Clinical study of Dachengqi Decoction combined with conventional treatment of western medicine to intervene sepsis with acute gastrointestinal injury

Min CHEN; Qian WANG

doi:10.16306/j.1008-861x.2022.S1.005

切换中文

Your Location：

Home >

Browse articles >

Clinical study of Dachengqi Decoction combined with conventional treatment of western medicine to intervene sepsis with acute gastrointestinal injury

Clinical Research | Updated：2022-08-29

- Clinical study of Dachengqi Decoction combined with conventional treatment of western medicine to intervene sepsis with acute gastrointestinal injury
- role： First author , 第一作者 ,
  
  Affiliation：
  Department of Emergency Internal Medicine， Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine， Shanghai 201203， China
  
  Email：
  
  Introduction：陈敏，女，在读硕士生，住院医师，主要从事急危重症临床研究
  
  No information about the author is available
  CHEN Min
  ,
  role： Corresponding author , 通讯作者 ,
  
  Affiliation：
  Department of Emergency Internal Medicine， Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine， Shanghai 201203， China
  
  Email： docqianwang@126.com
  
  Introduction：王倩，主任医师，硕士生导师；E-mail：docqianwang@126.com
  
  No information about the author is available
  WANG Qian
  ,
- Academic Journal of Shanghai University of Traditional Chinese Medicine Vol. 36, Issue S1, Pages: 20-22(2022)
- Affiliations：
  
  1.Department of Emergency Internal Medicine， Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine， Shanghai 201203， China
- Author bio：
- Funds：
- DOI：10.16306/j.1008-861x.2022.S1.005
  CLC：
Scan for full text
Cite this article

PDF
陈敏,王倩.大承气汤联合西医常规治疗干预脓毒症伴急性胃肠损伤的临床研究[J].上海中医药大学学报,2022,36(S1):20-22.

CHEN Min,WANG Qian.Clinical study of Dachengqi Decoction combined with conventional treatment of western medicine to intervene sepsis with acute gastrointestinal injury[J].Academic Journal of Shanghai University of Traditional Chinese Medicine,2022,36(S1):20-22.
陈敏,王倩.大承气汤联合西医常规治疗干预脓毒症伴急性胃肠损伤的临床研究[J].上海中医药大学学报,2022,36(S1):20-22. DOI： 10.16306/j.1008-861x.2022.S1.005.

CHEN Min,WANG Qian.Clinical study of Dachengqi Decoction combined with conventional treatment of western medicine to intervene sepsis with acute gastrointestinal injury[J].Academic Journal of Shanghai University of Traditional Chinese Medicine,2022,36(S1):20-22. DOI： 10.16306/j.1008-861x.2022.S1.005.

Abstract

Objective： To observe the clinical efficacy of Dachengqi Decoction on sepsis with acute gastrointestinal injury.

译

Methods

Forty patients suffering from sepsis with acute gastrointestinal injury were randomly divided into the treatment group and control group， 20 cases in each group. The control group was given routine treatment， and the treatment group was treated with Dachengqi Decoction on the basis of routine treatment. The treatment course of both groups was 7 days. The SOFA score， APACHE Ⅱ score， AGI score， intra-abdominal pressure， bowel sounds， and PCT， IL-6， TNF-α and IL-10 levels in serum were observed and compared.

译

Results

①The SOFA score and APACHE Ⅱ score in the two groups decreased significantly after treatment （P<0.05）. And those scores in the treatment group were lower than those in the control group （P<0.05）. ②After treatment， the intra-abdominal pressure and AGI scores in both groups were significantly decreased （P<0.05）， and the bowel sounds were significantly increased （P<0.05）. The intra-abdominal pressure and AGI scores in the treatment group were lower than those in the control group， and the bowel sounds in the treatment group were significantly more than those in the control group （P<0.05）. ③After treatment， the levels of PCT， IL-6 and TNF-α in serum in both groups decreased significantly （P<0.05）， and the level of IL-10 increased significantly （P<0.05）. The levels of PCT， IL-6 and TNF-α in the treatment group were significantly lower than those in the control group （P<0.05）， and the levels of IL-10 in the treatment group were significantly higher than those in the control group （P<0.05）.

译

Conclusion

Dachengqi Decoction combined with western medicine in the treatment of sepsis with acute gastrointestinal injury can effectively promote the recovery of gastrointestinal function and inhibit inflammatory reaction.

译

Keywords

Dachengqi Decoction; sepsis; acute gastrointestinal injury; clinical study

译

脓毒症是由于感染引起宿主反应失调导致的危及生命的器官功能障碍^［1］。胃肠道不仅是脓毒症、多器官功能障碍综合征的靶器官，也是炎症的激发器官^［2］。有文献报道脓毒症伴急性胃肠损伤（acute gastrointestinal injury，AGI）的发病率高达62%，AGI主要表现为胃潴留、腹泻、食物喂养不耐受综合征、腹腔间隔室综合征、腹腔内高压、下消化道麻痹及肠管扩张等^［3］。脓毒症AGI是多因素共同作用的结果，病理机制尚未明确。目前主要认为其病理变化与胃肠黏膜缺血再灌注损伤、微循环障碍、屏障功能损害、胃肠动力紊乱、微生态失衡等因素有关。现代医学尚无特异性治疗方案，主要以纠正原发疾病、控制感染及早期开展胃肠内营养、胃肠黏膜保护剂、胃肠道促动力剂、微生态补充制剂等对症治疗为主^［4］，疗效不甚满意。

中医药近年来在治疗脓毒症胃肠损伤方面取得较大进展，在改善症状、减少不良反应等方面具有一定优势^［5］。大承气汤是《伤寒论》中的经典方剂，具有峻下热结之功效。基于此，本研究在常规西医治疗基础上联合大承气汤治疗脓毒症AGI患者，以期为中医药的临床治疗提供参考，现报告如下。

1 资料与方法

1.1 病例选择

1.1.1 诊断标准

脓毒症的诊断参照美国重症医学会（SCCM）与欧洲重症医学会（ESICM）联合发布的“第三次脓毒症和脓毒症休克国家共识”中脓毒症3.0版本^［1］。AGI的诊断参照欧洲危重病医学会关于急性胃肠损伤的定义和处理指南^［3］。

1.1.2 纳入标准

符合上述疾病诊断标准；胃肠功能损伤为Ⅱ、Ⅲ级；年龄18～85岁；知情同意并签订知情同意书。

1.1.3 排除标准

过敏体质或对本药已知成分过敏或局部皮肤过敏者；存在精神疾患或者不能配合者；伴有其他病因导致的胃肠功能损伤的疾病。

1.2 一般资料

本研究选择的40例病例均为2021年1月至2021年10月入住本院EICU的脓毒症AGI患者，采用随机数字表法分为治疗组与对照组，每组20例。治疗组中男性10例，女性10例；平均年龄（65.05±11.94）岁；平均SOFA评分^［1］（11.70±2.29）分，APACHE Ⅱ评分^［1］（21.30±4.14）分，AGI评分^［1］（2.75±0.44）分；基础疾病方面，肺部感染10例，腹腔感染6例，泌尿道感染1例，外科术后感染3例。对照组中男性11例，女性9例；平均年龄（64.65±10.34）岁；平均SOFA评分（11.85±2.37）分，APACHE Ⅱ评分（22.25±4.84）分，AGI评分（2.65±0.49）分；基础疾病方面，肺部感染11例，腹腔感染5例，泌尿道感染2例，外科术后感染2例。两组患者性别、年龄、SOFA评分、APACHE Ⅱ评分等基线资料比较，差异无统计学意义（P>0.05），具有可比性。

1.3 治疗方法

1.3.1 对照组

给予积极抗感染、液体复苏、脏器支持等常规基础治疗，并予胃肠解压、开展肠内营养、补充微生态制剂等对症处理。疗程为7 d。

1.3.2 治疗组

在对照组治疗措施基础上加予大承气汤治疗。方剂组成：大黄12 g、厚朴15 g、枳实12 g、芒硝9 g。上4味，用水1 L，先煮厚朴、枳实，取500 ml，去滓；放入大黄，煮取200 ml，去滓，放入芒硝，上微火煎至沸腾，所得药液均分为2份，分别于早晚饭后温服，1剂/d，疗程为7 d。

1.4 观察项目与方法

1.4.1 临床评分

观察患者治疗前后的SOFA评分、APACHE II评分^［1］情况。

1.4.2 胃肠功能相关指标

观察患者治疗前后的腹内压、肠鸣音、AGI评分水平。

1.4.3 炎症指标

治疗前后，检测患者血清降钙素原（PCT）、白介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）、白介素-10（IL-10）水平。

1.5 统计学方法

试验数据应用SPSS 26.0统计软件处理。计量资料以 $\bar{x}$ ±s表示，采用t检验。以P<0.05为差异有统计学意义。

2 结果

2.1 临床评分变化情况

治疗前后组内比较，两组SOFA评分、APACHE Ⅱ评分均明显降低（P<0.05）；组间治疗后比较，治疗组SOFA评分、APACHE Ⅱ评分均低于对照组（P<0.05）。见表1。

表1 两组临床评分变化情况比较（

$\bar{x}$ ±s，分）

组　别	时点	SOFA评分	APACHE Ⅱ评分
对照组	治疗前	11.85±2.37	22.25±4.84
(n=20)	治疗后	6.60±1.79^*	13.25±3.02^*
治疗组	治疗前	11.70±2.29	21.30±4.14
(n=20)	治疗后	5.15±1.53^*#	10.75±2.34^*#

注：与本组治疗前比较，*P<0.05；与对照组治疗后比较，#P<0.05。下表同

Download: Export CSV

2.2 胃肠功能相关指标变化情况

治疗前后组内比较，两组腹内压、AGI评分均明显下降（P<0.05），肠鸣音明显增加（P<0.05）。组间治疗后比较，治疗组腹内压、AGI评分低于对照组，而肠鸣音明显多于对照组（P<0.05）。见表2。

表2 两组胃肠功能相关指标变化情况比较（

$\bar{x}$ ±s）

组　别	时点	腹内压（cmH₂O）	肠鸣音（次/分）	AGI评分（分）
对照组	治疗前	20.65±3.60	2.05±0.76	2.65±0.49
(n=20)	治疗后	12.85±2.03^*	2.90±0.64^*	2.25±0.44^*
治疗组	治疗前	20.80±3.75	1.95±0.89	2.75±0.44
(n=20)	治疗后	10.95±3.24^*#	3.55±0.76^*#	1.80±0.52^*#

Download: Export CSV

2.3 炎症指标变化情况

治疗前后组内比较，两组PCT、IL-6、TNF-α水平均明显下降（P<0.05），IL-10水平明显升高（P<0.05）。组间治疗后比较，治疗组PCT、IL-6、TNF-α水平低于对照组，而IL-10水平明显高于对照组（P<0.05）。见表3。

表3 两组炎症指标变化情况比较（

$\bar{x}$ ±s，ng/L）

组别	时点	PCT	IL⁃6	TNF⁃α	IL⁃10
对照组	治疗前	39.59±7.13	156.18±19.79	18.52±1.79	19.40±4.04
(n=20)	治疗后	9.41±2.84^*	87.05±12.92^*	8.44±1.64^*	55.59±14.47^*
治疗组	治疗前	39.04±8.68	155.21±18.25	18.85±2.05	19.15±2.30
(n=20)	治疗后	7.63±2.27^*#	75.50±14.59^*#	7.29±1.39^*#	68.27±17.20^*#

Download: Export CSV

3 讨论

脓毒症是ICU中非心源性病例死亡的主要原因，与机体炎症反应、循环障碍、免疫失调等因素有关，病死率高达25%^［6］，其易并发多器官功能障碍，胃肠道是脓毒症病理过程中最早及最严重的受累器官之一。胃肠道含有大约10¹⁴ CFU/ml的微生物^［7］，具有营养代谢、调节免疫等作用。胃肠道是机体最大的细菌及内毒素储存库，脓毒症时严重损伤后的应激反应可造成胃肠道功能失调，引起肠道细菌/内毒素移位，刺激机体释放大量炎症介质，炎症因子通过级联效应能够加重急性胃肠损伤，肠源性细菌毒素释放入血，又进一步加重炎症因子风暴。因此，对AGI的早期识别和治疗是改善脓毒症预后的关键之一。

中医学中无“脓毒症”“AGI”的病名，根据我科多年临证经验发现，此类疾病患者常以周身灼热、烦渴、腹满、便秘等主症以及舌绛少津、苔黄、脉数等舌脉情况为多见。究其病因病机，乃外感六淫，邪毒入里化热，热郁中焦，里热炽盛，腑气不畅，营血受困而致。大承气汤作为《伤寒论》中的经典方剂，方中以大黄为君，泻热通便、荡涤肠胃；臣药为芒硝，软坚润燥；辅以枳实、厚朴行气散结、消除痞满。四药合用可达通畅胃肠气机、推陈致新的作用。临床上本方常用于急性胰腺炎、急性肠梗阻等胃肠功能障碍的急危重症患者，疗效显著。现代研究表明，大承气汤具有兴奋肠管，增加胃肠局部血流量，抑菌、抗炎、解毒，防治肠道菌群移位等多种功效^［8-9］。药理学研究提示，大承气汤可通过抑制PI3K/Akt信号通路，下调炎症细胞相关因子（如IL-1β、 IL-6、TNF-α等）水平^［10］，增强免疫功能^［11］。

在全身严重细菌感染和脓毒症等刺激下，PCT由甲状腺髓质细胞产生并释放入血，可反映炎症的严重程度，可用于指导脓毒症的治疗^［12］；IL-6在炎症早期，由受到Toll样受体刺激的单核细胞和巨噬细胞产生，促进炎症因子释放，在脓毒症中表达增高，可作为反映脓毒症炎症程度的生物标志物^［13］；TNF-α是一种炎性细胞因子，主要由单核-巨噬细胞分泌，能激活炎症级联反应，可用于预测脓毒症的预后^［14］；IL-10由Th2细胞、巨噬细胞和单核细胞等合成释放，参与炎症、免疫反应，可抑制TNF-α、IL-6等促炎因子的产生，减少组织细胞的炎症和损伤^［15］。

本研究结果显示，治疗前后两组SOFA评分、APACHE Ⅱ评分、AGI评分、腹内压及血清PCT、IL-6、TNF-α水平均较治疗前明显降低（P<0.05），且治疗后治疗组均低于对照组（P<0.05）；治疗前后两组肠鸣音、IL-10水平均较治疗前明显增加（P<0.05），且治疗后治疗组改善明显优于对照组（P<0.05）。研究结果提示大承气汤联合西医常规治疗可改善胃肠功能，兴奋胃肠动力，抑制炎症反应，改善脓毒症AGI患者的症状，提高临床疗效。

（下转第102页）

摘要

目的,2,观察大承气汤联合西医常规治疗干预脓毒症伴急性胃肠损伤的临床疗效。,方法,2,将40例脓毒症伴急性胃肠损伤患者随机分为治疗组和对照组，每组20例。对照组予常规基础治疗，治疗组在对照组治疗基础上联合大承气汤治疗。两组疗程均为7d。观察比较SOFA评分、APACHEⅡ评分、AGI评分、腹内压、肠鸣音及血清PCT、IL-6、TNF-α、IL-10水平的变化情况。,结果,2,①治疗前后组内比较，两组SOFA评分、APACHE Ⅱ评分均明显降低（,P,<,0.05）；组间治疗后比较，治疗组SOFA评分、APACHE Ⅱ评分均低于对照组（,P,<,0.05）。②治疗前后组内比较，两组腹内压、AGI评分均明显下降（,P,<,0.05），肠鸣音明显增加（,P,<,0.05）。组间治疗后比较，治疗组腹内压、AGI评分低于对照组，而肠鸣音明显多于对照组（,P,<,0.05）。③治疗前后组内比较，两组PCT、IL-6、TNF-α水平均明显下降（,P,<,0.05），IL-10水平明显升高（,P,<,0.05）。组间治疗后比较，治疗组PCT、IL-6、TNF-α水平低于对照组，而IL-10水平明显高于对照组（,P,<,0.05）。,结论,2,大承气汤联合西医常规治疗脓毒症伴急性胃肠损伤，可有效促进患者胃肠功能的恢复，抑制炎症反应。

Abstract

Objective： To observe the clinical efficacy of Dachengqi Decoction on sepsis with acute gastrointestinal injury.,Methods,2,Forty patients suffering from sepsis with acute gastrointestinal injury were randomly divided into the treatment group and control group， 20 cases in each group. The control group was given routine treatment， and the treatment group was treated with Dachengqi Decoction on the basis of routine treatment. The treatment course of both groups was 7 days. The SOFA score， APACHE Ⅱ score， AGI score， intra-abdominal pressure， bowel sounds， and PCT， IL-6， TNF-α and IL-10 levels in serum were observed and compared.,Results,2,①The SOFA score and APACHE Ⅱ score in the two groups decreased significantly after treatment （,P,<,0.05）. And those scores in the treatment group were lower than those in the control group （,P,<,0.05）. ②After treatment， the intra-abdominal pressure and AGI scores in both groups were significantly decreased （,P,<,0.05）， and the bowel sounds were significantly increased （,P,<,0.05）. The intra-abdominal pressure and AGI scores in the treatment group were lower than those in the control group， and the bowel sounds in the treatment group were significantly more than those in the control group （,P,<,0.05）. ③After treatment， the levels of PCT， IL-6 and TNF-α in serum in both groups decreased significantly （,P,<,0.05）， and the level of IL-10 increased significantly （,P,<,0.05）. The levels of PCT， IL-6 and TNF-α in the treatment group were significantly lower than those in the control group （,P,<,0.05）， and the levels of IL-10 in the treatment group were significantly higher than those in the control group （,P,<,0.05）.,Conclusion,2,Dachengqi Decoction combined with western medicine in the treatment of sepsis with acute gastrointestinal injury can effectively promote the recovery of gastrointestinal function and inhibit inflammatory reaction.

关键词

大承气汤脓毒症急性胃肠损伤临床研究

Keywords

Dachengqi Decoctionsepsisacute gastrointestinal injuryclinical study

references

Views

278

Downloads

CSCD

CNKI Cited

Alert me when the article has been cited

Submit

Tools

Publicity Resources

Clinical study of Dahuang Fuzi Decoction in treatment of acute gastrointestinal injury caused by sepsis

Clinical effect of Yiqi Wenyang Tongmai Formula on patients with chemotherapy induced peripheral neuropathy

Research on intervention mechanism of modified Liangge Powder in sepsis acute lung injury/acute respiratory distress syndrome based on immune regulation of vitamin D

Effects of Yantiao No.II Formula on coagulation function of rats with sepsis

Clinical research progress of external application of Chinese medicine in the treatment of refractory wound

Related Author

No data

Related Institution

Intensive Care Unit， Sixth People’s Hospital Affiliated to Shanghai Jiaotong University

Emergency Department，Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine

Department of Oncology， Shanghai Seventh People’s Hospital Affiliated to Shanghai University of Traditional Chinese Medicine

Department of Traditional Chinese Medicine， Shanghai Ninth People’s Hospital， Shanghai Jiao Tong University School of Medicine

The Second Department of Oncology， Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine

⁰