调胃承气汤对脓毒症胃肠损伤患者胃肠功能及免疫状态的影响

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摘要目的 观察调胃承气汤对脓毒症胃肠损伤患者胃肠功能及免疫状态的影响。 方法 选取2017年10月—2019年5月于广州中医药大学第一附属医院重症医学科收治的脓毒症胃肠损伤患者56例，按就诊顺序进行编号，采用奇偶数法将其随机分为对照组和治疗组调胃承气汤吃多久有效，各28例。对照组予西医常规治疗，治疗组在对照组的基础上加用调胃承气汤，１剂/次，２次/d，口服或鼻饲，7 d为1个疗程。观察两组的中医证候疗效、肠鸣音、腹围、腹内压、病情危重程度评分、白细胞计数（WBC）、C反应蛋白（CRP）、降钙素原（PCT）、人白细胞DR抗原（HLA-DR）、淋巴细胞总数、CD3+、CD4+、CD8+、CD4+/CD8+、自然杀伤（NK）细胞及并发症发生情况。 结果 治疗组的总有效率高于对照组（P ＜ 0.05）。治疗后，两组的肠鸣音多于治疗前，腹围短于治疗前，腹内压低于治疗前，且治疗组的肠鸣音多于对照组，腹围短于对照组，腹内压低于对照组调胃承气汤吃多久有效，差异有统计学意义（P ＜ 0.05）。治疗后，两组的序贯器官衰竭估计评分及急性生理与慢性健康状况Ⅱ评分均低于治疗前，且治疗组低于对照组，差异有统计学意义（P ＜ 0.05）。两组治疗后的WBC、CRP及PCT水平均低于治疗前，且治疗组低于对照组，差异有统计学意义（P ＜ 0.05）。治疗后，两组HLA-DR、淋巴细胞总数、CD3+、CD4+、CD8+、CD4+/CD8+及NK细胞均高于治疗前，且治疗组高于对照组，差异有统计学意义（P ＜ 0.05）。两组均未见明显毒副作用。 结论 调胃承气汤结合西医治疗能有效改善脓毒症胃肠损伤患者的胃肠功能，良性调节患者的免疫状态，疗效优于单纯西医治疗，且安全无毒副作用。

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基金资助:广东省科学技术厅科技计划项目（）。