行气通腑类中药对腹部术后胃肠功能恢复的影响研究

发布时间：2019-04-03 09:30

【摘要】：目的:本课题应用文献及回顾性研究的方法,分析行气通腑类中药对腹部术后胃肠功能恢复的作用,为临床腹部术后胃肠功能恢复中医药治疗提供一定的参考依据。研究方法:1.文献研究通过对维普、中国知网、中国生物医学文献数据库、Pudmed四个数据库进行检索,收集2004-2014年的口服行气通腑类中药对腹部术后胃肠功能恢复作用的临床随机对照试验。对纳入研究的方法学质量进行评估,并进行Meta分析。2.临床研究回顾性调查广东省中医院妇科、外科300例腹部手术病例。记录并总结患者腹部术后中药使用情况。研究结果:1.文献研究通过文献检索,得出864篇文献,剔除重复的文献,根据纳入排除标准,最终纳入19篇随机对照的文献,用Meta分析评价了行气通腑类中药的常用方剂:大承气汤、小承气汤及四磨汤对腹部术后胃肠功能恢复的作用。与腹部术后单纯西医常规处理比较,大承气汤、小承气汤及四磨汤治疗对术后肠鸣音恢复时间、肛门排气时间、排便时间均有促进作用,P0.05。2.回顾性临床研究(1)300份病例中,术后首次中医辨证为腑气不通者共121例,占所有有明确中医辨证病例的47.6%。(2)300份病例中,在行气通腑类中药的使用方面,运用四磨汤汤剂或口服液的共有57例,运用小承气汤的有37例,运用大承气汤灌肠的有7例。(3)300份病例中,术后行气类中药的使用频数由高到低为:枳实、厚朴、枳壳、乌药、沉香、木香。研究结论:1.文献研究系统评价的结果显示,大承气汤、小承气汤及四磨汤有促进腹部术后患者胃肠功能恢复的作用,但所纳入的文献方法学质量普遍较低,有发表性偏倚可能,为深入客观评价行气通腑类中药对腹部术后胃肠功能恢复作用的疗效和安全性,有待今后高质量的临床研究。2.回顾性临床研究(1)腹部手术后患者的主要中医辨证为因气虚气滞所致的腑气不通,益气行气通腑是术后胃肠功能恢复治疗的基本原则。(2)术后行气类中药的使用频数由高到低为:枳实、厚朴、枳壳、乌药、沉香、木香。
[Abstract]:Aim: to analyze the effect of Qi-dredging and Fu-like herbs on the recovery of gastrointestinal function after abdominal surgery by literature and retrospective study in order to provide a certain reference for the clinical treatment of gastrointestinal function recovery after abdominal surgery. Methods of research: 1. Through searching the four databases of Vip, China knowledge Network, Chinese Biomedical Literature Database and Pudmed, the clinical randomized controlled trials on the recovery of gastrointestinal function after abdominal operation were collected from 2004 to 2014 by oral Xingqi Tongfu traditional Chinese medicine. The quality of the methodology included in the study was assessed and Meta analysis was performed. Clinical study retrospectively investigated 300 cases of abdominal operation in gynaecology and surgery department of Guangdong traditional Chinese medicine hospital. The use of traditional Chinese medicine after abdominal surgery was recorded and summarized. Research findings: 1. Through literature retrieval, 864 articles were obtained. According to the exclusion criteria, 19 randomized controlled literatures were finally included. Meta analysis was used to evaluate the common prescription of Xingqi Tongfu traditional Chinese medicine: Dachengqi decoction (Dachengqi decoction). Effect of Xiaochengqi decoction and Simo decoction on recovery of gastrointestinal function after abdominal surgery. Compared with the conventional treatment of simple western medicine after abdominal surgery, Dachengqi decoction, Xiaochengqi decoction and Simo decoction can promote the recovery time of intestinal sound, anal exhaust time and defecation time after operation, P0.05.2. Retrospective clinical study (1) of 300 cases, 121 (47.6%) of the 300 cases were diagnosed as apoplexy for the first time after operation, accounting for 47.6% of all cases with definite TCM syndrome differentiation. (2) of the 300 cases, the use of traditional Chinese medicine (TCM) in the treatment of Qi-dredging and Fu-organs was carried out for the first time. A total of 57 cases used Simo decoction or oral liquid, 37 cases used small Chengqi decoction, and 7 cases used Dachengqi decoction enema. (3) in 300 cases, the frequency of using traditional Chinese medicine after operation was from high to low: Fructus Aurantii, Magnolia officinalis, Fructus Aurantii, Black medicine, aloes, wood incense. Research conclusions: 1. The results of systematic review of literature study showed that Dachengqi decoction, Xiaochengqi decoction and Simo decoction could promote the recovery of gastrointestinal function in patients after abdominal surgery, but the quality of literature methodology included was generally low, and there was a possibility of episodic bias. In order to evaluate objectively the curative effect and safety of traditional Chinese medicine for the recovery of gastrointestinal function after abdominal surgery, high-quality clinical studies should be conducted in the future. 2. Retrospective clinical study (1) the main syndrome differentiation of the patients after abdominal operation is due to qi deficiency and qi stagnation. It is the basic principle to restore gastrointestinal function after operation. (2) the frequency of using traditional Chinese medicine after operation from high to low is as follows: Fructus Aurantii, Magnolia officinalis, Fructus Aurantii, Polygonum officinalis, Armillaria vulgaris and Muxiang.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R656

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