厚朴排气合剂治疗重型颅脑损伤并胃瘫患者的临床研究
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摘要
目的探讨中成药厚朴排气合剂治疗重型颅脑损伤并胃瘫患者的有效性。方法选取2012年1月至2016年6月入住解放军第一八〇医院的重型颅脑损伤并胃瘫患者125例,按随机数字表法将患者分为研究组(63例)和对照组(62例)。研究组患者于确诊并发胃瘫后予以经胃管注入厚朴排气合剂50 m L,每天2次,连续治疗1~3 d;对照组患者于确诊并发胃瘫后予以经胃管注入莫沙必利片5 mg,每天3次,连续治疗1~3 d。两组患者的其他治疗如脱水、预防感染、营养支持等措施均基本相同。记录两组患者用药前及用药后72 h的腹内压、腹围变化,用药后首次排便时间及用药后72 h亚甲蓝排泄试验尿液变蓝色的时间。用药后72 h评价两组患者胃肠功能恢复总体情况。观察两组患者治疗前后生命体征的变化及治疗过程中的毒副作用。对数据进行t检验和χ~2检验。结果治疗前两组患者腹内压、腹围差异均无统计学意义(P值均大于0.05);用药后72 h研究组患者的腹内压为(1.75±0.50)k Pa,对照组为(2.08±0.54)k Pa,两组比较差异有统计学意义(t=3.55,P<0.05);用药后72 h研究组患者的腹围为(115.6±11.4)cm,对照组为(121.8±12.6)cm,两组比较差异有统计学意义(t=2.89,P<0.05);用药后首次排便时间研究组为(39.3±10.7)h,要明显早于对照组(52.8±13.4)h,比较差异有统计学意义(t=6.26,P<0.05);用药后72 h,研究组亚甲蓝排泄试验尿液变蓝色时间为(4.3±1.2)h,明显短于对照组(5.9±1.7)h,两组比较差异有统计学意义(t=6.09,P<0.05);用药后72 h研究组胃肠功能恢复总有效率为88.89%(56/63),对照组为72.58%(45/62),比较差异有统计学意义(χ~2=5.36,P<0.05)。两组治疗前后患者生命体征无变化,均未见毒副作用。结论厚朴排气合剂可以明显促进重型颅脑损伤并胃瘫患者的胃肠功能恢复,且临床使用安全。
Objective To explore the efficacy of houpu paiqi mixture in treatment of patients with serious craniocerebral trauma complicated with gastroparesis. Methods One hundred and twenty five patients with serious craniocerebral trauma complicated with gastroparesis were admitted to the 180 th Hospital of People's Liberation Army from January 2012 to June 2016. They were randomly divided into study group( 63 cases) and control group( 62 cases) according to the random number table method. After diagnosis of gastric paralysis complicated,patients in study group were injected with houpu paiqi mixture 50 m L twice a day for 1 to 3 days. Patients in the control group were given 5 mg of mosapride tablets via gastric tube 3 times a day for 1 to 3 days. Other treatment measures as dehydration,prevention of infection,nutrition nerves,nutritional support,inhibition of gastric acid and etc. were basically the same in both groups. Intraabdominal pressure,abdominal circumference changes before and 72 h after treatment,first defecation time after treatment were recorded in both groups. The time of urine turning blue by methylene blue excretion test,gastrointestinal function to restore the situation 72 h after treatment of the two groups were recorded.The changes of vital signs before and after the treatment and the toxic and side effects in the course of treatment of the two groups were observed. Data were processed with t test and Chi-square test.Results There were no significant differences in intra-abdominal pressure and abdominal circumference between the two groups before treatment( with P values above 0. 05). The patients of the intra-abdominal pressure 72 h after treatment was( 1. 75 ± 0. 50) k Pa in the study group,which was( 2. 08 ± 0. 54) k Pa in the control group,the difference between the two groups was statistically significant( t = 3. 55,P < 0. 05).The abdominal circumference of the study group 72 h after treatment was( 115. 6 ± 11. 4) cm,the control group was( 121. 8 ± 12. 6) cm,the difference between the two groups was statistically significant( t = 2. 89,P < 0. 05). The first defecation time after treatment was( 39. 3 ± 10. 7) h in the study group,significantly earlier than the control group( 52. 8 ± 13. 4) h,the difference between the two groups was statistically significant( t = 6. 26,P < 0. 05). The time of urine turning blue by the methylene blue excretion test( 4. 3 ± 1. 2) h in the study group was significantly earlier than the control group( 5. 9 ± 1. 7) h,the difference between the two groups was statistically significant( t = 6. 09,P < 0. 05). The total effective rate of gastrointestinal function recovery was 88. 89%( 56/63) in the study group,which was 72. 58%( 45/62)in the control group,the difference was statistically significant( χ~2= 5. 36,P < 0. 05). There were no changes in vital signs before and after the treatment in the two groups,and no toxic or side effects were observed. Conclusion Houpu paiqi mixture can significantly promote gastrointestinal function in patients with serious craniocerebral trauma complinicated with gastroparesis,and it is safe to clinical application.
Objective To explore the efficacy of houpu paiqi mixture in treatment of patients with serious craniocerebral trauma complicated with gastroparesis. Methods One hundred and twenty five patients with serious craniocerebral trauma complicated with gastroparesis were admitted to the 180 th Hospital of People's Liberation Army from January 2012 to June 2016. They were randomly divided into study group( 63 cases) and control group( 62 cases) according to the random number table method. After diagnosis of gastric paralysis complicated,patients in study group were injected with houpu paiqi mixture 50 m L twice a day for 1 to 3 days. Patients in the control group were given 5 mg of mosapride tablets via gastric tube 3 times a day for 1 to 3 days. Other treatment measures as dehydration,prevention of infection,nutrition nerves,nutritional support,inhibition of gastric acid and etc. were basically the same in both groups. Intraabdominal pressure,abdominal circumference changes before and 72 h after treatment,first defecation time after treatment were recorded in both groups. The time of urine turning blue by methylene blue excretion test,gastrointestinal function to restore the situation 72 h after treatment of the two groups were recorded.The changes of vital signs before and after the treatment and the toxic and side effects in the course of treatment of the two groups were observed. Data were processed with t test and Chi-square test.Results There were no significant differences in intra-abdominal pressure and abdominal circumference between the two groups before treatment( with P values above 0. 05). The patients of the intra-abdominal pressure 72 h after treatment was( 1. 75 ± 0. 50) k Pa in the study group,which was( 2. 08 ± 0. 54) k Pa in the control group,the difference between the two groups was statistically significant( t = 3. 55,P < 0. 05).The abdominal circumference of the study group 72 h after treatment was( 115. 6 ± 11. 4) cm,the control group was( 121. 8 ± 12. 6) cm,the difference between the two groups was statistically significant( t = 2. 89,P < 0. 05). The first defecation time after treatment was( 39. 3 ± 10. 7) h in the study group,significantly earlier than the control group( 52. 8 ± 13. 4) h,the difference between the two groups was statistically significant( t = 6. 26,P < 0. 05). The time of urine turning blue by the methylene blue excretion test( 4. 3 ± 1. 2) h in the study group was significantly earlier than the control group( 5. 9 ± 1. 7) h,the difference between the two groups was statistically significant( t = 6. 09,P < 0. 05). The total effective rate of gastrointestinal function recovery was 88. 89%( 56/63) in the study group,which was 72. 58%( 45/62)in the control group,the difference was statistically significant( χ~2= 5. 36,P < 0. 05). There were no changes in vital signs before and after the treatment in the two groups,and no toxic or side effects were observed. Conclusion Houpu paiqi mixture can significantly promote gastrointestinal function in patients with serious craniocerebral trauma complinicated with gastroparesis,and it is safe to clinical application.
引文
1廖圣芳,王玉差,陈汉民,等.重型颅脑损伤并发胃瘫76例临床分析[J].临床军医杂志,2013,41(5):475-477.
2 张剑杰,孙勤,许信龙.颅脑外伤并发胃瘫的临床观察[J].浙江创伤外科,2009,14(6):557-558.
3 Pilit sis JG,Rengachary SS.Complications of head injury[J].J Neurol Res,2001,23(2/3):227-236.
4 朱俊卿.应用鼻肠管治疗特重型颅脑损伤的远期疗效分析[J].中国综合临床,2008,24(10):1070.
5 梁斌,张军,沈凯,等.厚朴排气合剂对开腹胃肠道手术后胃肠功能恢复影响的多中心前瞻性研究[J].中华消化外科杂志,2012,11(6):574-578.
6 何玲,齐小雪,谷霞.厚朴排气合剂促进剖宫产术后肠道功能恢复效果观察[J].现代中西医结合杂志,2013,22(20):2219-2220.
7 杨丽娜,王立,单梅.厚朴排气合剂对妇科术后患者胃肠功能恢复影响[J].临床军医杂志,2016,44(8):853-855.
8 廖圣芳,陈汉民,吴国鑫,等.亚甲蓝排泄试验在重型颅脑损伤早期合理营养支持中的应用研究[J].中国综合临床,2013,29(9):956-960.
9 王汉东,马驰原.重视颅脑外伤患者的营养支持[J].中华神经外科杂志,2012,28(11):1081-1082.
10 廖圣芳,陈汉民,张义王,等.鼻空肠管营养加鼻胃管减压在重型颅脑损伤并胃瘫中的应用研究[J/CD].中华损伤与修复杂志(电子版),2014,9(3):277-281.
11 龚建明,林勇.厚朴的现代研究与进展[J].东南国防医药,2008,10(2):125-126.
12 蔺亚平,权冬,易嵘.大黄药理作用的新进展[J].总装备部医学学报,2007,9(3):141-143.
13 林明侠.木香的药理及临床研究概况[J].中医药信息,2005,22(3):18-19.
14 王翠芬,杨德治,魏义全,等.枳实对大鼠胃肠电活动影响的初步研究[J].东南大学学报(医学版),2001,20(3):153-154.
15 朱玲,杨峰,唐德才.枳实的药理研究进展[J].中医药学报,2004,32(2):64-66.
16 杜卖奇,王晓素,苏暾,等.厚朴排气合剂治疗功能性消化不良的多中心随机对照临床研究[J].中华消化杂志,2016,36(6):412-417.
17 廖翠玲,张超.治疗早期肠麻痹新药-厚朴排气合剂[J].中南药学,2008,6(1):123-124.
18 欧阳斐,万敏,黄雯洁,等.观察肠内营养联合中药对重型颅脑损伤手术期患者营养指标及胃肠道功能的影响[C]//中国中药杂志2015/专集:基层医疗机构从业人员科技论文写作培训会议论文集,2016:2172.
19 白琳,史颜梅,周雅婷,等.腹内压测量的研究进展[J].护理学杂志,2016,31(11):109-112.
20 Ziebell JM,Morganti-Kossmann MC.Involvement of pro-and antiinflammatory cytokines and chemokines in the pathophysiology of traumatic brain injury[J].Neurotherapeutics,2010,7(1):22-30.
2 张剑杰,孙勤,许信龙.颅脑外伤并发胃瘫的临床观察[J].浙江创伤外科,2009,14(6):557-558.
3 Pilit sis JG,Rengachary SS.Complications of head injury[J].J Neurol Res,2001,23(2/3):227-236.
4 朱俊卿.应用鼻肠管治疗特重型颅脑损伤的远期疗效分析[J].中国综合临床,2008,24(10):1070.
5 梁斌,张军,沈凯,等.厚朴排气合剂对开腹胃肠道手术后胃肠功能恢复影响的多中心前瞻性研究[J].中华消化外科杂志,2012,11(6):574-578.
6 何玲,齐小雪,谷霞.厚朴排气合剂促进剖宫产术后肠道功能恢复效果观察[J].现代中西医结合杂志,2013,22(20):2219-2220.
7 杨丽娜,王立,单梅.厚朴排气合剂对妇科术后患者胃肠功能恢复影响[J].临床军医杂志,2016,44(8):853-855.
8 廖圣芳,陈汉民,吴国鑫,等.亚甲蓝排泄试验在重型颅脑损伤早期合理营养支持中的应用研究[J].中国综合临床,2013,29(9):956-960.
9 王汉东,马驰原.重视颅脑外伤患者的营养支持[J].中华神经外科杂志,2012,28(11):1081-1082.
10 廖圣芳,陈汉民,张义王,等.鼻空肠管营养加鼻胃管减压在重型颅脑损伤并胃瘫中的应用研究[J/CD].中华损伤与修复杂志(电子版),2014,9(3):277-281.
11 龚建明,林勇.厚朴的现代研究与进展[J].东南国防医药,2008,10(2):125-126.
12 蔺亚平,权冬,易嵘.大黄药理作用的新进展[J].总装备部医学学报,2007,9(3):141-143.
13 林明侠.木香的药理及临床研究概况[J].中医药信息,2005,22(3):18-19.
14 王翠芬,杨德治,魏义全,等.枳实对大鼠胃肠电活动影响的初步研究[J].东南大学学报(医学版),2001,20(3):153-154.
15 朱玲,杨峰,唐德才.枳实的药理研究进展[J].中医药学报,2004,32(2):64-66.
16 杜卖奇,王晓素,苏暾,等.厚朴排气合剂治疗功能性消化不良的多中心随机对照临床研究[J].中华消化杂志,2016,36(6):412-417.
17 廖翠玲,张超.治疗早期肠麻痹新药-厚朴排气合剂[J].中南药学,2008,6(1):123-124.
18 欧阳斐,万敏,黄雯洁,等.观察肠内营养联合中药对重型颅脑损伤手术期患者营养指标及胃肠道功能的影响[C]//中国中药杂志2015/专集:基层医疗机构从业人员科技论文写作培训会议论文集,2016:2172.
19 白琳,史颜梅,周雅婷,等.腹内压测量的研究进展[J].护理学杂志,2016,31(11):109-112.
20 Ziebell JM,Morganti-Kossmann MC.Involvement of pro-and antiinflammatory cytokines and chemokines in the pathophysiology of traumatic brain injury[J].Neurotherapeutics,2010,7(1):22-30.