CAJ | 학술논문

目的：观察冰冻紫地合剂灌胃救治急性上消化道出血的临床疗效。方法收集2011年1月至2013年8月广州中医药大学第一附属医院急诊科普内病区急性上消化道出血（upper gastrointestinal bleeding，UGIB）患者183例，按随机数字表法将患者随机分为两组，治疗组92例采用冰冻紫地合剂胃内灌注治疗；对照组91例采用冰盐水配合去甲肾上腺素胃内灌注治疗。分别于治疗前后观察两组患者的血压、血红蛋白、血尿素氮、脉搏及黑便等主要症状体征的变化，并评价治疗前后焦虑、抑郁、恐惧等不良情绪。结果①临床疗效比较：治疗后治疗组总有效率为96.7%（89/92）、对照组为85.7%（78/91），两组总有效率比较，差异有统计学意义（χ2＝2.943，P＜0.05）。②症状消失时间比较：治疗后治疗组呕血、黑便及隐血试验阴转时间均明显短于对照组（t值分别为6.628、14.052、21.706，P＜0.05或0.01）。③症状体征比较：治疗后治疗组收缩压、心率、血红蛋白、血尿素氮[(114.3±12.1)mmHg、(78.6±11.4)次/min、(98.1±10.5)g/L、(5.9±1.1)mmol/L]均较对照组治疗后[(106.3±11.2)mmHg、(88.7±12.1)次/min、(88.2±11.7)g/L、(6.9±1.4)mmol/L]明显改善（P＜0.05）。治疗后两组体温均升至正常，但组内组间比较差异均无统计学意义（P＞0.05）。④焦虑、抑郁及正负性情绪变化比较：治疗后治疗组焦虑、抑郁及正负性情绪[分别为(42.5±9.4)分、(41.6±9.7)分、(26.3±5.4)分]均较对照组治疗后[分别为(51.2±10.1)分、(50.4±11.5)分、(30.4±6.9)分]明显改善（P＜0.05）。结论冰冻紫地合剂胃内灌注治疗 UGIB，可升高患者收缩压、降低心率、升高血红蛋白，降低血尿素氮水平，缓解机体应激反应，减轻相关症状。
목적：관찰빙동자지합제관위구치급성상소화도출혈적림상료효。방법수집2011년1월지2013년8월엄주중의약대학제일부속의원급진과보내병구급성상소화도출혈（upper gastrointestinal bleeding，UGIB）환자183례，안수궤수자표법장환자수궤분위량조，치료조92례채용빙동자지합제위내관주치료；대조조91례채용빙염수배합거갑신상선소위내관주치료。분별우치료전후관찰량조환자적혈압、혈홍단백、혈뇨소담、맥박급흑편등주요증상체정적변화，병평개치료전후초필、억욱、공구등불량정서。결과①림상료효비교：치료후치료조총유효솔위96.7%（89/92）、대조조위85.7%（78/91），량조총유효솔비교，차이유통계학의의（χ2＝2.943，P＜0.05）。②증상소실시간비교：치료후치료조구혈、흑편급은혈시험음전시간균명현단우대조조（t치분별위6.628、14.052、21.706，P＜0.05혹0.01）。③증상체정비교：치료후치료조수축압、심솔、혈홍단백、혈뇨소담[(114.3±12.1)mmHg、(78.6±11.4)차/min、(98.1±10.5)g/L、(5.9±1.1)mmol/L]균교대조조치료후[(106.3±11.2)mmHg、(88.7±12.1)차/min、(88.2±11.7)g/L、(6.9±1.4)mmol/L]명현개선（P＜0.05）。치료후량조체온균승지정상，단조내조간비교차이균무통계학의의（P＞0.05）。④초필、억욱급정부성정서변화비교：치료후치료조초필、억욱급정부성정서[분별위(42.5±9.4)분、(41.6±9.7)분、(26.3±5.4)분]균교대조조치료후[분별위(51.2±10.1)분、(50.4±11.5)분、(30.4±6.9)분]명현개선（P＜0.05）。결론빙동자지합제위내관주치료 UGIB，가승고환자수축압、강저심솔、승고혈홍단백，강저혈뇨소담수평，완해궤체응격반응，감경상관증상。
Objective To observe the clinical effects of treating acute upper gastrointestinal bleeding(AUGIB) with freezing Zidi mixture lavage. Method 183 UGIB patients from the First Affiliated Hospital to Guanzhou University of TCM in August 2013 were randomly recruited into a control group with 91cases and a treatment group with 92 cases. The treatment group was treated with intragastric administration of freezing Zidi mixture, while the control group was treated with intragastric administration of cryohydrate and norepinephrine. The changes of clinical effects, blood pressure, hemoglobin, blood urea nitrogen, pulse and dark stool were observed and the bad emotions as anxiety, depression and fear were evaluated. Results ① On therapeutic effect, the total effective rate was 96.7% and 85.7% in the treatment group and the control group respectively, with statistical difference(χ2=2.943,P<0.05). ② On the time of symptom disappearance:the disappearing time of vomiting, dark stools and occult blood test in the treatment group was obviously shorter than the control group after the treatment(t=6.628、14.052、21.706,P<0.05 or 0.01). ③ On body symptom changes: after the treatment, the systolic pressure, heart rate, hemoglobin, and blood urea nitrogen [(114.3±12.1)mmHg,(78.6±11.4)/min,(98.1±10.5)g/L,(5.9±1.1)mmol/L] in the treatment group were all obviously improved than those [(106.3±11.2)mmHg, (88.7±12.1)/min,(88.2±11.7)g/L,(6.9±1.4)mmol/L] in the control group;body temperature returned to normal in both groups, and there was no statistical difference score was either in or between groups(P>0.05). ④ On changes of anxiety, depression and fear:the treatment group [the(42.5±9.4), (41.6±9.7), (26.3±5.4)for each]was obviously improved after the treatment than the control group[the score was(51.2±10.1),(50.4±11.5),(30.4±6.9)for each],P<0.05. Conclusion Freezing Zidi mixture lavage can obviously elevate systolic pressure, decrease heart rate, enhance hemoglobin, decrease blood urea nitrogen, relieve body stress reaction and other clinical symptoms. Its effects were better than intragastric administration of cryohydrate and norepinephrine in treating AUGIB.