通腑颗粒辅助治疗多器官功能障碍综合征患者肠功能障碍的随机对照观察

作者	单位
陈曦	首都医科大学附属北京友谊医院重症医学科
李昂	北京医院急诊科
张淑文	北京医院急诊科
段美丽	北京医院急诊科

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中文摘要:

目的观察腹腔内高压与肠功能障碍的相互影响以及通腑颗粒对多器官功能障碍综合征(MODS)患者腹内高压的作用。方法采用随机双盲对照临床观察方法,将本院中心重症监护病房(ICU)2007年8月—2008年1月收治的60例患者。通过掷硬币的方法将患者分为A、B组(一组为通腑颗粒治疗组,另一组为安慰剂组)。两组除给予经典西药治疗外,给予相应颗粒剂冲服,每天3次,每次1剂,口服或胃管注入。两组用药时间均为7天。于入选后当天、给药后第3、7天或死亡前,分别观察腹胀、排便情况及肠鸣音;测量腹围、腹内压,监测大便潜血情况,并进行胃肠功能评分及急性生理功能和慢性健康评分Ⅱ(APACHEⅡ)评分,记录患者28天转归情况。待完成60例病例观察后由试验前设立的揭盲人揭晓:A组为通腑颗粒治疗组,B组为安慰剂组。结果与B组比较,A组可促进MODS患者的肠蠕动,增加肠鸣音;降低腹内压及腹围;减少胃肠道出血的可能性;通腑颗粒可改善MODS患者胃肠功能评分;对改善患者A-PACHEⅡ评分及降低28天病死率起到一定的作用。结论通腑颗粒可促进MODS患者胃肠功能恢复;缓解MODS患者增高的腹腔内压;在一定程度上改善患者的预后。

英文摘要:

Objective To study the mutual influences between intra-abdominal hypertension(IAH) and intestinal dysfunction,and to observe the efficacy of Tongfu Granule(TFG) in treating IAH of patients with multiorgan dysfunction syndrome(MODS) .Methods Adopting randomized,double-blinded,controlled method,60 MODS patients hospitalized in authors’ ICU wards from August 2007 to January 2008 were equally assigned to two groups:A and B,that is,the TFG group and the placebo group,all were treated by conventional treatment but different in the administration of TFG and placebo,respectively 1 bag,three times per day,for 7 days via oral intake or gastric infusion.On the 1st,3rd and 7th day or before death,patients were monitored in terms of symptoms(abdominal distention,defecation,borborygmus,abdominal circumference,intra-abdominal pressure,and occult blood in stool),gastrointestinal function score,APACHE Ⅱ score,and 28-day outcome.The blind outcome was shown up by specified tester by the end of the observation of 60 cases,A is the TFG group,B is the placebo group.Results As compared with the placebo group,intestinal peristalsis and borborygmus were increased,the intra-abdominal pressure and circumference were decreased in the TFG group significantly,which could reduce the possibility of gastrointestinal hemorrhage.Moreover,the gastrointestinal function score and APACHE Ⅱ score were improved and the 28-day mortality was reduced to a certain degree in the TFG group.Conclusion TFG could promote the recovering of gastrointestinal function and relieve the heightened intra-abdominal pressure in patients with MODS so as to improve patients’ prognosis to some extents.

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