【摘要】 目的:观察健脾和胃法中药汤剂对危重症患者胃肠功能障碍的防治作用及对血乳酸水平的影响。方法:1选择2007年9月-2014年7月中山市中医院ICU收治的危重症患者120例,根据有无胃肠道功能不全分为阴性组和阳性组,再随机分为治疗组和对照组,每组30例。2治疗组:给予自拟健脾和胃汤治疗,药物组成:生黄芪15g,白术10g,茯苓15g,白芍15g,当归10g,丹参15g,生大黄(后下)10g,木香10g,鸡内金10g,莱菔子10g,生麦芽15g,苏叶10g,黄连5g,吴茱萸5g,甘草5g。该中药由本院中药房提供。2剂/d,水煎2次,取汁170m L/剂,分2次温服或鼻饲,5d为一个疗程。不足5d转出ICU或自动出院、死亡者,以转出前或自动出院、死亡前收集观察指标。3对照组:应用制酸剂及胃肠黏膜保护剂防治胃黏膜损伤。注意肠道菌群的变化,应用微生物制剂维持肠道正常菌群的比例,肠道菌群失调时可予口服万古霉素。从患者入ICU开始,以患者病情好转转出ICU、死亡或自动出院为治疗终点,及早配合鼻饲白粥水或胃肠道内营养(能全力)。4观察胃肠功能的改善情况、治疗前后各组患者血清乳酸的变化。5计量数据用均数±标准差(sx±)表示,组间采用t检验;计量资料用率表示,率的差别使用卡方检验,所得数据输入SPSS统计包,进行统计学分析,P<0.05为差异有显著的统计学意义。结果:治疗组胃肠功能改善情况有明显好转(P<0.05),治疗前后乳酸水平有非常显著的下降(P<0.01),治疗组乳酸水平改善情况非常显著(P<0.01)。结论:健脾和胃法对危重症患者胃肠功能障碍具有防治作用,并能降低血乳酸水平。更多还原

【Abstract】 Objective: The therapeutic effect of spleen and Stomach decoction ongastrointestinal dysfunction in critically ill patients and the influence on blood lactic acid level. Methods: 1The choice of 120 critically ill patients in Septamber 2007 to July 2014 ICU treated patients in Zhongshan Hospital of Traditional Chinese Medicine, has no gastrointestinal dysfunction were divided into negative group and positive group, and then were randomly divided into the treatment group and the control group, 30 cases in each group. 2The treatment group was given with spleen and stomach soup treatment. Drugs: Astragalus 15 g, Atractylodes 10 g, Poria cocos 15 g, White Peony root 15 g, Angelica10 g, Salvia15 g, Rhubarb(later) 10 g, Costas 10 g, Chicken’s gizzard skin 10 g, Radish seed10 g, Malt 15 g, Sage 10 g, Coptis chinensis 5g, Wu Cornus officinalis 5g, Licorice 5g. The Chinese medicine provided by the Institute of medicine room: 2 agent / d, water simmer in water 2, each agent take juice 170 m L, 2 clothes or nasal feeding, 5d for a course of treatment, lack of 5d roll out ICU or automatic discharge,death, to roll out before or automaticdischarge, death before collecting the observation index. 3Control group: the use of antacids and gastrointestinal mucosal protective agent for prevention and treatment of gastric mucosa injury. Note that the changes of intestinal microflora, the application of microbial preparation to maintain normal intestinal flora proportion,imbalance of intestinal flora can be treated with oral vancomycin. From the beginning of patients in the ICU, to the patient’s condition improves ICU roll out, death or automatic discharge for the end of treatment, early nasogastric feeding plain water or enteral nutrition(to). 4The changes of serum lactic acid in patients before and afterimprovement, observation and treatment of gastrointestinal function. 5Mean standard deviation with the measurement data( sx ±) said that the test using group; measurement data with the rate indicated that differences in the rate of chi square test, the data input of SPSS statistical package for statistical analysis, P<0.05, as the differencehad statistical significance. Results: The treatment group of gastrointestinal function improvement hasimproved significantly(P<0.05), lactate levels before and after treatment decreased very significantly(P<0.01), the treatment group to improve the situation very significant levels of lactic acid(P<0.01). Conclusion: The spleen and stomach method has a role in the prevention and treatment of gastrointestinal dysfunction in critically ill patients, and can reduce the level of blood lactic acid.更多还原