通腑法在结直肠手术前肠道准备中的应用
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摘要
目的:观察在择期经腹结直肠手术前口服通腑汤行肠道准备的临床效果及安全性。
方法:采用前瞻性随机对照研究,将2008年8月～2009年1月间入住南京市中医院行经腹结直肠手术患者30例,随机分为实验组15例和对照组15例。实验组在手术前两天开始口服通腑汤(生大黄30g(后下),制厚朴15g,炒枳实15g,芒硝10g),每日1付,每付煎两次10h、15h服用,每次300ml,术前连服两天进行肠道准备;对照组采用临床上较常用的3天肠道准备法,术前连续3d口服甲硝唑0.4g+丁氨卡那霉素1.0g,每天2次,术前1d口服硫酸镁50g。观察、比较两组患者对两种术前肠道准备的首次排便时间、排便次数、肠道准备耐受性、电解质紊乱情况、体重变化情况、肠道菌群的变化,记录手术后首次排气的天数,观察手术后切口、腹盆腔及其他部位有无感染、吻合口愈合情况。两组间计量资料用均数±标准差描述,计量资料比较采用独立样本t检验;计数资料比较采用卡方检验。检验水准取0.05,所有数据用SPSS 11.5 for windows软件进行统计学分析。
结果:两组患者年龄、性别构成、恶性肿瘤比例、手术方式均有可比性,在腹痛上实验组优于对照组,两组对比差异有显著性(P＜0.05)。总体依从性实验组优于对照组,两组对比差异有显著性(P＜0.05)。排便时间实验组长于对照组,两组对比差异有显著性(P＜0.05);排便次数实验组少于对照组,两组对比差异有显著性(P＜0.05)。肠道菌群紊乱率实验组低于对照组,两组对比有显著性差异(P＜0.05)。两组患者术后均未发现切口感染、盆腔或其他部位感染、吻合口漏现象的发生。肠道准备营养指标,体重丢失两组对比无显著性差异(P＞0.05)。肠道清洁度两组对比无显著性差异(P＞0.05)。术后首次排气天数两组对比无显著性差异(P＞0.05)。手术后外周血WBC数两组对比无显著性差异(P＞0.05)。
结论:通腑汤行结直肠术前肠道准备能得到满意的机械清肠效果和肠道除菌作用,并可能在维持肠道菌群平衡,提高患者舒适程度方面是有益的,而且没有增加手术并发症,安全有效,可以用于结直肠经腹手术前肠道准备。
Objective: In order to evaluate the effect and safety of Tong Fu Decoction used in the bowelpreparation of colorectal surgery.
Methods: A total of 30 patients undergone colorectal surgery who were in Nanjing MunicipalHospital of T.C.M between August 2008 and January 2009 were randomly divided into theExperimental group (n=15) and the Control group (n=15). Patients from the first group werereceived Tongfu Decoction (Dahuang 30g(later),Houpu 15g ,Zhishi 15g, Mangxiao 10g ) fromtwo days before the surgery, twice per-day. Each is 300ml. In the Control group, patients wereaccepted general three-day bowel preparation. We began to record the time and number ofdiarrhea, the scores of bowel preparation's complaint ,the weight lose, first exhaust after surgery.
Using the statistical software SPSS 11.5 database to obtain the result through statistics analysisadopting the t and x~2 test.
Results: Compared with the Control group, patients in the experimental group felt better with thebowel preparation, had less diarrhea occurred. And there was no significant difference in thequality. There was none complications such as anastomosis leakage, wound and abdominalinfections.
Conclusion: Tong Fu Decoction is a safe and reliable method for bowel preparation, it mayprevent the intestinal flora from disturbance.
方法:采用前瞻性随机对照研究,将2008年8月～2009年1月间入住南京市中医院行经腹结直肠手术患者30例,随机分为实验组15例和对照组15例。实验组在手术前两天开始口服通腑汤(生大黄30g(后下),制厚朴15g,炒枳实15g,芒硝10g),每日1付,每付煎两次10h、15h服用,每次300ml,术前连服两天进行肠道准备;对照组采用临床上较常用的3天肠道准备法,术前连续3d口服甲硝唑0.4g+丁氨卡那霉素1.0g,每天2次,术前1d口服硫酸镁50g。观察、比较两组患者对两种术前肠道准备的首次排便时间、排便次数、肠道准备耐受性、电解质紊乱情况、体重变化情况、肠道菌群的变化,记录手术后首次排气的天数,观察手术后切口、腹盆腔及其他部位有无感染、吻合口愈合情况。两组间计量资料用均数±标准差描述,计量资料比较采用独立样本t检验;计数资料比较采用卡方检验。检验水准取0.05,所有数据用SPSS 11.5 for windows软件进行统计学分析。
结果:两组患者年龄、性别构成、恶性肿瘤比例、手术方式均有可比性,在腹痛上实验组优于对照组,两组对比差异有显著性(P＜0.05)。总体依从性实验组优于对照组,两组对比差异有显著性(P＜0.05)。排便时间实验组长于对照组,两组对比差异有显著性(P＜0.05);排便次数实验组少于对照组,两组对比差异有显著性(P＜0.05)。肠道菌群紊乱率实验组低于对照组,两组对比有显著性差异(P＜0.05)。两组患者术后均未发现切口感染、盆腔或其他部位感染、吻合口漏现象的发生。肠道准备营养指标,体重丢失两组对比无显著性差异(P＞0.05)。肠道清洁度两组对比无显著性差异(P＞0.05)。术后首次排气天数两组对比无显著性差异(P＞0.05)。手术后外周血WBC数两组对比无显著性差异(P＞0.05)。
结论:通腑汤行结直肠术前肠道准备能得到满意的机械清肠效果和肠道除菌作用,并可能在维持肠道菌群平衡,提高患者舒适程度方面是有益的,而且没有增加手术并发症,安全有效,可以用于结直肠经腹手术前肠道准备。
Objective: In order to evaluate the effect and safety of Tong Fu Decoction used in the bowelpreparation of colorectal surgery.
Methods: A total of 30 patients undergone colorectal surgery who were in Nanjing MunicipalHospital of T.C.M between August 2008 and January 2009 were randomly divided into theExperimental group (n=15) and the Control group (n=15). Patients from the first group werereceived Tongfu Decoction (Dahuang 30g(later),Houpu 15g ,Zhishi 15g, Mangxiao 10g ) fromtwo days before the surgery, twice per-day. Each is 300ml. In the Control group, patients wereaccepted general three-day bowel preparation. We began to record the time and number ofdiarrhea, the scores of bowel preparation's complaint ,the weight lose, first exhaust after surgery.
Using the statistical software SPSS 11.5 database to obtain the result through statistics analysisadopting the t and x~2 test.
Results: Compared with the Control group, patients in the experimental group felt better with thebowel preparation, had less diarrhea occurred. And there was no significant difference in thequality. There was none complications such as anastomosis leakage, wound and abdominalinfections.
Conclusion: Tong Fu Decoction is a safe and reliable method for bowel preparation, it mayprevent the intestinal flora from disturbance.
引文
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