CAJ | 학술논문

目的：探讨中医辨证治疗急性肺损伤/急性呼吸窘迫综合征（ALI/ARDS）机械通气患者胃肠功能障碍的临床疗效。方法采用前瞻性随机对照临床研究，选择天津市第一中心医院重症监护病房（ICU） ALI/ARDS机械通气患者96例，按随机数字表法分为中西医结合组和常规治疗组，每组48例。常规治疗组给予常规治疗；中西医结合组在常规治疗基础上给予大承气汤为主方的中医辨证治疗〔组成：黄芪15 g，党参15 g，当归10 g，厚朴10 g，陈皮10 g，青皮10 g，桃仁10 g，白芍12 g，赤芍12 g，枳实6 g，蒲公英30 g，炒莱菔子30 g，谷芽20 g，麦芽20 g，芒硝9 g（冲化），大黄10 g（后下）〕，每日1剂，共28 d。比较两组患者治疗前及治疗后3、6、18 d腹内压（IAP）、胃肠疾病中医症状评分及胃肠功能障碍发生率。结果两组患者治疗前IAP、胃肠疾病中医症状评分比较差异均无统计学意义（均P＞0.05），但随治疗时间延长逐渐降低；两组治疗后IAP与胃肠疾病中医症状评分均较治疗前降低，治疗后18 d最低，且以中西医结合组的降低更显著〔IAP（mmHg，1 mmHg＝0.133 kPa）：0.91±0.69比2.08±0.92，胃肠疾病中医症状评分（分）：48.33±10.41比88.33±20.21，均P＜0.05〕；中西医结合组患者应激性溃疡出血、中毒性肠麻痹、腹胀、腹泻等胃肠功能障碍发生率均低于常规治疗组〔应激性溃疡出血：16.7%（8/48）比39.6%（19/48），中毒性肠麻痹：16.7%（8/48）比43.8%（21/48），腹胀：10.4%（5/48）比37.5%（18/48），腹泻：6.3%（3/48）比33.3%（16/48），均P＜0.05〕。结论大承气汤辨证疗法可有效减少ALI/ARDS机械通气患者胃肠功能障碍的发生。
목적：탐토중의변증치료급성폐손상/급성호흡군박종합정（ALI/ARDS）궤계통기환자위장공능장애적림상료효。방법채용전첨성수궤대조림상연구，선택천진시제일중심의원중증감호병방（ICU） ALI/ARDS궤계통기환자96례，안수궤수자표법분위중서의결합조화상규치료조，매조48례。상규치료조급여상규치료；중서의결합조재상규치료기출상급여대승기탕위주방적중의변증치료〔조성：황기15 g，당삼15 g，당귀10 g，후박10 g，진피10 g，청피10 g，도인10 g，백작12 g，적작12 g，지실6 g，포공영30 g，초래복자30 g，곡아20 g，맥아20 g，망초9 g（충화），대황10 g（후하）〕，매일1제，공28 d。비교량조환자치료전급치료후3、6、18 d복내압（IAP）、위장질병중의증상평분급위장공능장애발생솔。결과량조환자치료전IAP、위장질병중의증상평분비교차이균무통계학의의（균P＞0.05），단수치료시간연장축점강저；량조치료후IAP여위장질병중의증상평분균교치료전강저，치료후18 d최저，차이중서의결합조적강저경현저〔IAP（mmHg，1 mmHg＝0.133 kPa）：0.91±0.69비2.08±0.92，위장질병중의증상평분（분）：48.33±10.41비88.33±20.21，균P＜0.05〕；중서의결합조환자응격성궤양출혈、중독성장마비、복창、복사등위장공능장애발생솔균저우상규치료조〔응격성궤양출혈：16.7%（8/48）비39.6%（19/48），중독성장마비：16.7%（8/48）비43.8%（21/48），복창：10.4%（5/48）비37.5%（18/48），복사：6.3%（3/48）비33.3%（16/48），균P＜0.05〕。결론대승기탕변증요법가유효감소ALI/ARDS궤계통기환자위장공능장애적발생。
Objective To explore the clinical effect of traditional Chinese medicine (TCM) dialectical therapy for treatment of gastrointestinal dysfunction in patients with acute lung injury / acute respiratory distress syndrome(ALI/ARDS)undergoing mechanical ventilation. Methods A prospective,randomized controlled trial was conducted. Ninety-six ALI/ARDS patients admitted in intensive care unit(ICU)and treated with mechanical ventilation in Tianjin First Central Hospital were chosen and randomly divided into traditional Chinese medicine(TCM) group and conventional therapy group using a random number table,48 patients in each group. Conventional therapy alone was used in conventional therapy group,and TCM therapy of primarily using Dachengqi decoction combined with conventional therapy was applied in TCM group〔Dachengqi decoction was composed of mongolian milkvetch root 15 g, pilose asiabell toot 15 g,Chinese angelica 10 g,officinal magnolia bark 10 g,tangerine peel 10 g,immature tangerine fruit 10 g,peach seed 10 g,white peony root 12 g,red peony root 12 g,immature bitter orange 6 g,mongolian dandelion herb 30 g,radish seed(stir-fried)30 g,foxtail millet sprout 20 g,barley sprout 20 g,glauber salt 9 g (with water),rhubarb 10 g(added in water at last)〕,one dose orally taken daily for 28 days. The intra-abdominal pressure(IAP),gastrointestinal diseases in TCM symptom score and the incidence of gastrointestinal dysfunction were compared between the two groups before treatment and on the 3rd,6th and 8th day after treatment. Results There were no statistical significant differences in IAP and TCM symptom scores between the two groups before treatment (both P>0.05),but after treatment with the prolongation of therapeutic time the IAP and TCM symptom scores were decreased gradually compared with those before treatment,having reached the valley value on the 18th day and the changes in TCM group were more remarkable〔IAP(mmHg,1 mmHg=0.133 kPa):0.91±0.69 vs. 2.08±0.92, TCM symptom score:48.33±10.41 vs. 88.33±20.21,both P<0.05〕. In the TCM group,the incidences of the untoward symptoms and signs of gastrointestinal dysfunction such as bleeding of stress ulcer,toxic intestinal paralysis, abdominal distension,diarrhea and so on were lower than those in conventional therapy group〔stress ulcer bleeding:16.7%(8/48)vs. 39.6%(19/48),toxic intestinal paralysis:16.7%(8/48)vs. 43.8%(21/48),abdominal distension:10.4%(5/48)vs. 37.5%(18/48),diarrhea:6.3%(3/48)vs. 33.3%(16/48),all P<0.05〕. Conclusion Addition of TCM Dachengqi decoction on conventional treatment can effectively lower the incidence of gastrointestinal dysfunction in treatment of patients with ALI/ARDS undergoing mechanical ventilation.