不同剂量大黄对危重症患者胃肠道功能影响的观察

摘要/Abstract

摘要： 目的：观察不同剂量生大黄粉对危重症患者胃肠道功能的影响。方法：纳入我院重症监护病房（ICU）危重症胃肠功能受损患者120例，采用随机数字表法分为对照组、治疗A组、治疗B组、治疗C组，每组各30例。对照组患者接受常规西医治疗，治疗组患者在对照组治疗基础上加用生大黄粉，A组按照0.05 g·kg﹣1·d﹣1计量，B组按照0.10 g·kg﹣1·d﹣1计量，C组按照0.15 g·kg﹣1·d﹣1计量，2次/d，温开水稀释至50 mL鼻饲，疗程均为7 d。观察各组患者治疗前后胃肠功能评分、急性生理与慢性健康（APACHEⅡ）评分，治疗后各组患者胃肠损伤(AGI)改善情况、喂养不耐受率、腹泻发生率及患者ICU停留时间、28 d病死率。结果：治疗结束后，A组与对照组患者AGI改善率差异无统计学意义（P＞0.05），B组、C组患者AGI改善率均高于对照组（P＜0.05）；A组与对照组患者喂养不耐受率差异无统计学意义（P＞0.05），B组、C组患者喂养不耐受率均低于对照组（P＜0.05）；A组与对照组患者胃肠功能评分、APACHE Ⅱ 评分差异均无统计学意义（P＞0.05），B组、C组患者胃肠功能评分、APACHE Ⅱ 评分较对照组均降低（P＜0.05）；A组与对照组患者ICU停留时间差异无统计学意义（P＞0.05），B组、C组患者ICU停留时间较对照组均缩短（P＜0.05）；A组、B组患者腹泻发生率与对照组差异无统计学意义（P＞0.05），C组患者腹泻发生率较对照组升高（P＜0.05）。各组患者28 d病死率差异无统计学意义（P＞0.05）。结论：大黄可改善危重症患者胃肠功能，提高患者肠内营养耐受性，缩短患者ICU停留时间。生大黄鼻饲剂量为0.10 g·kg﹣1·d﹣1时，疗效好，安全性高，可达最佳量效关系。

关键词: font-size:medium, ">大黄；量效关系；危重症患者；急性胃肠损伤；喂养不耐受

Abstract: Objective： To observe the effect of different dose of raw rhubarb on the gastrointestinal function of critically ill patients. Method: A total of 120 critically ill patients with acute gastrointestinal injury (AGI) were enrolled in the study， and randomly assigned into the control group， the treatment group A， the treatment group B， and the treatment group C. Each group had 30 cases. The patients in the control group were given routine western medicine therapy， and the treatment group used raw rhubarb powder on the base of the treatment group. The dose of raw rhubarb varied in different treatment groups (group A: 0.05 g·kg﹣1·d﹣1， group B: 0.10 g·kg﹣1·d﹣1， group C: 0.15 g·kg﹣1·d﹣1). The rhubarb powder was mixed with warm water to 50 mL， twice a day for nasal feeding， and all the groups were treated for 7 d. The gastrointestinal function score， APACHEⅡscore， improving rate of AGI， feeding intolerance rate， incidence rate of diarrheas， ICU stay time and 28 d mortality rate of each group were observed. Results： After treatment， the AGI improving rate of group B and group C were higher than that of the control group (P<0.05)， while there were no statistical difference between group A and the control group (P＞0.05). Compared to the control group， the feeding intolerance rate， gastrointestinal function score and APACHEⅡ score of treatment group B and group C were lower (P<0.05)，while gastrointestinal function score and APACHEⅡscore of group A showed no statistical differences with the control group(P＞0.05). The ICU stay time of group B and group C were shorter than that of the control group (P<0.05)，while that of the group A had no statistical difference with the control group (P＞0.05). The diarrhea incidence rate of the group C was higher than that of the control group (P<0.05)， while group A and group B had no statistical difference when compared with the control group(P＞0.05). There was no statistical difference in 28-day mortality rate of each group (P＞0.05). Conclusion： Rhubarb can improve AGI and enteral nutritional tolerance rate of critically ill patients， shorten the ICU stay time. The safe and effective dosage for nasal feeding of raw rhubarb is 0.10 g·kg﹣1·d﹣1， which has the best dose-effect relationship.

Key words: Rhubarb, Dose-effect relationship, Critically ill patient, Acute gastrointestinal injury, Feeding intolerance

中图分类号:

王琳, 范滨, 吴建鹏, 余旭超, 赵锋. 不同剂量大黄对危重症患者胃肠道功能影响的观察[J]. 中国医药导刊, 2021, 23(9): 667-671.

WANG Lin, FAN Bin, WU Jianpeng, YU Xuchao, ZHAO Feng. Effects of Different Dose of Rhubarb on the Gastrointestinal Function of Critically Ill Patients[J]. CHINESE JOURNAL OF MEDICINAL GUIDE, 2021, 23(9): 667-671.

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