加味桃核承气汤内服和灌肠对腹部术后早期肠梗阻神经-炎症机制的影响

发布时间：2018-05-12 20:21

本文选题：术后肠梗阻 + 桃核承气汤　；参考：《中国实验方剂学杂志》2017年16期

【摘要】：目的:探讨加味桃核承气汤内服和灌肠治疗腹部术后早期肠梗阻的临床疗效及对神经介质和炎症因子的影响。方法:将138例患者采用入院先后顺序,随机按数字表法分为对照组和观察组各69例。两组患者均给予持续胃肠减压、补液、纠正酸碱平衡及水电解质紊乱、抗感染等综合基础治疗。对照组采用注射用头孢他啶,2.0 g/次,2次/d,静脉滴注,连续7 d;注射用生长抑素,6 mg·(24 h)~(-1),持续微泵泵入,连续3 d;甲硫酸新斯的明注射液,2 mL/次,肌肉注射。观察组在对照组治疗的基础上给予加味桃核承气汤胃管注入和灌肠,2剂/d。两组疗程均为7 d。记录腹痛减轻时间、腹胀缓解时间、肠鸣音恢复时间及通气排便时间、胃管留置时间、进食时间、体温恢复正常时间、白细胞计数恢复正常时间、住院时间;记录手术中转情况;进行治疗前后湿热瘀滞证评分;检测治疗前后血管活性肠肽(VIP),降钙素原(PCT),一氧化氮(NO),单核细胞趋化蛋白-1(MCP-1),血清白细胞介素-6(IL-6),肿瘤坏死因子-α(TNF-α)和C-反应蛋白(CRP)水平。结果:观察组临床疗效总有效率91.31%,高于对照组的75.37%(χ~2=6.618,P0.01);观察组腹痛减轻时间、腹胀缓解时间、肠鸣音恢复时间、首次通气时间、首次排便时间均短于对照组(P0.01);观察组管留置时间、进食时间、体温恢复正常时间、白细胞计数恢复正常时间和住院时间均短于对照组(P0.01);观察组中转手术率为5.8%,低于对照组的18.84%(χ2=5.434,P0.05);治疗后观察组患者血清VIP,PCT和NO均低于对照组(P0.01);观察组患者血清MCP-1,IL-6,TNF-α和CRP水平均低于对照组(P0.01)。结论:在西医常规治疗的基础上,加味桃核承气汤内服和灌肠治疗腹部术后早期肠梗阻患者,能调节神经介质,减轻炎症损伤,能解除肠梗阻,缩短病程,提高保守治疗的成功率,临床疗效优于单纯西医治疗。
[Abstract]:Objective: to investigate the clinical effect of Jiawei Taohe Chengqi decoction on early postoperative intestinal obstruction and its effect on neurotransmitter and inflammatory factors. Methods: 138 patients were randomly divided into control group (n = 69) and observation group (n = 69). The patients in both groups were treated with continuous gastrointestinal decompression, fluid resuscitation, acid and base balance, water and electrolyte disturbance, anti-infection and so on. The control group was treated with ceftazidime 2.0 g / L for 2 / d, intravenous drip for 7 days, somatostatin 6 mg / L for 24 h, continuous micropump for 3 days, and neostigmine methoxylate 2 mL/ for intramuscular injection. On the basis of treatment in the control group, the observation group was treated with Jiawei Taohe Chengqi decoction, gastric tube injection and enema 2 / d. The course of treatment in both groups was 7 days. The time of abdominalgia relief, abdominal distension relief, bowel sound recovery and ventilation defecation, gastric tube retention time, feeding time, body temperature returning to normal time, leukocyte count returning to normal time and hospitalization time were recorded. To record the conversion of operation, to score the syndrome of dampness and heat stagnation before and after treatment; Before and after treatment, the levels of vasoactive intestinal peptide (VIPP), procalcitonin (PCT), nitric oxide (no), monocyte chemoattractant protein (MCP-1), serum interleukin-6 (IL-6), tumor necrosis factor- 伪 (TNF- 伪) and C-reactive protein (CRP) were measured. Results: the total effective rate of clinical efficacy in the observation group was 91.31, which was higher than that in the control group (75.37) (蠂 ~ 2 = 6.618) P0.01.The time of abdominalgia relief, abdominal distension relief, the recovery time of bowel sound, the time of first ventilation and the time of first defecation in the observation group were all shorter than those in the control group, and the time of tube retention in the observation group was shorter than that in the control group. Eating time, body temperature returning to normal time, The leukocyte count recovery time and hospitalization time were shorter than that of the control group (P 0.01), the conversion rate of the observation group was 5.8, which was lower than that of the control group (蠂 2 = 5.434, P 0.05); the serum VIPP PCT and no in the observation group were lower than those in the control group (P 0.01); the serum MCP-1IL-6T NF- 伪 and CRP in the observation group were lower than those in the control group. All the levels were lower than those of the control group (P 0.01). Conclusion: on the basis of routine treatment of western medicine, oral administration and enema of modified Taohe Chengqi decoction for early intestinal obstruction after abdominal surgery can regulate neurotransmitter, alleviate inflammatory injury, relieve intestinal obstruction and shorten the course of disease. To improve the success rate of conservative treatment, the clinical efficacy is better than that of western medicine alone.
【作者单位】：四川省医学科学院四川省人民医院;
【基金】：四川省卫生厅科研项目(201303245)
【分类号】：R656

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