稀碘伏灌肠联合中药对恶性梗阻性黄疸患者围手术期凝血功能的影响

Effect of Dilute Povidone Iodine Coloclysis and Taking Traditional Chinese Herbal Drug in the Perioperative Period on Blood Coagulation Function of Patients with Malignant Obstructive Jaundice

目的:研究恶性梗阻性黄疸患者围手术期的血清内毒素水平及凝血功能的动态变化,探讨应用中西医结合肠道清洁去污的临床意义。方法:选择恶性梗阻性黄疸行胰十二指肠切除手术患者56例,按照随机数字表分为治疗组(A组,n=28)和治疗对照组(B组,n=28),另设正常对照组(C组,n=20)。A组入院后除术前一般准备外,另外每日服用中药茵陈小承气汤和生理盐水碘伏灌肠,B组行常规术前准备。观察监测两组患者术前、术后血清内毒素(plasma endotoxin,PE)、凝血功能。结果:A、B两组入院时PE、活化部分凝血激酶时间(APTT)、纤维蛋白原(FG)、D-二聚体(D-D)、血浆凝血酶原时间(PT)与C组比较差异有统计学意义(P<0.05),A、B两组比较差异无统计学意义(P>0.05)。A、B两组术前及术后PE、FG、D-D与APTT相比差异均有统计学意义(P<0.05),术前及术后A组PE、FG、D-D与APTT下降幅度明显大于B组(P<0.05)。结论:恶性梗阻性黄疸患者均存在不同程度的内毒素血症及凝血功能障碍,术前应用稀碘伏灌肠联合中药口服治疗能清洁胃肠道,降低内毒素血症,改善术前的高凝状态和术后的出血倾向及DIC的发生。

Objective： To study the dynamic condition of endotoxin levels and blood coagulation function of patients with malignant obstructive jaundice in the perioperative period and clinical significance of cleaning intestinal tract by using the method of integrated traditional and western medicine.Method： 56 patients with malignant obstructive jaundice who were prepared for operation were divided into the treatment group （ A group, n=28 ） and the control group （ B group, n=28 ）, and the normal control group （ C group, n=20 ） .Besides general preoperative preparation, Chinese herbs-Xiao Cheng Qi Decoction of Orintal Wormwood was taken and normal saline iodophor diluent enema were carried out in A group.Routine preoperative preparation was excuted in B group. The kinetic changes of plasma endotoxin （ PE ） levels and blood coagulation function during the perioperative period were compared.Result： The plasma endotoxin （ PE ）, fibrinogen （ FG ）, D-dimer （ D-D ）, prothrombin time （ PT ） and activated partial thromboplastin time （ APTT ） levels of A group and B group were obviously different contrast to these of C group on admission to hospital （ P〈0.05 ）, but the differences were not significant between A group and B group （ P〉0.05 ） .And PE, FG, D-D, PT and APTF levels of A group and B group were obviously different in the perioperative period （ P〈0.05 ）, and the differences were significant between A group and B group （ P〈0.05 ）, and PE, FG, D-D, PT and APTF levels of A group decreased more obviously than those of B group （ P〈0.05 ） .Conclusion： The patients with malignant jaundice all have endotoxemiaand dysfunction of blood coagulationto some extent.The use of the therapy with dilute Povidone Iodine coloclysis and taking Chinese herbs- Xiao Cheng Qi Decoction of Orintal Wormwood before operation can clean gastrointestinal tract, decrease the rate of endotoxeniia, improve hypercoagutation state before operation and decrease the rate of bleeding tendency and disseminated intravascular coagulation （ DIC ） .