红藤解毒汤对小儿阑尾脓肿的疗效研究

发布时间：2019-06-08 08:37

【摘要】：研究背景：小儿阑尾脓肿是小儿腹部外科常见的急腹症之一,是小儿急性阑尾炎未及时就诊而致炎症扩散,炎症被大网膜及周围肠管包裹局限化,或继发于阑尾穿孔、坏死形成局限性腹膜炎所致。由Fitz等人于1886年首次文献报道该病。由于小儿无法准确表述病情和积极配合检查等原因导致急性阑尾炎尤其是婴幼儿阑尾炎误诊率偏高,约为4%-10%的小儿急性阑尾炎发展成为阑尾脓肿。临床上考虑阑尾脓肿后主要依赖于腹部B超来确诊。腹部B超诊断小儿阑尾脓肿的正确率在90%以上。阑尾脓肿的治疗采用手术或非手术尚存在分歧。有学者认为阑尾脓肿应早期积极手术切除阑尾并引流脓肿,这样可防止炎症扩散蔓延,减轻全身中毒症状。但是手术难度比较大,而且肠瘘、粘连性肠梗阻等并发症发生率高。有学者主张腹腔脓肿引流术,但创伤性的治疗极易出现腹腔内脏损伤等并发症。有学者主张采用几种抗生素联合的保守治疗。但炎性包块周围组织的粘连,严重影响血液循环,使得抗生素在局部难以达到有效浓度,致使西药抗菌效果不佳。在当患者的体温和炎症指标都已恢复正常,而痛性脓肿迟迟无法消退,严重影响患儿的生活和生长发育。近年来有报道认为以内服中药为主的中西医结合可以提高阑尾脓肿的治疗疗效。红藤是传统的中药材,红藤具有清热解毒的功效。研究认为大黄素和β-谷甾醇是大血藤中抗菌消炎的有效成分。鞣质是红藤的主要化学成分,对多种细菌、真菌、酵母菌都有明显的抑制能力,鞣质对金黄色葡萄球菌抑菌效果尤为明显,且其抑菌活性与饮片中总皂苷、总鞣质、游离葸醌及总绿原酸的含量密切相关。红藤解毒汤是以红藤为主料,辅以蒲公英、败酱草、牡丹皮、赤芍、白芍、炒山楂和生甘草。临床应用较为广泛,目前常用于治疗妇科炎症如盆腔炎、消化道溃疡、胃肠炎症、慢性痢疾及各种肿瘤等。因此我们尝试用红藤解毒汤结合西医来治疗小儿阑尾脓肿。目的：观察红藤解毒汤结合西医对比单纯西医治疗小儿阑尾脓肿的临床疗效差别。方法：将100例患者随机分为治疗组和对照组,对照组50例采用西医抗生素治疗,治疗组50例采用西医基础上,结合红藤解毒汤治疗。对两组患者治疗后主要症状、体征消退的平均时间、平均住院时间以及白细胞计数(WBC)、C反应蛋白(CRP)和腹部B超等辅助检查结果进行比较。应用SPSS17.0统计软件对结果进行t检验和卡方检验,P0.05则认为差异具有统计学意义。结果：治疗组的症状、体征消退平均时间和住院平均时间明显短于对照组,P0.05,差异具有统计学意义。治疗组在第3天、第6天、第9天、第12天的WBC和CRP比对照组有更明显的下降,P0.05,差异具有统计学意义。治疗组在第6天、第12天的腹部B超结果比对照组有更明显的缩小,P0.05,差异具有统计学意义。结论：以红藤解毒汤为主的中西医结合治疗小儿阑尾脓肿可显著提高临床疗效。
[Abstract]:Study Background: Children's tail abscess is one of the most common acute abdominal diseases in the abdomen of children. It is the non-timely treatment of children's acute endophthalmitis. The inflammation is localized by the large omentum and the surrounding intestinal canal, or secondary to the perforation and necrosis of the tail of the body, and the localized peritonitis is formed. To........................................... The disease is due to the lack of accurate representation of the condition and the positive combination of the examination, etc., which leads to the high misdiagnosis rate of the acute endophthalmitis, especially the infant and the infant, and about 4% to 10% of the child's acute endophthalmitis has been developed into the purulent tail of the infant. Swelling. The clinical consideration of the tail abscess mainly depends on the abdominal B-ultrasound. The accuracy of abdominal B-ultrasound in the diagnosis of children's tail abscess was 90%. The treatment of the abscess of the tail of the tail is in the operation or non-surgical operation. Disambiguation. Some scholars believe that the tail abscess should be removed by the early and active operation and the abscess should be drained, so that the spread of the inflammation can be prevented, and the whole body poisoning can be reduced. but the operation difficulty is relatively large, and the incidence rate of complications such as intestinal obstruction and adhesion intestinal obstruction High. Some scholars advocate the drainage of abdominal abscess, but the traumatic treatment is very easy to have abdominal viscera injury and so on. . Some scholars advocate the use of a combination of several antibiotics. but the adhesion of the surrounding tissues of the inflammatory mass block can seriously affect the blood circulation, so that the antibiotic is difficult to reach the effective concentration in the local area, so that the antibacterial effect of the western medicine does not Good. The patient's body temperature and the index of inflammation have returned to normal, and the pain of the painful abscess can not be resolved, which seriously affects the life and the growth of the child. In recent years, it has been reported that the combination of the traditional Chinese and western medicine, which is the main part of the traditional Chinese medicine, can improve the treatment of the abscess of the tail of the The red vine is a traditional Chinese medicinal material, and the red vine has the functions of clearing away heat and toxic materials, The efficacy of the study is that the emodin and the p-glutanol are anti-bacterial and anti-inflammatory in the large intestine. the tannin is the main chemical component of the red vine, has obvious inhibitory capacity on various bacteria, fungi and yeasts, and the tannin has the obvious antibacterial effect on the staphylococcus aureus, and the antibacterial activity of the tannin is closely related to the total soap content, the total tannin, the free and total content of the total chlorogenic acid in the decoction pieces, The preparation method comprises the following steps: taking the red vine as a main material, and adding the dandelion, the Herba Patriniae, the Cortex Moutan, the Radix Paeoniae Rubra, the Radix Paeoniae Alba, and the Radix Saposhnikoviae; has wide clinical application and is used for treating gynecological inflammation such as pelvic inflammatory disease, digestive tract ulceration, gastrointestinal inflammation, chronic dysentery and various diseases The tumor and so on. So we try to use the red vine to detoxify the soup in combination with western medicine to treat small the tail of a child Abscess. Objective: To observe the treatment of the tail of the child by western medicine in combination with western medicine and western medicine. abscess Methods:100 patients were randomly divided into treatment group and control group. The mean time, mean hospital stay, and white blood cell count (WBC), C-reactive protein (CRP), and abdomen of the two groups of patients after treatment were treated with a combination of red-to-vine detoxification. The results of the auxiliary examinations such as B-ultrasound were compared. The results were t-test and chi-square test by using the SPSS17.0 statistical software. 5. The difference was statistically significant. Results: The symptoms, signs, mean time, and average hospital stay were significantly shorter in the treatment group than in the control group. The difference of WBC and CRP on day 3, day 6, day 9 and day 12 was significantly lower than that in the control group. The results of B-B ultrasound in the treatment group on day 6 and day 12 were more significant than that of the control group. Small, P 0.05. The difference is of statistical significance.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R272

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