中药促进气机壅滞证非胃肠手术后患者胃肠功能恢复的疗效观察

发布时间：2018-06-18 07:54

本文选题：大承气汤加味 + 非胃肠手术　；参考：《北京中医药大学》2017年硕士论文

【摘要】：一、文献综述术后早期胃肠功能障碍在术后患者中有着较高的发病率。SICU非胃肠手术术后患者的胃肠功能障碍,不但增加了患者滞留SICU时间,加重患者家庭的经济负担,也影响患者术后整体机能的恢复。解决这一问题很有现实意义。目前西医对术后早期胃肠功能障碍的认识,主要包括病因、发病机制、分型、诊断、治疗这个方面。由于目前的西医治疗并没有一种可以主动来干预胃肠功能障碍的措施,而中医治疗在此方面可能发挥自己独特的优势。目前的中医研究,一般将术后胃肠功能障碍归入不同的中医疾病范畴,对其病因、病机及治疗方法也有不少研究。这些研究为本次临床研究提供了理论基础。二、临床研究目的:观察中药口服、中药灌肠两种方法,对气机壅滞型SICU非胃肠手术后患者,胃肠功能恢复的疗效;并比较两种方法的疗效差异。方法:对SICU非胃肠手术患者,进行中医辨证,选取45位证属气机壅滞证的患者,随机分为3组:口服中药组、中药灌肠组和对照组。所有45位病人均给予术后常规治疗:如吸氧、心电监护、禁食、应用抗生素预防感染、补液、抑酸、止痛、维持电解质平衡治疗。自术后6h起,所有患者恢复自主进食,术后12h起,在上述治疗基础上,口服中药组加用厚朴三物汤加味(生厚朴24g、生大黄10g、党参20g、炒枳实9g)治疗;中药灌肠组加用大承气汤加味(生厚朴30g、焦槟榔40g、生大黄30g、白芍30g、炒枳实30g、炙甘草10g、芒硝30g、炒莱菔子40g)治疗。中药口服组每次口服中药200ml,中药灌肠组每次灌肠100ml,两组给药频率均为2次/天,直至术后排气、排便恢复(若患者在术后12h内出现排气排便,则剔除该病例),观察时限至术后第48h。记录每位患者的首次排气排便时间,肠鸣音恢复的时间,并根据每位患者治疗前后的症状体征进行评分,计算疗效指数。结果:①.术后肠鸣音恢复时间,对照组为34.32±3.64小时,口服中药组为28.92±3.92小时,中药灌肠组为29.13±3.62小时,对照组与两个治疗组相比,均有显著差异,P值0.01。两个治疗组之间没有明显差异,P=0.8780.05。②.首次排气时间,对照组为37.05±4.55小时,口服中药组为29.97±4.12小时,中药灌肠组为31.78±5.22小时,对照组与两个治疗组相比,均有显著差异,P值0.01。两个治疗组之间没有明显差异,P=0.3290.05。③.首次排便时间,对照组为41.45±3.59小时,口服中药组为32.17±4.08小时,中药灌肠组为32.03±5.11小时,对照组与两个治疗组相比,均有显著差异,P值0.01。两个治疗组之间没有明显差异,P=0.7690.05。④.在疗效指数方面,对照组为24.84%±0.10,口服中药组为69.47%±0.28,中药灌肠组为75.02%±0.28,对照组与两个治疗组相比,均有显著差异,P值0.01。两个治疗组之间没有明显差异,P=0.2250.05。⑤.对照组、中药口服组、中药灌肠组总有效率分别为30.77%、82.35%、86.67%。结论:厚朴三物汤加味口服、大承气汤加味灌肠均可促进SICU非胃肠手术术后病人早期胃肠功能恢复,改善患者胃肠道的症状体征。
[Abstract]:First, the early gastrointestinal dysfunction after the literature review has a higher incidence of postoperative gastrointestinal dysfunction in patients with.SICU non gastrointestinal surgery, which not only increases the time of the patient's retention of SICU, aggravates the economic burden of the patients, but also affects the recovery of the overall function after the operation. The understanding of the early gastrointestinal dysfunction in the former western medicine mainly includes the etiology, pathogenesis, classification, diagnosis, and treatment. Because of the current western medicine treatment, there is no initiative to intervene in gastrointestinal dysfunction, and traditional Chinese medicine may play its own unique advantages in this respect. The postoperative gastrointestinal dysfunction was classified into different categories of traditional Chinese medicine, and the etiology, pathogenesis and treatment methods were also studied. These studies provided a theoretical basis for this clinical study. Two, clinical research aims: To observe the two methods of oral administration of traditional Chinese medicine and traditional Chinese medicine enema, and the recovery of gastrointestinal function in patients with qi stagnation type SICU after non gastrointestinal surgery. The curative effect of the two methods was compared. Methods: the patients with SICU non gastrointestinal surgery were treated with TCM syndrome differentiation and 45 patients with qi stagnation syndrome were randomly divided into 3 groups: Oral Chinese medicine group, Chinese medicine enema group and control group. All 45 patients were given routine treatment after operation: such as oxygen inhalation, ECG monitoring, fasting, and antibiotics Prevention of infection, fluid infusion, acid suppression, analgesic and electrolyte balance treatment. From 6h after operation, all patients resumed self-feeding, after 12h, on the basis of the above treatment, oral Chinese medicine group plus Magnolia three material soup added (raw Magnolia 24g, rhubarb 10g, 20g, frying orange 9g); Chinese Medicine enema group added with Dachengqi Decoction plus flavor (raw Magnolia officinalis 30g, Coke areca 40g, raw rhubarb 30g, Paeonia lactiflora 30g, stir fry Fructus aurantii trifoliate 30g, Radix Glycyrrhiza 10g, mirabilite 30g, stir fried semen Raphani 40g). Oral Chinese medicine oral group oral traditional Chinese medicine 200ml, traditional Chinese medicine enema group each enema 100ml, the two groups are 2 times per day, until postoperative exhaust, defecation recovery (if patients in 12h after the operation of the exhaust defecation, then elimination of the case), outlook, then reject the case) view The time of the first exhaust and defecation of each patient was recorded at the time of 48h., and the recovery time of the bowel sounds was recorded, and the curative effect index was calculated according to the symptoms and signs of each patient before and after treatment. Results: (1) the recovery time of the postoperative bowel sounds was 34.32 + 3.64 hours in the control group, and the oral Chinese medicine group was 28.92 + 3.92 hours, the Chinese medicine enema group was 29.13 + 3.62 hours, the control group compared with the two treatment groups, there were significant differences, P value 0.01. two treatment groups, there was no significant difference, P=0.8780.05.. The first exhaust time, the control group was 37.05 + 4.55 hours, the oral Chinese medicine group was 29.97 + 4.12 hours, the Chinese medicine enema group was 31.78 + 5.22 hours, the control group compared with the two treatment groups, all of them were all There was no significant difference between the two treatment groups of the P value 0.01., P=0.3290.05. (3). The first defecation time, the control group was 41.45 + 3.59 hours, the oral Chinese medicine group was 32.17 + 4.08 hours, the Chinese medicine enema group was 32.03 + 5.11 hours, the control group was significantly different from that of the two treatment groups, and there was no significant difference between the 0.01. and the two treatment groups of the P value. The control group was 24.84% + 0.10, the control group was 24.84% + 0.10, the oral Chinese medicine group was 69.47% + 0.28, the traditional Chinese medicine enema group was 75.02% + 0.28, and the control group was significantly different from the two treatment groups. There was no significant difference between the P value 0.01. two treatment groups, and the control group, the control group, the Chinese medicine oral group and the Chinese medicine enema group were all effective. The rate of 30.77%, 82.35%, 86.67%. conclusion: Magnolia officinalis three soup plus orally, Dachengqi Decoction added enema can promote the recovery of early gastrointestinal function in patients with SICU after non gastrointestinal surgery, and improve the symptoms and signs of the gastrointestinal tract.
【学位授予单位】：北京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R269

【参考文献】