清热利胆方联合西药治疗胆肠吻合术后反流性胆管炎随机平行对照研究
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摘要
[目的]观察清热利胆方联合西药治疗胆肠吻合术后反流性胆管炎疗效。[方法]使用随机平行对照方法,将56例住院患者按抽签法简单随机分为两组。对照组28例头孢呋辛钠1.5g/次,2次/d或左氧氟沙星0.2g/次,2次/d,奥美拉唑40mg/次,1/d,还原形谷胱甘肽1.8g/次,1次/d,并予补充电解质、补充维生素、调节肠道菌群等治疗,效差时结合静脉血培养药敏调整抗生素。治疗组28例清热利胆方(金钱草30g,茵陈15g,芒硝冲服10g,生大黄后下8g,威灵仙、郁金、白芍各10g,柴胡8g,枳实10g,山栀子12g,黄芩15g,甘草8g;脾胃亏虚加白术、薏苡仁;热毒炽盛加石膏、知母、牡丹皮、黄连;气滞血瘀加川楝子、延胡索、红花、丹参;肝肾阴虚加生地、旱莲草、女贞子;久病气虚加黄芪、党参;阴虚内热加青蒿、地骨皮、天花粉、淡竹叶),水煎400m L,早晚温服;西药治疗同对照组。连续治疗4周为1疗程。观测临床症状、总胆红素、谷丙转氨酶、谷草转氨酶、转肽酶、不良反应。治疗1疗程,判定疗效。56例出院后6个月随访。[结果]治疗组痊愈9例,有效17例,无效2例,总有效率96.32%;对照组痊愈4例,有效15例,无效9例,总有效率33.25%;治疗组疗效优于对照组(P<0.05)。总胆红素、谷草转氨酶、谷草转氨酶、转肽酶治疗组改善优于对照组(P<0.05)。两组56例出院后6月随访复发率治疗组明显优于对照组(P<0.05),死亡率治疗组和对照组无明显差异(P>0.05)。[结论]清热利胆方联合西药治疗胆肠吻合术后反流性胆管炎,疗效满意,无严重不良反应,值得推广。
[Objective] To observe the Qingre Lidan Fang combined western medicine in treatment of bile reflux after intestinal anastomosis cholangitis curative effect. [Method] Using random parallel control method, the 56 cases of hospitalized patients with simple random divided into two groups according to the draw method. Control group 28 cases of cefuroxime sodium 1.5 g/time, 2 times/d or levofloxacin 0.2 g/time, 2 times/d, omeprazole, 40 mg/time/1d, also prototype glutathione 1.8 g/1/d, and electrolytes, vitamin supplements, regulating intestinal flora, such as treatment, poor effect when combined with venous blood culture antibiotics susceptibility to adjust. Treatment group 28 cases Qingre Lidan Fang(desmodium 30 g, herba artemisiae 15 g, glauber's salt a blunt 10 g, raw rhubarb after 8g, each 10 g clematis root, radix curcumae, radix paeoniae alba, radix bupleuri 8g, 10 g of frutus aurantii immaturus, mountain gardenia 12 g, radix scutellariae, 15 g, licorice 8g; spleen deficiency and atractylodes, coix seed, toxic heat, ablaze with gypsum fibrosum, cortex moutan, rhizoma coptidis, qi and blood stasis and sichuan fruit, rhizoma corydalis, safflower, salvia miltiorrhiza, liver and kidney Yin deficiency, fructus ligustri lucidi, radix rehmanniae, dry lotus grass long illness qi deficiency plus astragalus, codonopsis, Yin deficiency with internal ACTS, to skin and bones, radix trichosanthis, lophatherum gracile), Fried 400 m L water, morning and evening temperature suit; Western medicine treatment with the control group. For treatment of 4 weeks to 1 course of treatment. Observation of clinical symptoms, total bilirubin, alanine aminotransferase, aspertate aminotransferase, transpeptidase, adverse reactions. As a course treatment, judge curative effect. 56 patients discharged from hospital after 6 months follow-up. [Result] 9 cases in treatment group recovered, 17 cases effective, ineffective in 2 cases, total effective rate was 96.32%; The control group recovered in 4 cases, 15 cases, 9 no effect, the total effective rate was 33.25%; The treatment group curative effect is better than that of control group(P< 0.05). Total bilirubin, aspertate aminotransferase, aspertate aminotransferase, transpeptidase the treatment group improved better than that of control group(P<0.05). Two groups of 56 patients discharged from hospital after 6 months follow-up recurrence rate in treatment group was better than control group(P<0.05), the death rate in treatment group and control group no significant difference(P>0.05). [Conclusion] Qingre Lidan Fang combined western medicine in treatment of bile reflux after intestinal anastomosis cholangitis, curative effect is satisfied, no serious adverse reactions, worthy of promotion.
[Objective] To observe the Qingre Lidan Fang combined western medicine in treatment of bile reflux after intestinal anastomosis cholangitis curative effect. [Method] Using random parallel control method, the 56 cases of hospitalized patients with simple random divided into two groups according to the draw method. Control group 28 cases of cefuroxime sodium 1.5 g/time, 2 times/d or levofloxacin 0.2 g/time, 2 times/d, omeprazole, 40 mg/time/1d, also prototype glutathione 1.8 g/1/d, and electrolytes, vitamin supplements, regulating intestinal flora, such as treatment, poor effect when combined with venous blood culture antibiotics susceptibility to adjust. Treatment group 28 cases Qingre Lidan Fang(desmodium 30 g, herba artemisiae 15 g, glauber's salt a blunt 10 g, raw rhubarb after 8g, each 10 g clematis root, radix curcumae, radix paeoniae alba, radix bupleuri 8g, 10 g of frutus aurantii immaturus, mountain gardenia 12 g, radix scutellariae, 15 g, licorice 8g; spleen deficiency and atractylodes, coix seed, toxic heat, ablaze with gypsum fibrosum, cortex moutan, rhizoma coptidis, qi and blood stasis and sichuan fruit, rhizoma corydalis, safflower, salvia miltiorrhiza, liver and kidney Yin deficiency, fructus ligustri lucidi, radix rehmanniae, dry lotus grass long illness qi deficiency plus astragalus, codonopsis, Yin deficiency with internal ACTS, to skin and bones, radix trichosanthis, lophatherum gracile), Fried 400 m L water, morning and evening temperature suit; Western medicine treatment with the control group. For treatment of 4 weeks to 1 course of treatment. Observation of clinical symptoms, total bilirubin, alanine aminotransferase, aspertate aminotransferase, transpeptidase, adverse reactions. As a course treatment, judge curative effect. 56 patients discharged from hospital after 6 months follow-up. [Result] 9 cases in treatment group recovered, 17 cases effective, ineffective in 2 cases, total effective rate was 96.32%; The control group recovered in 4 cases, 15 cases, 9 no effect, the total effective rate was 33.25%; The treatment group curative effect is better than that of control group(P< 0.05). Total bilirubin, aspertate aminotransferase, aspertate aminotransferase, transpeptidase the treatment group improved better than that of control group(P<0.05). Two groups of 56 patients discharged from hospital after 6 months follow-up recurrence rate in treatment group was better than control group(P<0.05), the death rate in treatment group and control group no significant difference(P>0.05). [Conclusion] Qingre Lidan Fang combined western medicine in treatment of bile reflux after intestinal anastomosis cholangitis, curative effect is satisfied, no serious adverse reactions, worthy of promotion.
引文
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[9]刘军舰,李忠廉,张西波.利胆扶正颗粒对恶性阻塞性黄疸患者外周血CD4+CD25+调节性T细胞水平的影响[J].辽宁中医杂志,2013,40(6):1067.
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[13]祝翠霞,王超洋,王宝枝.胆管空肠Roux-Y吻合术后胆道感染相关因素分析[J].中华医院感染学杂志,2011,21(10).
[2]黄志强.当代胆道外科学[M].上海:上海科学文献技术出版社,1998:507-509.
[3]中华人民共和国卫生部.涉及人的生物医学研究伦理审查办法(试行)[S].(2007-03-26)[2015-01-05].http://www.moh.gov.cn/qjjys/s3581/200804/b9f1bfee4ab344ec892e68097296e2a8.shtml.
[4]国家中医药管理局.中医病证诊断疗效标准[S].南京:南京大学出版社,1994:245,249,277.
[5]周仲瑛.中医内科学[M].北京:中国中医药出版社,2004:261-269.
[6]李德新.中医基础理论[M].北京:人民卫生出版社,2001:57.
[7]廉永红.周福生教授治疗慢性胆囊炎经验介绍[J].新中医,2012,44(2):140-141.
[8]刘梅举.和木舒胶囊治疗慢性胆囊炎100例临床观察[J].四川中医,2007,26(1):83.
[9]刘军舰,李忠廉,张西波.利胆扶正颗粒对恶性阻塞性黄疸患者外周血CD4+CD25+调节性T细胞水平的影响[J].辽宁中医杂志,2013,40(6):1067.
[10]刘磊磊,陈娟,师彦平.清热解毒中药抗肿瘤作用[J].中草药,2012,43(6):1203.
[11]潘磊,陈培丰.清热解毒中药抗肿瘤作用机理研究[J].中华中医药学刊,2007,25(3):569-571.
[12]力建,李绍强.对胆肠吻合术的再认识[J].中国实用外科杂志,2008,28(6):450-452.
[13]祝翠霞,王超洋,王宝枝.胆管空肠Roux-Y吻合术后胆道感染相关因素分析[J].中华医院感染学杂志,2011,21(10).