腹部烫熨联合大承气汤加减灌肠治疗重症监护室患者胃肠功能障碍的临床观察

Effect of abdominal ironing combined with enema by modified Dachengqi Decoction on gastrointestinal dysfunction in intensive care unit patients

  • 摘要:
    目的 观察腹部烫熨联合大承气汤加减灌肠治疗重症监护室(ICU)患者胃肠功能障碍(GD)的临床效果。
    方法 选取入住ICU且符合纳入与排除标准的120例GD患者作为研究对象,随机分成西医组(西医常规治疗)、中药灌肠组(西医组基础上加用基于大承气汤加减的灌肠治疗)和联合组(中药灌肠组基础上加用中药腹部烫熨),每组40例,均治疗7 d。比较3组患者胃肠功能衰竭(GIF)评分、急性生理和慢性健康状况评分系统Ⅱ(APACHE Ⅱ)评分、胃肠道症状缓解时间和血清降钙素原(PCT)、C反应蛋白(CRP)水平。
    结果 3组GIF评分、APACHE Ⅱ评分和血清PCT、CRP水平均随治疗时间的增加而降低,组间和时点间存在交互作用(P < 0.05);治疗3、7 d时,联合组GIF评分、APACHE Ⅱ评分和血清PCT、CRP水平均低于中药灌肠组、西医组,且中药灌肠组低于西医组,差异有统计学意义(P < 0.05)。联合组腹胀缓解时间、肠鸣音恢复时间、肛门排气时间和排便时间均早于中药灌肠组、西医组,且中药灌肠组早于西医组,差异有统计学意义(P < 0.05)。
    结论 对存在GD的ICU患者实施大承气汤加减灌肠联合腹部烫熨治疗,可有效减轻炎症反应和GD症状,并显著缓解患者病情。

     

    Abstract:
    Objective To observe the clinical effect of abdominal ironing combined with enema by modified Dachengqi Decoction on gastrointestinal dysfunction (GD) in intensive care unit(ICU).
    Methods A total of 120 GD patients who were admitted to the ICU of our hospital and met the inclusion and exclusion criteria were selected as study objects. They were randomly divided into western medicine group (n=40, conventional treatment of western medicine), Chinese medicine enema group (n=40, added enema treatment with modified Dachengqi Decoction on the basis of western medicine group) and combination group (n=40, applied traditional Chinese medicine abdominal ironing on the basis of Chinese medicine enema group), all groups were treated for 7 days. Gastrointestinal failure (GIF) score, Acute Physiology And Chronic Health Evaluation Scoring System Ⅱ (APACHE Ⅱ) score, remission time of gastrointestinal symptoms, serum procalcitonin (PCT) and C-reactive protein (CRP) levels were compared among the three groups.
    Results GIF score, APACHE Ⅱ score, serum PCT and CRP levels in the three groups decreased with the prolonging of treatment time (P < 0.05), and there was an interaction effect among groups and time points (P < 0.05). The above scores of the combination group were obviously lower than those of the Chinese medicine enema group and the western medicine group at 3 and 7 days of treatment, and were obviously lower in the Chinese medicine enema group than those of the western medicine group (P < 0.05). Abdominal distension relief time, bowel sound recovery time, anal exhaust time and defecation time in the combination group were earlier than those in Chinese medicine enema group and western medicine group (P < 0.05).
    Conclusion Abdominal ironing combined with enema by modified Dachengqi Decoction for ICU patients with GD can effectively relieve inflammation, improve the symptoms of GD, and obviously alleviate the condition of disease.

     

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