参联通结汤结肠滴注治疗恶性肠梗阻32例临床研究

Clinical Study of Intra -colonic Drip of Shenlian Tongjie Decoction for Malignant Bowel Obstruction: An Observation of 32 Cases

目的:观察参联通结汤结肠滴注治疗恶性肠梗阻(MBO)的临床疗效。方法:将62例MBO病例随机分为治疗组32例、对照组30例,2组患者均禁食,纠正水、电解质和酸碱平衡紊乱,给予鼻胃管胃肠减压、全胃肠外营养、对症用药(包括解痉剂、止痛剂、止呕剂)及皮下注射奥曲肽。对照组另予肥皂水灌肠;治疗组另予参联通结汤结肠滴注。2组均治疗6天为1疗程,治疗1～2疗程评定疗效。观察肠梗阻相关症状的变化、胃肠减压引流液量、排气排便恢复率、鼻胃管留置时间及拔管率、肠梗阻近期疗效以及KPS评分、阴离子间隙(AG)、C反应蛋白(CRP)的变化。结果:治疗组腹痛、腹胀、呕吐及对照组腹痛、呕吐症状评分均较治疗前均有明显下降(P<0.05),且治疗组腹胀、呕吐症状评分下降优于对照组(P<0.05);治疗组胃肠减压平均引流液量、排气排便恢复率、鼻胃管留置时间、拔管率与对照组比较,差异均有显著性或非常显著性意义(P<0.05,P<0.01);近期疗效有效率治疗组为84.37%,对照组为60.00%,2组比较,差异有显著性意义(P<0.05);治疗组KPS评分、AG、CRP改善均优于对照组(P<0.01)。结论:参联通结汤结肠滴注治疗MBO的临床效果较好。

Objective： To evaluate the clinical efficacy of intra-colonic drip of Shenlian Tongjie Decoction in the treatment of malignant bowel obstruction（MBO）. Methods： Sixty-two MBO patients were random- ized into treatment group（N=32） and control group（N=30）. Both groups were fasted, and their water, electrolyte and acid-base disorders were corrected. The patients in both groups were given gastrointestinal decompression through nasogastric tube, total parenteral nutrition, symptomatic treatment（including anti- spasmodic agents, analgesics, antiemetics） and subcutaneous injection of octreotide. Additionally, the patients in the control group were given soapy water enema once every morning and evening, and the treatment group was given intra-colonic drip of Shenlian Ton^ie Decoction, every 12h. Six days constituted one treatment course, and after 1 ~ 2 courses the efficacy was assessed. Changes of intestinal obstruc- tion symptoms（including frequency and severity of abdominal pain, bloating, vomiting） gastrointestinal decompression drainage volume, recovery rate of flatus and defecation, nasogastric tube retention time and extubation rate, short-term effect of intestinal obstruction and its Karnofsky Performance Status（KPS） anion gap（AG） and C-reactive protein（CRP） were observed. Results： The scores of abdominal pain, ab- dominal distention, and vomiting in treatment group as well as abdominal pain and vomiting in the control group were decreased significantly than those before treatment （P 〈 0.05） and the scores of abdominal distention and vomiting in the treatment group decreased more significantly than those in the control group （P 〈 0.05）. The average gastrointestinal decompression drainage volume, recovery rate of flatus and defe- cation, nasogastric tube retention time and extubation rate in the treatment group were significantly im- proved as compared with those in the control group（P 〈 0.05 or P 〈 0.01）. The short-term effective rate of treatment group was 84.37%, significantly higher 60.00% in the control group. KPS, AG and CRP in the treatment group were improved significantly（P 〈 0.01 compared with the control group）. Conclusion, In- tra-colonic drip of Shenlian Tongjie Decoction shows good clinical efficacy on malignant bowel obstruction.