通腑运肠汤内服加灌肠治疗粘连性肠梗阻46例

Tongfu Yunchang Decoction Treat Adhesion Sex Intestinal Obstruction by Taken Orally and Enema Remedy with 46 Cases

目的:观察通腑运肠汤内服加灌肠治疗粘连性肠梗阻的临床疗效及对肠道屏障功能的保护机制。方法:92例患者采用随机按住院前后分为对照组和观察组各46例。对照组采用禁食、持续胃肠减压、补液、纠正酸碱平衡及水电解质紊乱;注射用头孢噻肟钠,4 g/次,静脉滴注,2次/d;奥曲肽,0.1 mg/次,皮下注射,3次/d。观察组在对照组治疗的基础上加用通腑运肠汤内服和灌肠,1剂/d。1个疗程5 d,可连续2个疗程。治疗期间严密观察患者病情变化,以决定是否采用手术治疗。记录两组排气、排便、胃管留置、饮食恢复及住院时间和中转手术例数;记录治疗前和治疗第5天主要症状、体征评分;检测治疗前和第5天血清白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、二胺氧化酶(DAO)和丙二酸(MDA)水平。结果:观察组总有效率为89.13%,优于对照组的71.74%(P<0.05);观察组排气时间、排便时间、胃管留置时间、饮食恢复时间及住院时间均短于对照组(P<0.01);对照组手术中转率为28.26%,观察组手术中转率为10.87%,观察组低于对照组(P<0.05);治疗后5 d,观察组腹胀腹痛、恶心呕吐、发热、肠鸣音及排气评分均低于对照组(P<0.01);治疗后5 d,观察组IL-6,TNF-α,DAO和MDA水平低于对照组(P<0.01)。结论:在西医常规治疗基础上,使用通腑运肠汤内服和灌肠能改善粘连性肠梗阻的临床症状、促进肠道功能的恢复,降低手术中转率,并能降低IL-6,TNF-α,DAO和MDA水平,显示通腑运肠汤对肠道屏障功能有一定的保护作用。

Objective： To observer the curative effect of Tongfu Yunchang decoction to treat adhesion sex intestinal obstruction by taken orally and enema remedy and protection mechanism to intestinal barrier function. Method： Ninety-two patients were randomly divided into control group （46 cases） and observation group （46 cases） according to digital method. Both groups received conventional western medicine treatment. Patients in control group received fasting, continuous gastrointestinal decompression, rehydration, balance acid-base and water electrolyte disorder. Control group patients took cefotaxime sodium, 4 g/time, intravenous drip, 2 does/ day, octreotide, 0. 1 mg/time, subcutaneous injectionm, 3 times/day. Based on the treatment of control group, patients in observation group added Tongfu Yunchang decoction by taken orally and enema remedy, 1 does/day. One treatment course for five days and they could received 2 continuous treatment courses. Closely observe patients＇ condition change to decide to use surgery or not during the treatment. Record exhaust time, defecation time, gastric tube indwelling time, recovery time, hospital stay-time and transit mode for two groups. Record the main signs and symptoms score before the treatment and at the fifth day during cure. Record the level of seruminterleukin-6 （IL-6） , tumor necrosis factor-α （TNF-α）, diamine oxidase （DAO） and malonic acid （MDA） at the fifth day during treatment. Result： The total effective rate in observation group was 89.13% superior to 71.74% in control group （P 〈 0. 05 ）. The exsufflation time, defecating time, indwelling time of gastric, delayed restoration of gastrointestinal function and length of stay in observation group were all shorter than those in control group （P 〈0.01）. Operating conversive rate in observation group was 28.26% lower than 10. 87% in control group （P 〈 0.05）. After five days of treatment, scores of abdominal distension and pain, nausea and vomit, fever, gurgling sound and exsufflation in observation group were all less than those in control group （P 〈 0.01）. Levels of IL-6, TNF-α, DAO and MDA in observation group were all less than those in control group （P 〈 0.01 ）. Conclusion ： Based on the treatment of conventional western medicine, Tongfu Yunchang decoction combined with clysis can ameliorate clinical symptoms of adhesive intestinal obstruction, accelerate recovery of intestinal function and reduce operating conversive rate, there was a significant curative efficacy. And it can also reduce levels of IL-6,TNF-α, DAO and MDA.