复方大承气汤保留灌肠治疗食管/贲门癌术后胃瘫

Enteroclyster with composite Dachengqi decoction in the treatment of gastroparesis syndromes after resection of esophageal carcinoma or cardiac carcinoma

目的:食管/贲门癌术后发生的胃瘫综合征,通常持续时间较长,严重影响了患者术后机体的功能恢复。观察复方大承气汤保留灌肠对治疗食管/贲门癌术后胃瘫的可行性及其临床价值。方法:选择2004-09/2006-04于南京中医药大学附属医院胸心外科行食管/贲门癌手术且术后出现胃瘫的患者共11例,男6例,女5例,平均(62.3±10.8)岁。复方大承气汤组方药物由大黄后下10g,芒硝冲5g,枳实10g,厚朴20g,桃仁10,赤芍10g,炒莱菔子30g组成。盐酸甲氧氯普胺注射液(胃复安)由上海禾丰制药有限公司生产(批准文号:国药准字H31021522,生产批号为:5A08006)。电脑将患者随机分为实验组和对照组。实验组6例,男女各半,平均年龄(60.1±10.8)岁。对照组5例,男3例,女2例,平均年龄(68.6±5.1)岁。两组患者年龄及性别构成比具有可比性,无统计学差异(χ2性别=0.1103,P=0.7398;χ2年龄=3.0359,P=0.0814,P均>0.05)。食管癌5例,其中上段癌1例,中段癌2例,下段癌2例;贲门癌6例。纳入标准:①已行食管/贲门癌手术的患者。②符合1994年3月第3届国际内镜及胃肠病学术研究会制定胃瘫的诊断标准。③已签署知情同意书者。④一般体质情况尚可。⑤未应用影响平滑肌收缩的药物,如654-2、阿托品等。排除标准:①不能耐受灌肠者。②不合作者。③患有糖尿病、结缔组织病或甲状腺功能减退者。④合并心、脑、肾及其他严重疾病。两均进行基础治疗。实验组用复方大承气汤100mL保留灌肠,2次/d;对照组用盐酸甲氧氯普胺注射液10mg肌注,2次/d。两组其他治疗措施相同。治疗前及治疗结束后检测患者血清胃泌素,记录肠鸣音的次数,评价患者治疗前后临床症状改善的程度及临床疗效。结果:11例患者均进入结果分析。①两组治疗前血清胃泌素、临床症状、肠鸣音次数无统计学差异(P>0.05)。②两组治疗后临床症状评分与治疗前相比,差异显著(Z=-10.5,P<0.05)。③实验组治疗后肠鸣音次数与治疗前比较,差异显著(Z=10.5,P<0.05)。④两组临床疗效比较,差异显著(实验组:痊愈:83.3%,好转:16.7%,无效:0;对照组:痊愈:20%,好转:40%,无效:40%,Z=4.49,P<0.05)。结论:复方大承气汤保留灌肠可治疗食管/贲门癌术后胃瘫,能有效地提高临床疗效,治疗效果优于胃复安。

AIM： To study the feasibility and clinical value of the enteroclyster with composite Dachengqi decoction （CDD） for gastroparesis syndromes after resection of esophageal carcinoma or cardiac carcinoma, which lasts for a long term and affects the functional recovery of patients. METHODS： Totally 11 patients with gastroparesis syndromes after resection of esophageal carcinoma or cardiac carcinoma were enrolled from Department of Cardiothoracic Surgery, Affiliated Hospital, Nanjing University of Traditional Chinese Medicine between September 2004 and Apdl 2006, including 6 males and 5 females, mean age of （62.3~10.8） years. CCD was consisted of 10 g rhubarb （last prescription）, 5 g sodium sulfate （powder preparation）, 10 g immature orange fruit, 20 g magnolia bark, 10 g peach seed, 10 g red peony root and 30 g stir-baked semen raphani. Metoclopramide Dihydrochloride Injection was produced by Shanghai Harvest Pharmaceutical Co., Ltd （Approval document： H31021522, Product number： 5A08006）. All the patients were randomized into： （1）Investigative group （n =6）： either gender, mean age of （60.1±10.8） years;（2）Control group （n =5）： 3 males and 2 females, mean age of （68.6±5.1） years. They were matched in age and gender constituent ratio, but no statistical difference was found （X^2=0.110 3, P =0.739 8; X^2=3.035 9, P =0.081 4, P〉 0.05）. Among 5 cases of esophageal carcinoma, there were one for superior segment, 2 for middle piece and 2 for inferior segment. Other 6 cases were cardiac carcinoma. Inclusive cdteria：（1） undergo resection of esophageal carcinoma or cardiac carcinoma; （2）in accordance with the diagnosis standard for gastroparesis by the Third International Academindegoc Association of Digestive Endoscope and Gastroenterology; （3） sign the informed consents; （4）in a fair fitness;（5）no application of drugs affecting smooth muscle contraction, such as 6,54-2, atropine. Exclusive criteria： （1）intolerant for enteroclyster; （2）loners; （3） patients with diabetes, connective tissue disease or hypothyrosis; （4）complicated with heart, brain, kidney and other serious disease. Investigative group was enteroclystered with 100 mL CDD for 6 days, twice one day. The patients of the control group were injected with Metoclopramide Dihydrochloride intramuscularly. The other treatments were the same in the two groups. Serological gastrin and the times of bowel sound were recorded before and after the different treatments. Besides, the extent of improving the patients＇ clinical syndromes and clinical effect was also evaluated. RESULTS： Totally 11 patients entered the result analysis.（1）The serological gastrin, times of bowel sound and the clinical syndromes had no statistic difference between the two groups before treatment （P 〉 0.05）.（2）The clinical syndromes had significant difference between the two groups before and after treatment （Z =-10.5, P 〈 0.05）. （3）The times of bowel sound in the two groups were also significantly different before and after treatment （Z=10.5, P 〈 0.05）. （4）There was significant difference in curative effects of the two groups （investigative group： healing： 83.3%; improved： 16.7%; ineffective： 0; control group： healing： 20%; improved： 40%; ineffective： 40%, Z =4.49, P 〈 0.05）. CONCLUSION： The enteroclystering with CDD can increases the clinical curative effects effectively in the gastroparesis syndromes after resection of esophageal carcinoma or cardiac carcinoma, and it is better than Metoclopramide Dihydrochloride.