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经皮穴位给药治疗脓毒症肠功能障碍的临床研究

Clinical Reserch on Treatment of Percutaneous Acupoint Drug Delivery on Sepsis Patients with Gastrointestinal Dysfunction

作者: 专业:中医学(专业学位) 导师:李健 年度:2015 学位:硕士  院校: 广州中医药大学

Keywords

Sepsis, Gastrointestinal Dysfunction, HuoXue TiaoChang Stick, XingQi TiaoChang Stick, Acupoint Shenque

        目的:本研究通过随机、双盲、安慰剂对照的方法来观察行气调肠贴及活血调肠贴外敷神阙穴治疗脓毒症肠功能障碍患者的临床疗效,探讨经皮穴位给药治疗脓毒症肠功能障碍的有效性,挖掘经皮穴位给药的有效药物。方法:制作行气调肠贴、活血调肠贴及安慰剂贴;脓毒症肠功能障碍患者被随机分成行气组、活血组及对照组。行气组给予常规西医治疗,以行气调肠贴外敷神阙穴;活血组给予常规西医治疗,并以活血调肠贴外敷神阙穴;对照组给予常规西医治疗加安慰剂贴外敷神阙穴;三组疗程均为五天,每日一贴,每次12小时。观察治疗前、治疗后第三天、第五天的肠鸣音次数、腹腔压力大小、胃潴留、.腹围大小、肠功能障碍评分、胃肠疾病中医症候评分、炎症指标、血乳酸水平、APACHE Ⅱ评分、SIRS评分、MODS评分、SOFA评分,比较三组患者的入住ICU天数及28天病死率。运用SPSS 18.0软件对数据进行统计学分析及处理。结果:三组治疗后肠鸣音次数均有增加,活血组、行气组肠鸣音次数均多于对照组(P<0.05),且活血组肠鸣音次数多于行气组(P<0.05)。三组治疗后腹腔压力、胃潴留率、腹围大小、肠功能障碍评分、胃肠疾病中医证候评分、白细胞计数、中性粒细胞百分比、CRP, PCT、LAC、APACHE Ⅱ评分、MODS评分、SOFA评分均有下降,与治疗前比较差异均有统计学意义(P<0.05)。活血组、行气组28天病死率、腹腔压力、肠功能障碍评分、胃肠疾病中医证候评分、中性粒细胞百分比、PCT、LAC、APACHE Ⅱ评分、MODS评分、SOFA评分均低于对照组(P<0.05)。活血组腹腔压力、腹围大小、胃肠疾病中医证候评分、白细胞计数、中性粒细胞百分比、CRP、LAC、MODS评分、SOFA评分均低于行气组(P<0.05)。结论:活血调肠贴和行气调肠贴均可改善患者肠鸣音、肠功能障碍评分、腹腔压力、胃肠道中医症候评分、炎症指标等,降低病死率,改善预后,提示经皮穴位给药可减轻脓毒症肠功能障碍患者的病情严重程度及炎症反应,可通过改善脓毒症患者的肠功能障碍达到治疗脓毒症的作用,初步研究表明吴茱萸、厚朴、川芎组成的行气调肠贴及活血调肠贴为经皮穴位给药治疗脓毒症肠功能障碍的有效药物,而且按照行气活血法组成的活血调肠贴可能更为有效。
    ObjectiveThe study was observe the clinical curative effect of HuoXue Tiao-Chang Stick and XingQi TiaoChang Stick Sticking Shen Que(CV-8) in sepsis with gastrointestinal Dysfunction. Evaluate the effectiveness of point ap-plication in improving gastrointestinal function for sepsis. Explore the effectiveness and the effective drug of treating sepsis by acupoint stick-ing therapy improving gastrointestinal dysfunction.MethodsMake HuoXue TiaoChang stick,XingQi TiaoChang stick and placebo stick. Ninety patients with sepsis has gastrointestinal dysfunction were random-ly divided into HX group, XQ group and control group. In XQ group, patients was given XingQi TiaoChang stick at Shen Que(CV-8) based on conventional western medicine treatment. In the HX group, patients was given HuoXue TiaoChang stick at Shen Que(CV-8) based on conventional western medicine treatment. In the control group, patients was given the patch of placebo Sticking Shen Que(CV-8) based on conventional western medicine treatment. Recorded the inflammatory function, bowel sounds, the abdominal pressure, the gastric retention, the abdomen circumference, dysfunction score, the TCM symptom score of Gastrointestinal disease, in patients with ICU hospi-talization, SIRS score, MODS score, SOFA score and APACHE II score,28-day case fatality.The data would be analyzed by SPSS 18.0.ResultsThe times of bowel sounds of three groups increase after treatment. There was a significicant difference among the times of bowel sounds of three groups. There was a significicant difference in the times of bowel sounds between the HX group and the XQ group.There was a significicant difference among the abdominal pressure, the gastric retention, the abdomen circumference, dysfunction score, the inflammatory function, LAC, SIRS score, MODS score, SOFA score and APACHE Ⅱ score before and-after treatment.Compared to control group, there was a significicant difference among 28-day case fatality, the abdominal pressure, dysfunction score, the TCM symptom score of Gastrointestinal disease, NEUT%, PCT, LAC, MODS score, SOFA score and APACHE II score in HX group and XQ group.There was a significicant difference among the abdominal pressure, the abdomen circumference, the TCM symptom score of Gastrointestinal di-sease, WBC, NEUT%, LAC, MODS score, SOFA score between HX group and XQ group.ConclusionHuoXue TiaoChang stick and XingQi TiaoChang stick can achieve to im-prove the treatment of bowel dysfunction in patients with sepsis by acu-point sticking therapy.HuoXue TiaoChang stick, XingQi TiaoChang stick can improve intestinal dysfunction in patients with sepsis severity and in-flammation, reduce 28-day case fatality and improve prognosis. After treat-ment, the bowel sounds, the abdominal pressure, dysfunction score, the TCM symptom score of Gastrointestinal disease of HX group and XQ group have significantly improved, and positively correlated with the degree of improvement in the condition was, suggesting that transcutaneous to drug treatment of sepsis can be achieved by improving the intestinal dysfunc-tion in patients with sepsis effect, indicating Evodia, Magnolia, Chuan-xiong were the effective drugs, and promoting blood circulation of qi and blood transfer method in accordance with the patch of promoting blood Circulation to adjust intestinal function composition may be more effect-tive.
        

经皮穴位给药治疗脓毒症肠功能障碍的临床研究

摘要3-4
Abstract4-5
引言8-10
第一章 文献研究10-20
    1.1 脓毒症肠功能障碍现代医学研究进展10-16
        1.1.1 流行病学与发病机制10
        1.1.2 脓毒症与肠功能障碍10-12
        1.1.3 诊断进展12-13
        1.1.4 治疗进展13-16
    1.2 脓毒症肠功能障碍的中医学研究进展16-20
        1.2.1 脓毒症的病因病机16
        1.2.2 脓毒症肠功能障碍的病因病机16-17
        1.2.3 脓毒症的治法17
        1.2.4 脓毒症肠功能障碍的中医治疗进展17-20
第二章 临床研究20-38
    2.1 对象与方法20-23
        2.1.1 研究对象20
        2.1.2 研究方法20-22
        2.1.3 研究内容22
        2.1.4 统计方法22-23
    2.2 结果23-30
        2.2.1 基线特征比较23
        2.2.2 入住ICU天数、28天病死率比较23
        2.2.3 APACHE Ⅱ评分比较23-24
        2.2.4 SIRS评分比较24
        2.2.5 MODS评分比较24-25
        2.2.6 SOFA评分比较25
        2.2.7 血乳酸水平比较25-26
        2.2.8 炎症反应指标比较26-27
        2.2.9 胃肠疾病中医证候评分比较27-28
        2.2.10 肠功能障碍评分比较28
        2.2.11 肠鸣音次数比较28-29
        2.2.12 腹腔压力比较29
        2.2.13 胃潴留情况比较29-30
        2.2.14 腹围大小比较30
    2.3 讨论30-38
        2.3.1 调肠贴可减轻脓毒症患者病情严重程度及改善预后30-31
        2.3.2 调肠贴可减轻脓毒症患者的炎症反应31-33
        2.3.3 调肠贴改善脓毒症患者的肠功能33-35
        2.3.4 调肠贴治疗机制的理论探讨35-36
        2.3.5 问题及展望36-38
结语38-40
参考文献40-46
附录46-66
致谢66
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