Clinical effect of Jianpi Xiaozhang Decoction umbilical paste in the treatment of sepsis with gastrointestinal dysfunction
ZHANG Jidan ZHANG Lifen ZHU Yuanqing XU Zhibing
Emergency Department of Internal Medicine, the Seventh People′s Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 200137, China
Abstract:Objective To explore clinical effect of Jianpi Xiaozhang Decoction umbilical paste in the treatment of sepsis patients with gastrointestinal dysfunction. Methods Eighty sepsis patients with gastrointestinal dysfunction hospitalized in Emergency Intensive Care Unit of the Seventh People′s Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from July 2017 to February 2019 were selected and randomly divided into treatment group (40 cases) and control group (40 cases) by random number table method. Two groups were given basic treatment. In treatment group, shenque point was pasted with Jianpi Xiaozhang Decoction on the basis of basic treatment, the course was 7 days. The sequential organ function (SOFA) score, gastrointestinal dysfunction score, gastrointestinal dysfunction index level and comprehensive efficacy between two groups were compared. Results The score of SOFA in control group after treatment was higher than that before treatment (P < 0.05). After treatment, the scores of SOFA and intraperitoneal pressure in treatment group were lower than those before treatment and in control group, and the peritoneum in treatment group was shorter than that before treatment and in control group (P < 0.05). The scores of gastrointestinal dysfunction and traditional Chinese medicine syndrome in control group after treatment were lower than those before treatment (P < 0.05). After treatment, the number of bowel sounds in treatment group was more than that before treatment and in control group, and the scores of gastrointestinal dysfunction and traditional Chinese medicine syndrome were lower than those before treatment and in control group (P < 0.05). The level of serum intestinal fatty acid binding protein (IFABP) in control group after treatment was lower than that before treatment (P < 0.05). The levels of IFABP and D-lactate in treatment group were lower than those before treatment and in control group (P < 0.05). The total effective rate of Chinese medicine syndrome effect and comprehensive effect of treatment group was higher than control group, the difference was statistically significant (P < 0.05). The incidence of multiple organ dysfunction syndrome of treatment group was lower than control group, the difference was statistically significant (P < 0.05). Conclusion Jianpi Xiaozhang Decoction umbilical paste can improve clinical symptoms such as abdominal distention, abdominal pain, fatigue and defecation, enhance gastrointestinal motility, improve gastrointestinal barrier function and the state of ischemia and anoxia.
[1] Singer M,Deutschman CS,Seymour CW,et al. The third international consensus definitions for sepsis and septic shock (Sepsis3) [J]. JAMA,2016,315(8):801.
[2] 中华医学会重症医学分会.中国严重脓毒症/脓毒性休克治疗指南(2014)[J].中华内科杂志,2015,54(6):557-581.
[3] Prescott HC,Angus DC. Postsepsis morbidity [J]. JAMA,2018,391(1):91.
[4] Dellinger RP,Carlet JM,Masur H,et al. Surviving sepsis campaign guidelines for management of severe sepsis and septic shock [J]. Crit Care Med,2004,32(3):858-873.
[5] Reintam BA,Malbrain ML,Starkopf J,et al. Gastrointestinal function in intensive care patients:terminology,definitions and management. Recommendations of the ESICM Working Group on Abdominal Problems [J]. ICM,2012,38(3):384-394.
[6] 中国中西医结合学会急救医学专业委员会.重修“95庐山会议”多器官功能障碍综合征病情分期诊断及严重程度评分标准(2015)[J].中华危重病急救医学,2016,28(2):99-101.
[7] 郑筱萸.中药新药临床研究指导原则(试行)[M].北京:中国医药科技出版社,2002:134-139.
[8] 朱文锋.中医诊断学[M].北京:中国中医药出版社,2007:150-151.
[9] 中华医学会重症医学分会.危重患者营养支持指导意见(草案)[J].中国危重病急救医学,2006,18(10):584-585.
[10] 汪刚.消胀贴治疗危重病胃肠功能障碍的疗效观察[D].北京:北京中医药大学,2013.
[11] 王芳芳.中药贴敷神阙穴对严重脓毒症胃肠功能障碍的疗效观察[D].广州:广州中医药大学,2011.
[12] 赵红芳,江其敏,刘清泉.刘清泉教授应用中医药治疗脓毒症的临床经验[J].中国中医急症,2017,26(9):1563-1565.
[13] 张晓璇,邱华云,王芳芳.酒调吴茱萸和丁香敷脐治疗脓毒症胃肠功能障碍疗效观察[J].中国中医急症,2011, 20(11):1746-1760.
[14] 孔立,郭琪钰,赵浩.脓毒症胃肠功能障碍中医证候分布规律探讨[J].中国中西医结合急救杂志,2013,20(3):134-137.
[15] 吴国琳,余国友.余国友主任医师论治急危重症并发胃肠功能衰竭经验[J].中国中医急症,2015,24(1):85-87.
[16] 李闪闪,江荣林.中西医结合防治脓毒症胃肠功能障碍研究进展[J].浙江中西医结合杂志,2015,25(7):705-710.
[17] 程源,徐鹏远.D-乳酸与I-FABP在肠屏障功能受损中作用的研究进展[J].中国临床新医学,2018,11(9):949-953.
[18] 金伟,钟娟,李情洁,等.中药治疗急性胰腺炎并发急性胃肠损伤的系统评价[J].世界科学技术-中医药现代化,2016,18(4):699-708.
[19] 刘畅,杨秀捷,赵昕,等.消胀贴神阙穴贴敷辅助治疗脓毒症胃肠功能障碍的中医证候疗效观察[J].北京中医药,2018,37(3):276-279.
[20] 许志恒,李宏贵,巢阳发,等.通腑泄热方对脓毒症大鼠肺功能与外周血T淋巴细胞亚群的影响[J].世界中医药,2019,14(5):1177-1180.
[21] Derikx JP,Luyer MD,Heineman E,et al. Non-invasive markers of gut wall integrity in health and disease [J]. World J Gastroenterol,2010,16(42):5272-5279.
[22] 赵锋利,冼绍祥,罗苑苑,等.参附注射液对脓毒症小鼠免疫调节及炎症因子的影响[J].中国医药导报,2019, 16(22):21-25.
[23] Shi H,Wu BY,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 Gas,2015,39(3):373-378.