中药内服外敷对腹部术后胃肠功能恢复的影响

Influence of Oral and External Therapy of Traditional Chinese Medicine to Recovery of Gastrointestinal after Abdominal Surgery

目的:探讨排气饮加减内服及中药外敷脐部对腹部术后胃肠功能恢复的疗效及对胃泌素(GAS)、胃动素(MTL)和血管活性肠肽(VIP)水平的影响。方法:选择126例腹部术后胃肠功能紊乱患者随机按数字表法分为西药组62例和中药组64例。两组术后均给予相应的基础处理措施。西药组口服枸橼酸莫沙必利片,5 mg/次,3次/d;中药组采用排气饮加减内服和中药外敷脐部治疗。两组疗程均为7 d。记录术后肠鸣音恢复时间;记录术后首次排气、排便时间;分别于术后第1,2,3,5,7天进行记录主要症状、体征评分;采用放射免疫法测定术后第1,2,3天患者GAS,MTL和VIP水平。结果:术后中药组肠鸣音恢复时间、首次排气和排便时间均短于西药组(P<0.01);术后第2天西药组主要症状、体征评分比术后1 d上升(P<0.01),然后逐渐下降;中药组术后第2天至术后7 d主要症状、体征评分呈下降趋势(P<0.01),术后第2,3,5,7天中药组主要症状、体征评分均低于西药组(P<0.01);术后第2天西药组GAS和MTL水平比术后1 d下降,VIP水平上升(P<0.01);术后第3天西药组GAS和MTL水平比术后2 d上升,VIP水平下降(P<0.01);术后第2,3天中药组GAS和MTL水平均呈上升趋势(P<0.01),术后第2天中药组VIP水平升高,但差异无统计学意义;术后第3天中药组VIP水平明显下降(P<0.01);术后第2,3天中药组GAS和MTL水平明显高于西药组,VIP水平低于西药组(P<0.01);治疗后西药组胃肠功能恢复优良率为40.32%,中药组为62.5%,中药组优于西药组(P<0.05)。结论:采用排气饮加减内服及中药外敷脐部能快速促进腹部术后患者胃肠功能的恢复,改善症状和体征,其作用机制可能与升高患者血清GAS和MTL水平,抑制VIP水平有关。

Objective： Discuss curative effect of addition and subtraction of Paiqi decoction taken orally combined with external application of Chinese medicine at navel to the recovery of gastrointestinal function and influence to levels of gastrin（GAS）,motilin（MTL） and vasoaetive intestinal peptide（VIP） after abdominal surgery. Method： One hundred and twenty-six patients with gastrointestinal dysfunction after abdominal surgery were randomly divided into western medicine group（62 cases） and Chinese medicine group（64 cases） by random number table. After the operation,both groups＇ patients received corresponding basic treatment. Patients in western medicine group received mosapride citrate tablets,5 mg /time,3 times /day,and taken orally. Patients in Chinese medicine group received addition and subtraction of Paiqi decoction combined with external application of Chinese medicine at navel. Course of treatment in two groups were both 7 days. After the operation,recovery time of gurgling sound,the first aerofluxus and defecation time were recorded. At the first,second,third,fifth and seventh day after the operation,scores of patients＇ main symptoms and signs were recorded. and at the first,second and third day after the operation, levels of GAS, MTL and VIP in blood were detected by radioimmunoassay. Result： After the operation, recovery time of gurgling sound, the first aerofluxus and defecation time in Chinese medicine group were all shorter than those in western medicine group（P〈0. 01）. At the second day after operation,compared with the first day,scores of patients＇ main symptoms and signs in western medicine group increased（P〈0. 01）, and then decreased gradually. At the second to seventh day after operation,there was a decreasing trending of scores of patients＇ main symptoms and signs in Chinese medicine group（P〈0. 01）,and at the second,third,fifth and seventh day after the operation,those scores were lower than in western medicine group（P〈0. 01）. At the second day after the operation,compared with the first day,levels of GAS and MTL in western medicine group were decreased,and level of VIP increased（P〈0. 01）. At the third day after the operation,compared with the second day,levels of GAS and MTL in western medicine group were increased,and level of VIP decreased（P〈0. 01）. At the second and third day after the operation,there was a increasing trending of levels of GAS and MTL in Chinese medicine group（P〈0. 01）,and at the second day after the operation, level of VIP increased, but there was no statistical significance from the differences. At the third day after the operation,level of VIP in Chinese medicine group decreased significantly（P〈0. 01）. At the second and third day after the operation,levels of GAS and MTL in Chinese medicine group were higher than those in western medicine group,and level of VIP was lower than western medicine group（P〈0. 01）. The excellent and good rate of gastrointestinal function in Chinese medicine group was 62. 5% superior to40. 32% in western medicine group（P〈0. 05）. Conclusion： Paiqi decoction combined with external application of Chinese medicine at navel can promote gastrointestinal function to recovery quickly,ameliorate symptoms and signs,its＇ mechanism of action may be related to improving levels of GAS and MTL and inhibiting level of VIP.