参苓白术散联合西药防治重症患者胃肠功能障碍随机平行对照研究

目的]观察参苓白术散联合西药防治重症患者胃肠功能障碍疗效。方法]使用随机平行对照方法,将80例住院患者按病志号抽签方法随机分为两组。对照组38例治疗原发病基础上,实施营养支持,应激期按照"允许性低热卡"原则(20~25kcal/kg?d);应激与代谢状态稳定后适当增加至(30~35kcal/kg?d);肠内营养量以所需量1/3~1/4开始,每天以1/4递增至全量;营养液温度控制在37~38℃。治疗组42例参苓白术散(党参20g,白术、茯苓各15g,山药20g,扁豆10g,莲子6g,薏苡仁20g,砂仁10g,桔梗、甘草炙各6g),兼肝郁气滞加柴胡、郁金、木香等疏肝理气,兼血瘀加桃仁、红花、川芎以活血化瘀改善胃肠瘀血,兼腹胀加厚朴、枳实等下气破积,兼血虚加黄芪、当归以补气养血,兼痰多加半夏、陈皮等燥湿化痰,1剂/d,水煎300mL,早晚口服;西药治疗同对照组。连续治疗7d为1疗程。观测临床症状、胃肠功能障碍发生率、不良反应。治疗1疗程,判定疗效。结果]胃潴留、腹胀、腹泻发生率低于对照组(P0.05),二重感染、消化道出血发生率两组间无明显差异(P0.05)。结论]参苓白术散联合西药防治重症患者胃肠功能障碍,能有效降低常见胃肠功能障碍发生率,无副作用,值得推广。

Random Parallel Control Study about Shenlingbaizhu Powder Combined the Western Medicine on the Prevention and Treatment Gastrointestinal Dysfunction in Critically III Patients

Objective ] To observed the effect of Shenlingbaizhu powder combined the western medicine to prevent and treat gastrointestinal dysfunction in critically ill patients. E Methods ] Using random parallel control method, 80 cases of hospitalized patients were randomly divided into two groups according to the case number to draw method. Control group of 42 cases of treatment on the basis of the primary disease, nutritional support, stress period in accordance with the principle of ＂allow low thermal card＂ （ 20 ~ 25 kcal/kg, d ） ;Stress and metabolic state stability after the increase to the appropriate （ 30 ~ 35 kcal/kg, d ） ;Amount of enteral nutrition in the required amount of 1/3 ~ 1/4 beginning, increasing by a quarter every day to the full amount ; Nutrient solution temperature control in 37 ~ 38 ~C. Treatment group 38 cases used Shenlingbaizhu powder （ Codonopsis 20g, Atractylodes, Poria each 15g, yams 20g, lentils 10g, lotus seed 6g, Coix seed 20g, Amomum 10g, bellflower, Zhigancao each 6g ）, if stagnation of liver qi stagnation, added bupleurum, radix cnrcumae, Radix Aucklandiae for Shugan Qi, if blood stasis, added peach kernel, safflower, Chuanxiong for blood circulation improving gastrointestinal blood stasis, if abdominal distension, added Magnolia officinalis, Zhishi for gas breaking blood, if blood deficiency, added astragalus, angelica to nourishing qi, if Phlegm, added tangerine peel, Pinellia dampness and phlegm.1 doses of/d, water simmer in water 300mL, morning and evening oral; Western medicine treatment the same with the control group. Continuous treatment of 7 d for 1 course of treatment. Observation of clinical symptoms, the incidence of gastrointestinal dysfunction and adverse reactions. After 1 course of treatment, judge curative effect. E Results ] Gastric retention, abdominal distension, diarrhea rate lower than that of the control group （P 〈 0.05 ）, double infection, gastrointestinal hemorrhage rate of no significant difference between the two groups （ P 〉 0.05 ?