduce the inflammatory response.It has certain clinical application value.