大承气汤加味灌肠治疗小儿术后炎性肠梗阻的临床观察
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摘要
目的:探讨大承气汤加味灌肠治疗小儿术后炎性肠梗阻(EPISBO)的疗效,及对炎症因子、胃肠动力和肠屏障功能的影响。方法:将106例患儿采用随机按数字表法分为对照组52和观察组54例。两组患儿均给予禁食水、胃肠减压、维持水电解质平衡、营养支持等基础治疗。对照组采用注射用生长抑素,0.003 5 mg·h~(-1)·kg~(-1),持续微泵泵入,连续3 d;口服醋酸地塞米松片,2.5～5 mg/次,2次/d;合并感染采用注射用头孢他啶,30～100 mg·kg~(-1),分2～3次静脉滴注。观察组基础治疗同对照组,并给予大承气汤加味灌肠,125 mL/次,2次/d。两组疗程均为连续治疗5 d。记录腹胀缓解时间、肠鸣音恢复时间、恢复排气、恢复排便时间和饮食恢复时间;记录住院时间和中转手术情况;进行治疗前后主要胃肠道症状、体征评分;检测治疗前后血清白细胞介素-6(IL-6),肿瘤坏死因子-α(TNF-α),超敏C-反应蛋白(hs-CRP),血管活性肠肽(VIP),胃泌素,胃动素,二胺氧化酶(DAO)和D-乳酸水平。结果:经秩和检验分析,观察组临床疗效优于对照组(P<0.05);观察组胃肠道功能指标(腹胀缓解时间、肠鸣音恢复时间、恢复排气、恢复排便时间、饮食恢复时间)恢复时间均短于对照组(P<0.05,P<0.01);观察组平均住院时间短于对照组(P<0.01),两组患儿中转手术率,经确切概率法分析,无统计学差异;观察组血清IL-6,TNF-α和hs-CRP水平均低于对照组(P<0.01);观察组VIP水平低于对照组,胃动素和胃泌素水平均高于对照组(P<0.05);观察组DAO,D-乳酸水平均低于对照组(P<0.01);观察组主要胃肠道症状、体征评分均低于对照组(P<0.01)。结论:在西医常规治疗的基础上,给予大承气汤加味灌肠治疗小儿EPISBO,能起到抗炎、调节胃肠激素和保护肠屏障功能作用,从而起到改善胃肠动力、减轻症状、缩短病程及提高临床疗效。
Objective:To discuss the clinical efficacy of modified Da Chengqitang by enema in treatment of postoperative inflammatory intestinal obstruction(EPISBO) after the operation and its effect on inflammatory factors,gastrointestinal motility and intestinal barrier function.Method:One hundred and six patients were randomly divided into control group(52 cases) and observation group(54 cases) by random number table.Patients in both groups were given fasting for solids and liquids,gastrointestinal decompression,maintaining water and electrolyte balance,nutritional support and other basic therapies.Patients in control group were given somatostatin for injection for continuous micro-pumping,0.003 5 mg·h-1·kg~(-1),dexamethasone acetate tablets,2.5-5 mg/time,2 time/days.Patients with concurrent infection got ceftazidime for injection,30-100 mg·kg~(-1),2-3 intravenous drips.In addition to the therapy of control group,patients in observation group were also given modified Da Chengqitang,125 mL/time,2 times/days.A course of treatment was 5 days.Time of remission of abdominal distention,recovery of exhaust gas,bowel sounds and diet,defecation,hospitalization and transitional surgery were recorded.And main gastrointestinal symptoms and signs were scored.And levels of serum interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),high-sensitivity C-reactive protein(hs-CRP),vasoactive intestinal peptide(VIP),gastrin,motilin,diamine oxidase and D lactic acid were detected.Result:After treatment,according to rank sum test analysis,the clinical efficacy in observation group was better than that in control group(P<0.05).And indicators of gastrointestinal function(abdominal distension relief time,bowel sounds recovery time,recovery of exhaust,defecation time and diet recovery time) were all shorter than those in control group(P<0.05,P<0.01).And average length of stay in observation group was shorter than that in control group(P<0.01).According to exact probability analysis,there was no statistical difference in conversion rate between the two groups.And levels of IL-6,TNF-α,hs-CRP,VIP,DAO,D-lactic acid and scores of main gastrointestinal symptoms and signs were all lower than those in control group(P<0.01),while levels of motilin and gastrin were higher than those in control group(P<0.01).Conclusion:In addition of routine therapy of western medicine,modified Dachengqi Tang had effects in resisting inflammation,regulating gastrointestinal hormones,and protecting intestinal barrier function,so can improve gastrointestinal motility,alleviate symptoms,shorten the course of disease and improve the clinical efficacy.
Objective:To discuss the clinical efficacy of modified Da Chengqitang by enema in treatment of postoperative inflammatory intestinal obstruction(EPISBO) after the operation and its effect on inflammatory factors,gastrointestinal motility and intestinal barrier function.Method:One hundred and six patients were randomly divided into control group(52 cases) and observation group(54 cases) by random number table.Patients in both groups were given fasting for solids and liquids,gastrointestinal decompression,maintaining water and electrolyte balance,nutritional support and other basic therapies.Patients in control group were given somatostatin for injection for continuous micro-pumping,0.003 5 mg·h-1·kg~(-1),dexamethasone acetate tablets,2.5-5 mg/time,2 time/days.Patients with concurrent infection got ceftazidime for injection,30-100 mg·kg~(-1),2-3 intravenous drips.In addition to the therapy of control group,patients in observation group were also given modified Da Chengqitang,125 mL/time,2 times/days.A course of treatment was 5 days.Time of remission of abdominal distention,recovery of exhaust gas,bowel sounds and diet,defecation,hospitalization and transitional surgery were recorded.And main gastrointestinal symptoms and signs were scored.And levels of serum interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),high-sensitivity C-reactive protein(hs-CRP),vasoactive intestinal peptide(VIP),gastrin,motilin,diamine oxidase and D lactic acid were detected.Result:After treatment,according to rank sum test analysis,the clinical efficacy in observation group was better than that in control group(P<0.05).And indicators of gastrointestinal function(abdominal distension relief time,bowel sounds recovery time,recovery of exhaust,defecation time and diet recovery time) were all shorter than those in control group(P<0.05,P<0.01).And average length of stay in observation group was shorter than that in control group(P<0.01).According to exact probability analysis,there was no statistical difference in conversion rate between the two groups.And levels of IL-6,TNF-α,hs-CRP,VIP,DAO,D-lactic acid and scores of main gastrointestinal symptoms and signs were all lower than those in control group(P<0.01),while levels of motilin and gastrin were higher than those in control group(P<0.01).Conclusion:In addition of routine therapy of western medicine,modified Dachengqi Tang had effects in resisting inflammation,regulating gastrointestinal hormones,and protecting intestinal barrier function,so can improve gastrointestinal motility,alleviate symptoms,shorten the course of disease and improve the clinical efficacy.
引文
[1]徐玉彬,张培建.术后早期炎症性肠梗阻的发病机制与诊治进展[J].中华普通外科学文献:电子版,2015,6(3):234-237.
[2]陈永满,孙立宝,徐渭贤,等.乌司他丁联用奥曲肽治疗小儿术后炎性肠梗阻的疗效及对血清炎性因子的影响[J].河北医药,2017,39(22):103-105.
[3]张忠涛,李宇.术后早期炎症性肠梗阻的诊断与治疗理念[J].中华普外科手术学杂志:电子版,2011,5(3):10-12.
[4]高聪,韩勇,林大勇,等.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[J].中国实验方剂学杂志,2017,23(16):176-181.
[5]莫黎,何永恒,康安定,等.枳实通降颗粒对结直肠肿瘤患者术后胃肠功能恢复及术后早期炎性肠梗阻防治作用的双中心前瞻性研究[J].中医杂志,2017,58(20):1760-1763.
[6]刘涛,雷星,刘勇峰,等.大承气汤加减治疗术后早期炎性肠梗阻的Meta分析[J].蚌埠医学院学报,2017,42(1):52-56.
[7]傅志泉,朱鹏翀,李清林,等.大承气汤治疗胃肠功能障碍的Meta分析[J].中华中医药学刊,2017,35(1):169-172.
[8]吴雪英,郑清盛,王守铭,等.大承气汤内服联合外用灌肠治疗粘连性肠梗阻的疗效观察[J].福建医药杂志,2018,40(3):101-103.
[9]吴阶平,裘法祖.黄家驷外科学[M].7版.北京:人民卫生出版社,2008:1492-1493.
[10]潘立群,崔学教,侯勇,等.中医外科学[M].北京:科学出版社,2007:99-102.
[11]孙明,王蔚文.临床疾病诊断与疗效判断标准[M].北京:科学技术文献出版社,2010:401-403.
[12]肖志强,钟卫权,刘其龙.白萝卜提取物对大鼠术后早期炎性肠梗阻血清炎症因子及胃肠动力的影响[J].中国当代医药,2018,25(20):4-7.
[13]沈彬彬.小儿阑尾穿孔术后炎性肠梗阻临床分析[J].浙江临床医学,2018,20(1):118-119.
[14]黄圣余,曾玉英,张清姬,等.小儿术后早期炎症性肠梗阻16例诊治体会[J].临床小儿外科杂志,2011,10(4):314-315.
[15]沈江立,李娜,焦云婷.加味六磨汤治疗结直肠癌术后早期炎症性肠梗阻临床研究[J].中医学报,2017,32(3):325-328.
[16]魏江存,陈勇,谢臻,等.大承气汤的药理作用研究概况[J].中国民族民间医药,2017,26(21):70-72,74.
[17]张洁慧,肖铁刚,阙任烨,等.大承气汤治疗胃肠功能障碍的临床及作用机制研究进展[J].中国中西医结合消化杂志,2019,27(1):72-76.
[18]张军,谢秀平.常规西药联合大承气汤化裁对于上消化道穿孔术后早期炎性肠梗阻患者hs-CRP,TNF-α及IL-6的影响[J].现代中西医结合杂志,2017,26(22):56-58.
[19]倪猛,樊宏伟,高改云.通腑运肠汤内服加灌肠治疗粘连性肠梗阻46例[J].中国实验方剂学杂志,2014,20(14):215-218.
[20]张丽秀,王称,王陆军,等.肠道屏障功能生化指标在新生儿坏死性小肠结肠炎分级中的意义[J].中国妇幼卫生杂志,2018,9(6):24-27,61.
[2]陈永满,孙立宝,徐渭贤,等.乌司他丁联用奥曲肽治疗小儿术后炎性肠梗阻的疗效及对血清炎性因子的影响[J].河北医药,2017,39(22):103-105.
[3]张忠涛,李宇.术后早期炎症性肠梗阻的诊断与治疗理念[J].中华普外科手术学杂志:电子版,2011,5(3):10-12.
[4]高聪,韩勇,林大勇,等.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[J].中国实验方剂学杂志,2017,23(16):176-181.
[5]莫黎,何永恒,康安定,等.枳实通降颗粒对结直肠肿瘤患者术后胃肠功能恢复及术后早期炎性肠梗阻防治作用的双中心前瞻性研究[J].中医杂志,2017,58(20):1760-1763.
[6]刘涛,雷星,刘勇峰,等.大承气汤加减治疗术后早期炎性肠梗阻的Meta分析[J].蚌埠医学院学报,2017,42(1):52-56.
[7]傅志泉,朱鹏翀,李清林,等.大承气汤治疗胃肠功能障碍的Meta分析[J].中华中医药学刊,2017,35(1):169-172.
[8]吴雪英,郑清盛,王守铭,等.大承气汤内服联合外用灌肠治疗粘连性肠梗阻的疗效观察[J].福建医药杂志,2018,40(3):101-103.
[9]吴阶平,裘法祖.黄家驷外科学[M].7版.北京:人民卫生出版社,2008:1492-1493.
[10]潘立群,崔学教,侯勇,等.中医外科学[M].北京:科学出版社,2007:99-102.
[11]孙明,王蔚文.临床疾病诊断与疗效判断标准[M].北京:科学技术文献出版社,2010:401-403.
[12]肖志强,钟卫权,刘其龙.白萝卜提取物对大鼠术后早期炎性肠梗阻血清炎症因子及胃肠动力的影响[J].中国当代医药,2018,25(20):4-7.
[13]沈彬彬.小儿阑尾穿孔术后炎性肠梗阻临床分析[J].浙江临床医学,2018,20(1):118-119.
[14]黄圣余,曾玉英,张清姬,等.小儿术后早期炎症性肠梗阻16例诊治体会[J].临床小儿外科杂志,2011,10(4):314-315.
[15]沈江立,李娜,焦云婷.加味六磨汤治疗结直肠癌术后早期炎症性肠梗阻临床研究[J].中医学报,2017,32(3):325-328.
[16]魏江存,陈勇,谢臻,等.大承气汤的药理作用研究概况[J].中国民族民间医药,2017,26(21):70-72,74.
[17]张洁慧,肖铁刚,阙任烨,等.大承气汤治疗胃肠功能障碍的临床及作用机制研究进展[J].中国中西医结合消化杂志,2019,27(1):72-76.
[18]张军,谢秀平.常规西药联合大承气汤化裁对于上消化道穿孔术后早期炎性肠梗阻患者hs-CRP,TNF-α及IL-6的影响[J].现代中西医结合杂志,2017,26(22):56-58.
[19]倪猛,樊宏伟,高改云.通腑运肠汤内服加灌肠治疗粘连性肠梗阻46例[J].中国实验方剂学杂志,2014,20(14):215-218.
[20]张丽秀,王称,王陆军,等.肠道屏障功能生化指标在新生儿坏死性小肠结肠炎分级中的意义[J].中国妇幼卫生杂志,2018,9(6):24-27,61.