杨思雯 李思耐 张鑫 张羽 徐霄龙 宋麦芬

摘要 目的：探討多因素与脓毒症并发急性胃肠损伤的相关性以及中医干预该病的应用价值。方法：选取2014年7月至2017年5月友谊医院、广安门医院、北京中医医院重症监护病房（ICU）收治的脓毒症患者340例作为研究对象，根据住院期间是否出现急性胃肠损伤分为急性胃肠损伤组（n=88）和对照组（n=252），收集患者年龄、性别、机械通气、格拉斯哥昏迷（Glasgow Coma Scale，GCS）评分、平均动脉压（MAP）、发热、心率、呼吸频率、感染部位、肠鸣音、大便、白细胞（WBC）、红细胞（RBC）、血红蛋白（HGB）、总胆红素（TB）、血小板（PLT）、肌酐（Cr）及入院30 d预后情况;再根据患者是否应用中医药干预将脓毒症并发AGI患者分为中西医结合组和非中西医结合组，收集胃肠道症状及体征，构建多因素Logistic回归模型分析相关发病因素。结果：并发急性胃肠损伤患者病死率较对照组明显增多（P<0.01）。影响急性胃肠损伤的因素有机械通气比例、心率、发热比率、呼吸系统感染比率、消化系统感染比率、TB、Cr均显著高于对照组;AGI组患者MAP、PLT、中西医结合干预比率均显著低于对照组。多因素回归分析显示为机械通气（OR 2.508，P=0.005）、TB（OR 1.01、P=0.044）、中西医结合干预（OR 0.19，P<0.01）3个指标为脓毒症并发AGI的独立危险因素。中西医结合干预可有效改善脓毒症合并AGI患者的肠鸣音消失（P<0.01）及便秘（P<0.05）。结论：机械通气、TB、中西医结合干预是临床判断脓毒症合并AGI的有效指标，中西医结合干预可有效改善胃肠功能。

关键词 脓毒症;急性胃肠损伤;危险因素;中医药干预;多因素分析;Logistic回归模型;改善胃肠功能;胃气

Risk Factors of Acute Gastrointestinal Injury in Sepsis and Effect of TCM

YANG Siwen1，LI Sinai1，2，ZHANG Xin1，ZHANG Yu1，XU Xiaolong1，2，3，SONG Maifen1

（1 Beijing Hospital of Traditional Chinese Medicine，Beijing 100010，China; 2 Beijing Institute of Traditional Chinese Medicine，Beijing 100010，China; 3 Clinical Treatment and Research Center of Sepsis in Traditional Chinese Medicine，Beijing 100010，China）

Abstract Objective：This study aims to explore the factors inducing acute gastrointestinal injury（AGI） in sepsis and the potential of traditional Chinese medicine（TCM） for treatment.Methods：A retrospective analysis of the clinical data of 340 patients with sepsis who were admitted in the ICU of Beijing Friendship Hospital of Capital Medical University，Guang′anmen Hospital of China Academy of Chinese Medical Sciences，and Beijing Hospital of Traditional Chinese Medicine from July 2014 to May 2017 was performed.Those with AGI during hospitalization were regarded as the AGI group and cases without the AGI were classified into the control group.The information on the age，gender，mechanical ventilation，Glasgow Coma Scale（GCS） score，mean arterial pressure（MAP），fever，heart rate，respiratory frequency，infection site，bowel sound，stool，white blood cells（WBC），red blood cells（RBC），hemoglobin（HGB），total bilirubin（TB），platelets（PLT），creatinine（Cr），and the prognosis 30 days after admission was collected.Then，patients with AGI in sepsis to whom Chinese medicine was applied were categorized into integrated traditional Chinese and western medicine（TCMW） group and those without the application of Chinese medicine were included in the non-TCMW group.Data on the gastrointestinal symptoms and signs were collected，and a multivariate logistic regression model was constructed to analyze related pathogenic factors.Results：The mortality rate in the AGI group was higher than that in the control group（P<0.01）.The proportion of mechanical ventilation，heart rate，fever rate，respiratory system infection rate，digestive system infection rate，TB，and Cr were significantly higher in the AGI group than in the control group，while the MAP，PLT，and proportion of intervention with TCMW were significantly lower than those in the control group.Multivariate regression analysis suggested that mechanical ventilation（OR 2.508，P=0.005），TB（OR 1.01，P=0.044），and intervention with TCMW（OR 0.19，P<0.01） were independent risk factors for AGI in sepsis.TCMW can effectively improve the disappearance of bowel sound（P<0.01） and constipation（P<0.05） in patients with AGI in sepsis.Conclusion：Mechanical ventilation，TB，and TCMW are predictors of AGI in sepsis in clinical settings，and TCMW can improve the gastrointestinal function.C2D5BA86-65F2-4874-9215-7F046271D7EC

Keywords Sepsis; Acute gastrointestinal injury; Risk factors; Traditional Chinese medicine intervention; Multivariate analysis; Logistic regression model; Improving gastrointestinal function; Stomach qi

中图分类号：R242文献标识码：Adoi：10.3969/j.issn.1673-7202.2022.08.019

脓毒症是重症医学临床工作中经常面对的问题，是重症医学领域重难点问题。脓毒症导致多器官功能障碍综合征（Multiple Organ Dysfunction Syndrome，MODS），最常累及的器官为胃肠道[1]。急性胃肠损伤（Acute Gastrointestinal Injury，AGI）是MODS的局部器官表现。当AGI发生时肠道内毒素、细菌易位可诱发、加重脓毒症的病情，进而促进MODS的病理生理进程，造成恶性循环，提升死亡率及住院费用。如何预测和识别脓毒症AGI的发生，加强对脓毒症AGI患者的预防和治疗，及时恢复患者胃肠功能，已成为脓毒症患者诊治的关键环节之一[2-3]。……