济川煎加味治疗慢性阻塞性肺疾病急性加重期合并胃肠功能损伤(阳虚便秘型)的疗效研究

金宇兰; 王姣; 韩一骄; 龚月仙; 张烨

doi:10.16766/j.cnki.issn.1674-4152.004003

济川煎加味治疗慢性阻塞性肺疾病急性加重期合并胃肠功能损伤(阳虚便秘型)的疗效研究

doi: 10.16766/j.cnki.issn.1674-4152.004003

1.
东阳市中医院重症医学科，浙江东阳 322100
2.
浙江大学医学院附属第一医院重症医学科，浙江杭州 311100
3.
东阳市中医院呼吸科

基金项目:

浙江省医药卫生科技计划项目 2023KY681

金华市科技计划项目 2023-4-238

详细信息

通讯作者:
张烨，E-mail：a1010635823@163.com

中图分类号: R563 R289.5
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出版历程
- 收稿日期: 2024-04-10
- 网络出版日期: 2025-08-14

Study on therapeutic effect of modified Jichuanjian Decoction Jiawei on acute exacerbation of chronic obstructive pulmonary disease complicated with gastrointestinal function injury (constipation type due to yang deficiency)

1.
Department of Critical Care Medicine, Dongyang Hospital of Traditional Chinese Medicine, Dongyang, Zhejiang 322100, China

摘要

摘要: 目的探讨济川煎加味应用于慢性阻塞性肺疾病急性加重期(AECOPD)合并急性胃肠功能损伤(AGI)(阳虚便秘型)患者的临床疗效和安全性。方法纳入2022年7月—2023年12月入住东阳市中医院重症监护病房(ICU)的80例AECOPD合并AGI(阳虚便秘型)患者，根据治疗方法分为常规组(西医常规治疗)和研究组(常规组的基础上加用济川煎加味汤)，各40例；比较组间AGI综合疗效、胃肠道指标等。结果研究组AGI综合疗效[87.50%(35/40)]显著高于常规组[60.00%(24/40)，P < 0.05]。治疗7 d后，研究组腹内压、胃残留量低于常规组，肠鸣音高于常规组(P < 0.05)。治疗后，研究组肿瘤坏死因子α(TNF-α)、C反应蛋白(CRP)及白介素-6(IL-6)水平均低于常规组，便秘腹胀、畏寒肢冷和神疲乏力评分低于常规组(P < 0.05)。研究组与常规组不良反应发生率[10.00%(4/40)vs.7.50%(3/40)]比较，差异无统计学意义(P>0.05)。结论联合济川煎加味治疗AECOPD合并AGI(阳虚便秘型)患者，有助于提高AGI综合疗效，可改善胃肠道指标和炎症因子水平，缓解便秘腹胀、畏寒肢冷、神疲乏力等症状，并且具有较好的安全性。
- 慢性阻塞性肺疾病 /
- 济川煎加味汤 /
- 胃肠功能损伤 /
- 便秘 /
- 中医症型
Abstract: Objective To explore the clinical efficacy and safety of Jichuanjian Decoction Jiawei in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) complicated with acute gastrointestinal function injury (AGI, constipation type due to yang deficiency). Methods Eighty patients with AECOPD complicated with AGI (constipation type due to yang deficiency) admitted to intensive care unit (ICU) of Dongyang Hospital of Traditional Chinese Medicine from July 2022 to December 2023, and they were divided into routine group (routine treatment of western medicine) and research group (addition of Jichuanjian Decoction Jiawei on the basis of routine group) according to the treatment methods, with 40 patients in each group. The comprehensive curative effect of AGI and gastrointestinal indexes were compared between groups. Results The comprehensive curative rate of AGI in the study group [87.50% (35/40)] was significantly higher than that in the routine group [60.00% (24/40), P < 0.05]. After 7 days of treatment, the intra-abdominal pressure and gastric residue in the study group were lower than those in the routine group, and the bowel sounds were higher than those in the routine group (P < 0.05). After treatment, the levels of tumor necrosis factor-α (TNF-α), C-reactive protein (CRP), and interleukin-6 (IL-6) in the study group were lower than those in the routine group, and the scores of constipation, abdominal distension, cold limbs, and mental fatigue were lower than those in the routine group (P < 0.05). There was no significant difference in adverse reaction rate between the study group and the routine group [10.00% (4/40) vs.7.50% (3/40), P>0.05]. Conclusion Treating AECOPD with AGI (constipation type due to yang deficiency) with Jichuanjian Decoction is helpful to improve the comprehensive curative effect of GI, improve gastrointestinal indicators and inflammatory factors, and relieve constipation, abdominal distension, cold limbs, and mental fatigue, with good security.
- Chronic obstructive pulmonary disease /
- Jichuanjian Decoction Jiawei /
- Gastrointestinal function injury /
- Constipation /
- Syndrome types of traditional Chinese medicine

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表 1 2组AECOPD合并AGI(阳虚便秘型)患者一般资料比较

Table 1. Comparison of general data between two groups of AECOPD patients complicated with AGI (constipation due to yang deficiency)

组别	例数	性别(男性/女性，例)	年龄(x±s，岁)	病程(x±s，h)	AGI分级(Ⅰ级/Ⅱ级，例)
常规组	40	24/16	66.38±5.20	40.15±5.14	19/21
研究组	40	25/15	66.21±5.17	40.20±5.17	17/23
统计量		0.053^a	0.147^b	0.043^b	0.202^a
P值		0.818	0.884	0.966	0.653
注：^a为χ²值，^b为t值。

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表 2 2组AECOPD合并AGI(阳虚便秘型)患者AGI综合疗效比较[例(%)]

Table 2. Comparison of comprehensive therapeutic effects of AGI in patients with AECOPD and AGI (constipation due to yang deficiency) between the two groups [cases (%)]

组别	例数	痊愈	好转	无效	综合疗效
常规组	40	5(12.50)	19(47.50)	16(40.00)	24(60.00)
研究组	40	17(42.50)	18(45.00)	5(12.50)	35(87.50)
统计量			-3.487^a		7.813^b
P值			< 0.001		0.005
注：^a为Z值，^b为χ²值。

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表 3 2组AECOPD合并AGI(阳虚便秘型)患者治疗前后胃肠道指标比较(x±s)

Table 3. Comparison of gastrointestinal indexes between two groups of AECOPD patients complicated with AGI (constipation due to yang deficiency) before and after treatment(x±s)

组别	例数	腹内压(cmH₂O)
组别	例数	治疗前	治疗24 h	治疗48 h	治疗72 h	治疗7 d
常规组	40	10.26±2.47	12.18±2.68^a	15.05±2.75^ab	14.36±2.38^ab	11.78±1.52^acd
研究组	40	10.31±2.39	12.36±2.57^a	14.28±2.66^ab	15.06±2.48^ab	9.20±1.25^abcd
F值		0.951	0.388	0.831	3.524	4.945
P值		0.332	0.535	0.365	0.064	0.029

组别	例数	胃残留量(mL/d)
组别	例数	治疗前	治疗24 h	治疗48 h	治疗72 h	治疗7 d
常规组	40	34.18±5.08	185.26±13.20^a	276.05±29.04^ab	195.34±22.48^abc	98.26±18.04^abcd
研究组	40	32.05±5.47	179.36±15.06^a	269.05±26.58^ab	188.26±20.30^abc	23.15±5.02^abcd
F值		3.881	3.110	0.899	3.658	846.943
P值		0.052	0.068	0.346	0.057	< 0.001

组别	例数	肠鸣音(次/min)
组别	例数	治疗前	治疗24 h	治疗48 h	治疗72 h	治疗7 d
常规组	40	3.50±1.57	1.29±0.46^a	0.80±0.15^ab	1.68±1.20^ac	2.24±0.86^acd
研究组	40	3.48±0.52	1.22±0.64^a	0.75±0.20^ab	1.69±0.52^abc	4.01±1.09^abcd
F值		0.036	0.035	< 0.001	0.151	60.325
P值		0.849	0.853	0.999	0.699	< 0.001
注：与同组治疗前比较，^aP < 0.05；与同组治疗24 h比较，^bP < 0.05；与同组治疗48 h比较，^cP < 0.05；与同组治疗72 h比较，^dP < 0.05。1 cmH₂O=0.098 kPa。

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表 4 2组AECOPD合并AGI(阳虚便秘型)患者治疗前后血清细胞因子水平比较(x±s)

Table 4. Comparison of serum cytokine levels before and after treatment between two groups of AECOPD patients complicated with AGI (Yang deficiency constipation type)(x±s)

组别	例数	TNF-α(ng/L)		CRP(mg/L)		IL-6(ng/L)
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
常规组	40	186.47±16.22	172.35±14.51^b	30.25±5.97	15.04±2.71^b	33.17±5.84	15.39±4.05^b
研究组	40	188.52±17.05	159.07±15.06^b	29.76±6.04	11.03±2.43^b	34.08±5.76	10.67±3.06^b
统计量		0.551^a	15.992^c	0.365^a	45.237^c	0.702^a	30.923^c
P值		0.583	< 0.001	0.716	< 0.001	0.485	< 0.001
注：^a为t值，^c为F值；与同组治疗前比较，^bP < 0.05。

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表 5 2组AECOPD合并AGI(阳虚便秘型)患者治疗前后中医症候评分比较(x±s，分)

Table 5. Comparison of TCM symptom scores before and after treatment between two groups of AECOPD patients complicated with AGI (Yang deficiency constipation type)(x±s, points)

组别	例数	肢体浮肿		心悸		便秘腹胀			胸闷喘息
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后		治疗前	治疗后
常规组	40	1.54±0.26	0.74±0.17^b	1.34±0.21	0.60±0.14^b	2.74±0.68	1.60±0.65^b		2.05±0.34	0.89±0.20^b
研究组	40	1.58±0.30	0.69±0.18^b	1.36±0.24	0.54±0.15^b	2.76±0.70	0.75±0.13^b		2.07±0.36	0.85±0.17^b
统计量		0.637^a	4.145^c	0.397^a	2.557^c	0.130^a	34.533^c		0.255^a	1.269^c
P值		0.526	0.051	0.693	0.114	0.897	< 0.001		0.799	0.263

组别	例数	畏寒肢冷		神疲乏力		舌苔白滑
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前		治疗后
常规组	40	1.70±0.52	1.14±0.31^b	2.14±0.57	1.48±0.32^b	2.43±0.28		1.29±0.40^b
研究组	40	1.68±0.53	0.92±0.21^b	1.96±0.60	1.02±0.29^b	2.40±0.25		1.10±0.43^b
统计量		0.170^a	14.700^c	1.376^a	18.541^c	0.505^a		0.721^c
P值		0.865	< 0.001	0.173	< 0.001	0.615		0.398
注：^a为t值，^c为F值；与同组治疗前比较，^bP < 0.05。

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