张吉丹 张莉芬 朱袁青

[摘要] 目的 探讨健脾消胀方脐部敷贴治疗脓毒症胃肠功能障碍患者的临床效果。 方法 选取2017年7月～2019年2月于上海中医药大学附属第七人民医院急诊重症监护室住院并明确诊断为脓毒症胃肠功能障碍患者80例，按随机数字表法将其随机分为治疗组（40例）和对照组（40例）。两组均给予基础治疗，治疗组在基础治疗上加用健脾消胀方贴敷神阙穴，疗程7 d。 比较两组序贯性器官功能（SOFA）评分、胃肠功能障碍评分、胃肠功能障碍指标水平及综合疗效。 结果 对照组治疗后SOFA评分高于治疗前，差异有统计学意义（P < 0.05）;治疗组治疗后SOFA評分及腹腔内压均低于治疗前及对照组，腹围短于治疗前及对照组，差异有统计学意义（P < 0.05）。对照组治疗后胃肠功能障碍评分及中医证候积分均低于治疗前，差异有统计学意义（P < 0.05）;治疗组治疗后肠鸣音次数多于治疗前及对照组，胃肠功能障碍评分及中医证候积分均低于治疗前及对照组，差异有统计学意义（P < 0.05）。对照组治疗后血清肠脂肪酸结合蛋白（IFABP）水平低于治疗前，差异有统计学意义（P < 0.05）;治疗组治疗后IFABP及D-乳酸水平均低于治疗前及对照组，差异有统计学意义（P < 0.05）。治疗组中医证候疗效和综合疗效的总有效率均高于对照组，差异有统计学意义（P < 0.05）。治疗组多器官功能障碍综合征发生率低于对照组，差异有统计学意义（P < 0.05）。 结论 健脾消胀方脐部贴敷可改善患者腹胀腹痛、神疲乏力、大便秘结等临床症状，增强胃肠动力，并改善胃肠屏障功能和缺血缺氧状态。

[关键词] 健脾消胀方;脐部敷贴;肠脂肪酸结合蛋白;D-乳酸;脓毒症;胃肠功能障碍

[中图分类号] R256.3          [文献标识码] A          [文章编号] 1673-7210（2020）07（a）-0123-05

[Abstract] Objective To explore clinical effect of Jianpi Xiaozhang Decoction umbilical paste in the treatment of sepsis patients with gastrointestinal dysfunction. Methods Eighty sepsis patients with gastrointestinal dysfunction hospitalized in Emergency Intensive Care Unit of the Seventh People′s Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from July 2017 to February 2019 were selected and randomly divided into treatment group （40 cases） and control group （40 cases） by random number table method. Two groups were given basic treatment. In treatment group， shenque point was pasted with Jianpi Xiaozhang Decoction on the basis of basic treatment， the course was 7 days. The sequential organ function （SOFA） score， gastrointestinal dysfunction score， gastrointestinal dysfunction index level and comprehensive efficacy between two groups were compared. Results The score of SOFA in control group after treatment was higher than that before treatment （P < 0.05）. After treatment， the scores of SOFA and intraperitoneal pressure in treatment group were lower than those before treatment and in control group， and the peritoneum in treatment group was shorter than that before treatment and in control group （P < 0.05）. The scores of gastrointestinal dysfunction and traditional Chinese medicine syndrome in control group after treatment were lower than those before treatment （P < 0.05）. After treatment， the number of bowel sounds in treatment group was more than that before treatment and in control group， and the scores of gastrointestinal dysfunction and traditional Chinese medicine syndrome were lower than those before treatment and in control group （P < 0.05）. The level of serum intestinal fatty acid binding protein （IFABP） in control group after treatment was lower than that before treatment （P < 0.05）. The levels of IFABP and D-lactate in treatment group were lower than those before treatment and in control group （P < 0.05）. The total effective rate of Chinese medicine syndrome effect and comprehensive effect of treatment group was higher than control group， the difference was statistically significant （P < 0.05）. The incidence of multiple organ dysfunction syndrome of treatment group was lower than control group， the difference was statistically significant （P < 0.05）. Conclusion Jianpi Xiaozhang Decoction umbilical paste can improve clinical symptoms such as abdominal distention， abdominal pain， fatigue and defecation， enhance gastrointestinal motility， improve gastrointestinal barrier function and the state of ischemia and anoxia.

[Key words] Jianpi Xiaozhang Decoction; Umbilical paste; Intestinal fatty acid binding protein; D-lactate; Sepsis; Gastrointestinal dysfunction

脓毒症是宿主对感染的反应失调而导致的危及生命的器官功能损害[1]。流行病学研究显示，全世界每年超过1900万人患有脓毒症，其中25%以上的患者死亡，这与世界人口的老龄化、抗生素耐药性的增加、倾入性血流动力学监测和有创医疗操作的增加密切相关[2-3]。近年来，研究已证实，脓毒症通常伴有不同程度胃肠功能障碍，肠黏膜屏障被损害，细菌与内毒素易位，微生态系统紊乱，进而导致严重脓毒症、多器官功能障碍综合征（MODS）以及脓毒性休克，预后极差。2004年国际专家小组发起了拯救脓毒症运动，并发布了第一版严重脓毒症与脓毒性休克指南，为全球重症医学工作者诊治脓毒症提供了规范和指导[4]。随着研究的不断深……