复元活血汤对瘀血阻络型肝硬化脾功能亢进患者脾动脉栓塞术后综合征的干预疗效
|
摘要
目的:分析复元活血汤对瘀血阻络型乙型肝炎肝硬化脾功能亢进患者脾动脉栓塞(PSE)术后综合征的干预效应。方法:选择86例瘀血阻络型肝硬化脾功能亢进PSE术后患者进行观察,其中观察组44例,对照组42例。观察组及对照组均给予常规护肝、抗病毒、术后预防性抗感染及对症支持治疗,观察组于PSE术后第1天开始口服复元活血汤。观察两组患者术后7 d的疼痛程度评分、发热持续时间、腹胀便秘程度及生化指标改变。结果:与本组治疗前比较,两组患者PSE术后经治疗,γ-谷氨酰转肽酶(GGT),白细胞(WBC)水平均明显升高(P <0. 05),白蛋白(ALB)均明显下降(P <0. 05);手术前后丙氨酸氨基转移酶(ALT),天冬氨酸氨基转移酶(AST)平稳,无肝衰竭征象,ALT及AST无显著改变;观察组患者术后经口服复元活血汤治疗后,WBC水平明显高于对照组(P <0. 05);与对照组比较,观察组患者疼痛程度评分明显低于对照组(P <0. 05),而且发热持续时间明显短于对照组(P <0. 05);腹胀便秘缓解总有效率优于对照组(P <0. 05),且整个治疗过程中无明显不良反应,安全性良好。结论:复元活血汤可通过减轻患者疼痛、缩短发热持续时间及缓解腹胀便秘程度而有效干预PSE术后综合征。
Objective: To analyze the effect of Fuyuan Huoxuetang for the postoperative syndrome of partial splenic arterial embolization(PSE) in patients with hypersplenism of blood stasis type hepatic cirrhosis.Method: 86 patients with hypersplenism of blood stasis type hepatic cirrhosis treated with PSE were divided into observation group(44 cases) and control group(42 cases). Patients in both groups were treated with routine liver protection, antiviral, postoperative prophylactic anti-infection and symptomatic supportive care. Patients in treatment group started to take the Fuyuan Huoxuetang on the first day after the operation of PSE. The degree of pain,duration of fever,abdominal distention,and biochemical index changes of the two groups were observed 7 days after surgery. Result: After postoperative treatment,both groups of patients showed significant increases in the levels of-glutamyl transpeptidase(GGT) and white blood cell(WBC)(P < 0. 05),and significant decreases in albumin(ALB)(P < 0. 05). After surgery,alanine aminotransferase(ALT) and aspartate aminotransferase(AST) levels were stable,with no significant changes and no signs of liver failure. The WBC level of patients in observation group was significantly higher than that of control group(P < 0. 05) after the treatment with oral Fuyuan Huoxuetang. As compared with control group,the pain score was significantly lower in observation group(P <0. 05); the duration of fever was significantly shorter(P < 0. 05); the total effective rate of relieving abdominal distension constipation was higher(P < 0. 05),and there was no obvious adverse reaction during the whole treatment process,with good safety in observation group. Conclusion: Fuyuan Huoxuetang could effectively interfere with the postoperative syndrome of PSE in patients with hepatic cirrhosis combined with hypersplenism by reducing pain,shortening the duration of fever and relieving the degree of abdominal distension and constipation.
Objective: To analyze the effect of Fuyuan Huoxuetang for the postoperative syndrome of partial splenic arterial embolization(PSE) in patients with hypersplenism of blood stasis type hepatic cirrhosis.Method: 86 patients with hypersplenism of blood stasis type hepatic cirrhosis treated with PSE were divided into observation group(44 cases) and control group(42 cases). Patients in both groups were treated with routine liver protection, antiviral, postoperative prophylactic anti-infection and symptomatic supportive care. Patients in treatment group started to take the Fuyuan Huoxuetang on the first day after the operation of PSE. The degree of pain,duration of fever,abdominal distention,and biochemical index changes of the two groups were observed 7 days after surgery. Result: After postoperative treatment,both groups of patients showed significant increases in the levels of-glutamyl transpeptidase(GGT) and white blood cell(WBC)(P < 0. 05),and significant decreases in albumin(ALB)(P < 0. 05). After surgery,alanine aminotransferase(ALT) and aspartate aminotransferase(AST) levels were stable,with no significant changes and no signs of liver failure. The WBC level of patients in observation group was significantly higher than that of control group(P < 0. 05) after the treatment with oral Fuyuan Huoxuetang. As compared with control group,the pain score was significantly lower in observation group(P <0. 05); the duration of fever was significantly shorter(P < 0. 05); the total effective rate of relieving abdominal distension constipation was higher(P < 0. 05),and there was no obvious adverse reaction during the whole treatment process,with good safety in observation group. Conclusion: Fuyuan Huoxuetang could effectively interfere with the postoperative syndrome of PSE in patients with hepatic cirrhosis combined with hypersplenism by reducing pain,shortening the duration of fever and relieving the degree of abdominal distension and constipation.
引文
[1] Bashour F N,Teran J C,MuHen K D. Prevalence of peripheral blood cytopnias(hypersplenism)in patients with nonalcoholic chronic liver disease[J]. Am J Gastrouenterol,2000,95(10):2936-2939.
[2] Boyer T D,Habib S. Big spleens and hypersplenism:fix it or forget it?[J]. Liver Int,2015,35(5):1492-1498.
[3]陈刚,唐晓军,王涌臻,等.部分脾动脉栓塞治疗肝硬化继发脾功能亢进的疗效分析[J].现代医学,2016,44(3):345-348.
[4]郝伟远,虞希祥,朱国庆,等.三丙烯微球在部分性脾栓塞治疗继发性脾功能亢进中的临床应用[J].介入放射学杂志,2011,20(2):112-115.
[5] Tajiri T,0nda M,Yoshida H,et al. Long-term hematological and biochemical effects of partial splenic embolization in hepatic cirrhosis[J]. Hepatogastroenterology,2002,49(47):1445-1448.
[6] Smith M,Ray C E. Splenic artery embolization as an adjunctive procedure for portal hypertension[J]. Semin Interventional Radiol,2012,29(2):135-139.
[7]于长辉,黄纯炽,毛华,等.糖皮质激素与解热镇痛药治疗肝硬化脾栓术后综合征的疗效比较[J].南方医科大学学报,2013,33(10):1525-1528.
[8]李征然,邹艳,唐文杰,等.部分脾栓塞术后并发症及其处理[J].中国临床医学影像杂志,2000,11(6):415-417.
[9]王秀敏,董洪林.部分脾动脉栓塞术后发热机制及处理[J].中国实用医药,2007,2(27):37-39.
[10]刘乔.部分脾动脉栓塞术脾脓肿的预防[J].中华医院感染学杂志,2013,23(18):4540.
[11]孙刚庆.部分性脾栓塞治疗肝硬化门脉高压继发的脾功能亢进[J].当代医学,2012,18(6):71-72.
[12]邓鑫,文彬.肝硬化门静脉高压症的中医病机特点分析[J].辽宁中医杂志,2012,39(5):816-818.
[13]梁海珠,杨利学,孙香林.早期应用复元活血汤加减治疗单纯脊柱骨折临床观察[J].甘肃中医学院学报,2009,26(5):22-23.
[14]王卉,雷勇,黄金昶.复元活血汤治疗胸膜肿瘤疼痛[J].中国实验方剂学杂志,2011,17(21):304-306.
[15]中华医学会肝病学分会,中华医学会感染病学分会.慢性乙型肝炎防治指南(2015年更新版)[J].临床肝胆病杂志,2015,31(12):1941-1960.
[16]陈灏珠,林果为.实用内科学[M]. 13版.北京:人民卫生出版社,2009:2078-2079.
[17]中西医结合学会消化系统疾病专业委员会.肝硬化临床诊断、中医辨证和疗效评定标准(试行方案)[J].中国中西医结合杂志,1994,14(4):237-238.
[18] Feldt K S,Ryden M B,Miles S. Treatment of pain in cognitively impaired compared with cognitively intact older patients with hip-fracture[J]. J Am Geriatr Soc,1998,46(9):1079-1085.
[19]陈文彬,潘祥林.诊断学[M]. 8版.北京:人民卫生出版社,2013:8-9.
[20]国家中医药管理局.中医病证诊断疗效标准[M].南京:南京大学出版社,1994:11.
[21]梁彦,伊文静,贾战生,等.肝硬化患者脾功能亢进治疗研究进展[J].临床肝胆病杂志,2015,31(11):1924-1927.
[22]李征然,邹艳,唐文杰,等.部分脾栓塞术后并发症及其处理[J].中国临床医学影像杂志,2000,11(6):415-417.
[23]王东林,刘金朝,史岩鹏,等.部分性脾动脉栓塞术后并发症的原因及防治[J].山东医药,2005,45(30):57.
[24]秦建平,蒋明德,徐辉,等.部分脾动脉栓塞术后并发症的临床分析[J].四川医学,2008,29(1):16-18.
[25]廖文城,陈兰玲.肝硬化脾大及脾功能亢进的中医药治疗概况[J].湖南中医杂志,2014,30(4):169-171.
[26]祖丽红,王继文.复元活血汤抗炎镇痛作用的实验研究[J].中医正骨,2003,15(9):17-18,64.
[27]许大勇.复元活血汤对脊柱骨折患者术后炎性因子、凝血功能及疼痛程度的影响[J].中药药理与临床,2015,31(3):140-142.
[28]苏全武,李道本,朱佑明.加味复元活血汤防治大鼠肝纤维化研究[J].中国中西医结合消化杂志,2005,13(1):45-48.
[2] Boyer T D,Habib S. Big spleens and hypersplenism:fix it or forget it?[J]. Liver Int,2015,35(5):1492-1498.
[3]陈刚,唐晓军,王涌臻,等.部分脾动脉栓塞治疗肝硬化继发脾功能亢进的疗效分析[J].现代医学,2016,44(3):345-348.
[4]郝伟远,虞希祥,朱国庆,等.三丙烯微球在部分性脾栓塞治疗继发性脾功能亢进中的临床应用[J].介入放射学杂志,2011,20(2):112-115.
[5] Tajiri T,0nda M,Yoshida H,et al. Long-term hematological and biochemical effects of partial splenic embolization in hepatic cirrhosis[J]. Hepatogastroenterology,2002,49(47):1445-1448.
[6] Smith M,Ray C E. Splenic artery embolization as an adjunctive procedure for portal hypertension[J]. Semin Interventional Radiol,2012,29(2):135-139.
[7]于长辉,黄纯炽,毛华,等.糖皮质激素与解热镇痛药治疗肝硬化脾栓术后综合征的疗效比较[J].南方医科大学学报,2013,33(10):1525-1528.
[8]李征然,邹艳,唐文杰,等.部分脾栓塞术后并发症及其处理[J].中国临床医学影像杂志,2000,11(6):415-417.
[9]王秀敏,董洪林.部分脾动脉栓塞术后发热机制及处理[J].中国实用医药,2007,2(27):37-39.
[10]刘乔.部分脾动脉栓塞术脾脓肿的预防[J].中华医院感染学杂志,2013,23(18):4540.
[11]孙刚庆.部分性脾栓塞治疗肝硬化门脉高压继发的脾功能亢进[J].当代医学,2012,18(6):71-72.
[12]邓鑫,文彬.肝硬化门静脉高压症的中医病机特点分析[J].辽宁中医杂志,2012,39(5):816-818.
[13]梁海珠,杨利学,孙香林.早期应用复元活血汤加减治疗单纯脊柱骨折临床观察[J].甘肃中医学院学报,2009,26(5):22-23.
[14]王卉,雷勇,黄金昶.复元活血汤治疗胸膜肿瘤疼痛[J].中国实验方剂学杂志,2011,17(21):304-306.
[15]中华医学会肝病学分会,中华医学会感染病学分会.慢性乙型肝炎防治指南(2015年更新版)[J].临床肝胆病杂志,2015,31(12):1941-1960.
[16]陈灏珠,林果为.实用内科学[M]. 13版.北京:人民卫生出版社,2009:2078-2079.
[17]中西医结合学会消化系统疾病专业委员会.肝硬化临床诊断、中医辨证和疗效评定标准(试行方案)[J].中国中西医结合杂志,1994,14(4):237-238.
[18] Feldt K S,Ryden M B,Miles S. Treatment of pain in cognitively impaired compared with cognitively intact older patients with hip-fracture[J]. J Am Geriatr Soc,1998,46(9):1079-1085.
[19]陈文彬,潘祥林.诊断学[M]. 8版.北京:人民卫生出版社,2013:8-9.
[20]国家中医药管理局.中医病证诊断疗效标准[M].南京:南京大学出版社,1994:11.
[21]梁彦,伊文静,贾战生,等.肝硬化患者脾功能亢进治疗研究进展[J].临床肝胆病杂志,2015,31(11):1924-1927.
[22]李征然,邹艳,唐文杰,等.部分脾栓塞术后并发症及其处理[J].中国临床医学影像杂志,2000,11(6):415-417.
[23]王东林,刘金朝,史岩鹏,等.部分性脾动脉栓塞术后并发症的原因及防治[J].山东医药,2005,45(30):57.
[24]秦建平,蒋明德,徐辉,等.部分脾动脉栓塞术后并发症的临床分析[J].四川医学,2008,29(1):16-18.
[25]廖文城,陈兰玲.肝硬化脾大及脾功能亢进的中医药治疗概况[J].湖南中医杂志,2014,30(4):169-171.
[26]祖丽红,王继文.复元活血汤抗炎镇痛作用的实验研究[J].中医正骨,2003,15(9):17-18,64.
[27]许大勇.复元活血汤对脊柱骨折患者术后炎性因子、凝血功能及疼痛程度的影响[J].中药药理与临床,2015,31(3):140-142.
[28]苏全武,李道本,朱佑明.加味复元活血汤防治大鼠肝纤维化研究[J].中国中西医结合消化杂志,2005,13(1):45-48.