奥曲肽联合复方大承气汤对腹部手术后早期炎性肠梗阻患者血清炎症因子水平的影响及疗效观察

Influence on Serum Inflammatory Factors Level and Efficacy of Octreotide Combined with Potent Purgative Decoction with Additions in Patients with Early Postoperative Inflammatory Bowel Obstruction (EPISBO) after Abdominal Operation

目的：探讨奥曲肽联合复方大承气汤对腹部手术后早期炎性肠梗阻（EPISBO）患者血清炎症因子水平的影响及疗效观察。方法：腹部手术后EPISBO患者78例分为观察组和对照组各39例。两组患者均予禁食禁水、胃肠减压、维持水电解质酸碱平衡、抗感染和胃肠外营养支持等基础治疗。对照组加用奥曲肽注射液0.1 mg,im,q8h;观察组在对照组基础上再加用复方大承气汤每日1剂,分2-3次口服或经胃管注入,两组疗程均为1周。观察并比较两组患者治疗前和治疗1周后血清超敏C反应蛋白（hs-CRP）和肿瘤坏死因子-α（TNF-α）水平的变化,并评估其临床效果及药品不良反应。结果：治疗1周后,两组患者血清hs-CRP和TNF-α水平均有明显下降（P〈0.05或P〈0.01）,且观察组下降值明显大于对照组（P〈0.05）。观察组临床总有效率为94.87%,明显优于对照组的79.49%（P〈0.05）。两组不良反应发生率比较差异无统计学意义（P〉0.05）。结论：奥曲肽联合复方大承气汤对腹部手术后EPISBO患者的疗效显著,安全性较好,其作用机制与降低血清hs-CRP和TNF-α水平,抑制肠道局部炎症反应有关。

Objective： To discuss the influence and curative effect of octreotide combined with potent purgative decoction with additions on serum inflammatory factors level in the patients with early postoperative inflammatory bowel obstruction （EPISBO） after abdominal operation. Methods： Totally 78 cases of patients with EPISBO after abdominal operation were divided into the observation group and the control group with 39 ones in each. The patients in the two groups were given the basic medical treatment, such as fasting, water deprivation, gastrointestinal decompression, maintenance of water, electrolyte and acid-bose balance, infection prevention, parenteral nutrition support and etc. The patients in the control group were given 0.1mg octreotide via hypodermic injection, q8h, while the patients in the observation group were additionally given potent purgative decoction with additions, one dose per day completed by twice or three times through mouth or nasogastric tube. The course of treatment was 1 week. The changes of serum hs-CRP and TNF-α levels in the two groups before the treatment and after the medical treatment were observed and compared, and the curative effect and adverse drug reactions （ADR） were evaluated as well. Results： After the one-week medical treatment, the serum hs-CRP and TNF-a levels in the two groups were obviously declined （P 〈 0.05 or P 〈 0.01 ）, and the declining rate in the observation group was much higher than that in the control group （P 〈0.05）, and the total clinical efficiency in the observation group （94.87%） was much higher than that in the control group （79.49%, P 〈 0.05 ）. Totally 3 and 5 cases of ADR were respectively appeared in the con- trol group and the observation group with mild symptom, and no statistical difference was shown between the two groups （P 〉 0.05 ）. Conclusion： Octreotide combined with potent purgative decoction with additions has significant curative effect in the patients with EPISBO after abdominal operation with high security, and the mechanisms are related with such effects as reducing serum hs-CRP and TNF-α levels and inhibiting local inflammatory response in intestinal tract.