CAJ | 학술논문

目的：观察健脾和胃法中药汤剂对危重症患者胃肠功能障碍的防治作用及对血乳酸水平的影响。方法：①选择2007年9月-2014年7月中山市中医院ICU收治的危重症患者120例，根据有无胃肠道功能不全分为阴性组和阳性组，再随机分为治疗组和对照组，每组30例。②治疗组：给予自拟健脾和胃汤治疗，药物组成：生黄芪15g，白术10g，茯苓15g，白芍15g，当归10g，丹参15g，生大黄（后下）10g，木香10g，鸡内金10g，莱菔子10g，生麦芽15g，苏叶10g，黄连5g，吴茱萸5g，甘草5g。该中药由本院中药房提供。2剂/d，水煎2次，取汁170mL/剂，分2次温服或鼻饲，5d为一个疗程。不足5d转出ICU或自动出院、死亡者，以转出前或自动出院、死亡前收集观察指标。③对照组：应用制酸剂及胃肠黏膜保护剂防治胃黏膜损伤。注意肠道菌群的变化，应用微生物制剂维持肠道正常菌群的比例，肠道菌群失调时可予口服万古霉素。从患者入ICU开始，以患者病情好转转出ICU、死亡或自动出院为治疗终点，及早配合鼻饲白粥水或胃肠道内营养（能全力）。④观察胃肠功能的改善情况、治疗前后各组患者血清乳酸的变化。⑤计量数据用均数±标准差（ x ±s）表示，组间采用t检验；计量资料用率表示，率的差别使用卡方检验，所得数据输入SPSS统计包，进行统计学分析，P<0.05为差异有显著的统计学意义。结果：治疗组胃肠功能改善情况有明显好转（P<0.05），治疗前后乳酸水平有非常显著的下降（P<0.01），治疗组乳酸水平改善情况非常显著（P<0.01）。结论：健脾和胃法对危重症患者胃肠功能障碍具有防治作用，并能降低血乳酸水平。
목적：관찰건비화위법중약탕제대위중증환자위장공능장애적방치작용급대혈유산수평적영향。방법：①선택2007년9월-2014년7월중산시중의원ICU수치적위중증환자120례，근거유무위장도공능불전분위음성조화양성조，재수궤분위치료조화대조조，매조30례。②치료조：급여자의건비화위탕치료，약물조성：생황기15g，백술10g，복령15g，백작15g，당귀10g，단삼15g，생대황（후하）10g，목향10g，계내금10g，래복자10g，생맥아15g，소협10g，황련5g，오수유5g，감초5g。해중약유본원중약방제공。2제/d，수전2차，취즙170mL/제，분2차온복혹비사，5d위일개료정。불족5d전출ICU혹자동출원、사망자，이전출전혹자동출원、사망전수집관찰지표。③대조조：응용제산제급위장점막보호제방치위점막손상。주의장도균군적변화，응용미생물제제유지장도정상균군적비례，장도균군실조시가여구복만고매소。종환자입ICU개시，이환자병정호전전출ICU、사망혹자동출원위치료종점，급조배합비사백죽수혹위장도내영양（능전력）。④관찰위장공능적개선정황、치료전후각조환자혈청유산적변화。⑤계량수거용균수±표준차（ x ±s）표시，조간채용t검험；계량자료용솔표시，솔적차별사용잡방검험，소득수거수입SPSS통계포，진행통계학분석，P<0.05위차이유현저적통계학의의。결과：치료조위장공능개선정황유명현호전（P<0.05），치료전후유산수평유비상현저적하강（P<0.01），치료조유산수평개선정황비상현저（P<0.01）。결론：건비화위법대위중증환자위장공능장애구유방치작용，병능강저혈유산수평。
Objective:The therapeutic effect of spleen and Stomach decoction ongastrointestinal dysfunction in critically ill patients and the influence on blood lactic acid level. Methods: ①The choice of 120 critically ill patients in Septamber 2007 to July 2014 ICU treated patients in Zhongshan Hospital of Traditional Chinese Medicine, has no gastrointestinal dysfunction were divided into negative group and positive group, and then were randomly divided into the treatment group and the control group, 30 cases in each group. ②The treatment group was given with spleen and stomach soup treatment. Drugs: Astragalus 15g, Atractylodes 10g, Poria cocos 15g, White Peony root 15 g, Angelica10g, Salvia15g, Rhubarb(later) 10g, Costas 10g, Chicken’s gizzard skin 10g, Radish seed10g, Malt 15g, Sage 10g, Coptis chinensis 5g, Wu Cornus officinalis 5g, Licorice 5g. The Chinese medicine provided by the Institute of medicine room:2 agent/d, water simmer in water 2, each agent take juice 170mL, 2 clothes or nasal feeding, 5d for a course of treatment, lack of 5d roll out ICU or automatic discharge,death, to roll out before or automaticdischarge, death before collecting the observation index. ③Control group:the use of antacids and gastrointestinal mucosal protective agent for prevention and treatment of gastric mucosa injury. Note that the changes of intestinal microflora, the application of microbial preparation to maintain normal intestinal flora proportion,imbalance of intestinal flora can be treated with oral vancomycin. From the beginning of patients in the ICU, to the patient’s condition improves ICU roll out, death or automatic discharge for the end of treatment, early nasogastric feeding plain water or enteral nutrition (to). ④The changes of serum lactic acid in patients before and afterimprovement, observation and treatment of gastrointestinal function. ⑤Mean standard deviation with the measurement data ( x ± s ) said that the test using group;measurement data with the rate indicated that differences in the rate of chi square test, the data input of SPSS statistical package for statistical analysis, P<0.05, as the differencehad statistical significance. Results: The treatment group of gastrointestinal function improvement hasimproved significantly (P<0.05), lactate levels before and after treatment decreased very significantly (P<0.01), the treatment group to improve the situation very significant levels of lactic acid (P<0.01). Conclusion: The spleen and stomach method has a role in the prevention and treatment of gastrointestinal dysfunction in critically ill patients, and can reduce the level of blood lactic acid.