Clinical Study on the Treatment of Severe Pneumonia Combined with Acute Gastrointestinal Injury by Supplemented Xuanbai Chengqi Decoction
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摘要:
目的 评价加味宣白承气汤治疗重症肺炎合并急性胃肠损伤(Acute gastrointestinal injury, AGI)的临床疗效。 方法 采用随机对照研究, 将76例重症肺炎合并AGI住院患者随机分成对照组和治疗组各38例, 对照组给予西医常规治疗, 包括积极治疗原发病和合并疾病、尽早给予肠内营养、胃肠动力药等, 治疗组在对照组治疗基础上联用加味宣白承气汤鼻饲给药, 疗程均为7 d。治疗前及治疗7 d评估2组患者临床疗效; 治疗前及治疗3 d、治疗7 d检测胃肠功能指标变化[胃肠功能衰竭(Gastrointestinal failure，GIF)评分、肠内营养日喂养量和腹内压力(Intraabdominal pressure，IAP)]，ELISA法检测患者血清胃动素(Motilin，MTL)水平及二胺氧化酶(Diamine oxidase，DAO)活性; 记录患者住院期间机械通气时间、ICU住院时间及28 d病死率。 结果 治疗后, 治疗组总有效率优于对照组(P < 0.05);治疗组GIF、肠内营养日喂养量、IAP显著改善(P < 0.01), 治疗组治疗7 d GIF、肠内营养日喂养量、IAP改善优于对照组(P < 0.05);治疗3 d、治疗7 d 2组患者血清MTL水平、DAO活性均显著升高(P < 0.01), 治疗组治疗3 d、治疗7 d MTL水平显著高于对照组(P < 0.05，P < 0.01);治疗组机械通气时间、ICU住院天数均明显少于对照组(P < 0.01);2组患者28 d病死率比较无显著性差异(P>0.05)。 结论 加味宣白承气汤能有效改善重症肺炎合并AGI患者的胃肠功能, 缩短ICU住院时间, 促进患者康复。 Abstract:OBJECTIVE To evaluate the clinical efficacy of Supplemented Xuanbai Chengqi Decoction in the treatment of severe pneumonia combined with acute gastrointestinal injury (AGI). METHODS In a randomized controlled study, 76 patients with severe pneumonia combined with AGI were randomly divided into the control group and the treatment group, 38 patients in each group. The control group was given conventional western medical treatment, including active treatment of protopathy and complicating disease. In addition, early administration of enteral nutrition and gastrointestinal excitomotor were given in the group. The patients in the treatment group were treated with supplemented Xuanbai Chengqi Decoction intranasally on top of the treatments in the control group. The course of treatment was 7 days and the clinical efficacy of the two groups was evaluated before treatment and 7 days after treatment. The changes of gastrointestinal function indexes [Gastrointestinal failure (GIF) score, enteral nutrition daily feeding amount and intraabdominal pressure (IAP)] were measured before treatment, 3 and 7 days after the treatment separately. Motilin (MTL) levels and diamine oxidase (DAO) activity were measured by ELISA. Besides, the duration of mechanical ventilation, ICU stay length and 28-d mortality rate were recorded. RESULTS After treatment, the total effective rate of the treatment group was better than that of the control group (P < 0.05). The GIF, enteral nutrition daily feeding amount and IAP of the treatment group significantly improved (P < 0.01). However, the GIF, enteral nutrition daily feeding amount and IAP of the treatment group showed better Results than those of the control group after 7 days of treatment (P < 0.05). In addition, the serum MTL level and DAO activity were significantly increased in both groups after 3 and 7 days of treatment (P < 0.01). However, the MTL levels in the treatment group were significantly higher than those in the control group after 3 and 7 days of treatment (P < 0.05, P < 0.01). The duration of mechanical ventilation and ICU stay length in the treatment group were significantly less than those in the control group (P < 0.01). Besides, there was no significant difference in the 28-d mortality rate between the two groups (P > 0.05). CONCLUSION Supplemented Xuanbai Chengqi Decoction can effectively improve the gastrointestinal function of patients with severe pneumonia combined with AGI, shorten the ICU stay length, and promote the recovery of patients. -
表 1 2组患者基线资料比较(x±s, n=38)
Table 1. Comparison of general baseline data between the two groups (x±s, n=38)
组别 男 女 年龄/岁 APACHE Ⅱ 合并疾病 AGI分级 COPD 肺纤维化 脑血管病 冠心病 Ⅰ级 Ⅱ级 Ⅲ级 治疗组 29 9 70.82±1.60 25.97±0.86 12 7 19 10 7 21 10 对照组 28 10 71.87±1.98 26.75±0.95 13 6 18 13 8 20 10 
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表 2 2组患者临床疗效比较(n=38)
Table 2. Comparison of clinical efficacy between the two groups (n=38)
组别 显效 有效 无效 总有效率/% 治疗组 23 10 5 86.84* 对照组 13 11 14 63.16 注: 2组比较, χ2=7.098, *P < 0.05。
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表 3 2组患者治疗前后胃肠功能指标变化比较(x±s, n=38)
Table 3. Comparison of gastrointestinal function indexes between the two groups before and after treatment (x±s, n=38)
组别 时间 GIF 肠内营养日喂养量/(mL·d-1) IAP/kPa 治疗组 治疗前 2.11±0.69 351.97±176.18 1.72±0.48 治疗3 d 1.63±1.02** 540.92±362.23** 1.22±0.57** 治疗7 d 0.76±1.24**△△# 980.39±473.46**△△# 0.85±0.57**△△# 对照组 治疗前 2.08±0.71 350.13±172.52 1.71±0.52 治疗3 d 2.03±1.05 418.82±325.79 1.49±0.66* 治疗7 d 1.71±1.66 648.95±601.21**△△ 1.35±0.93*△ 注: 行重复测量方差分析, F(GIF)组间=4.131, P < 0.05;F(GIF)时间=27.516, P < 0.01;F(GIF)交互=8.549, P < 0.01；F(肠内营养日喂养量)组间=4.603, P < 0.05;F(肠内营养日喂养量)时间=55.600, P < 0.01;F(肠内营养日喂养量)交互=6.752, P < 0.01；F(IAP)组间=4.072, P < 0.05;F(IAP)时间=43.074, P < 0.01;F(IAP)交互=7.610, P < 0.01；与治疗前比较, *P < 0.05, * *P < 0.01;与治疗3 d比较, △P < 0.05, △△P < 0.01；与对照组比较, #P < 0.05。
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表 4 2组患者治疗前后血清MTL、DAO水平比较(x±s, n=38)
Table 4. Comparison of serum MTL and DAO between the two groups before and after treatment (x±s, n=38)
组别 时间 MTL/(ng·L-1) DAO/(U·L-1) 治疗组 治疗前 220.09±14.39 135.00±23.30 治疗3 d 271.93±33.47**## 107.10±36.80** 治疗7 d 328.05±46.36**△△# 58.47±44.20**△△ 对照组 治疗前 219.52±17.47 135.29±22.42 治疗3 d 247.93±43.20** 114.43±34.40** 治疗7 d 282.16±77.81**△△ 87.86±59.00**△△ 注: 行重复测量方差分析, F(MTL)组间=8.295, P < 0.01;F(MTL)时间=134.304, P < 0.01;F(MTL)交互=9.471, P < 0.01；F(DAO)组间=2.646, P>0.05;F(DAO)时间=120.505, P < 0.01;F(DAO)交互=7.124, P < 0.01；与治疗前比较, * *P < 0.01;与治疗3 d比较, △△P < 0.01；与对照组比较, #P < 0.05, ##P < 0.01。
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表 5 2组患者机械通气时间、ICU住院时间及28 d病死率比较(x±s, n=38)
Table 5. Comparison of mechanical ventilation time, ICU stay time and 28-d mortality between the two groups (x±s, n=38)
组别 机械通气时间/d ICU住院天数/d 28 d病死率/% 治疗组 10.42±5.23** 13.08±6.70** 23.68 对照组 15.21±7.60 17.95±8.47 36.84 注: 2组比较, χ28天病死率2=1.559；**P < 0.01。
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