中西医结合四联疗法治疗麻痹性肠梗阻的临床疗效观察

An observation on clinical effect of quadruple therapy of integrated traditional Chinese and western medicine for treatment of paralytic ileus

目的观察中西医结合四联疗法治疗麻痹性肠梗阻的临床疗效。方法采用前瞻性随机对照研究方法，选择天津市第一中心医院2015年1月至2016年2月确诊为麻痹性肠梗阻的住院患者95例，按计算机产生的随机数分为对照组（47例）和研究组（48例）。对照组给予西医常规治疗，研究组在西医常规治疗基础上加用四联疗法：前列地尔注射液10μg，静脉滴注（静滴），每日1次；血必净注射液40mL静滴，每日2次；凉膈散加减（由大黄10g、芒硝10g、栀子15g、连翘20g、黄芩15g、甘草6g、薄荷6卧竹叶10g、蜂蜜10g组成）胃管注入；取足三里、三阴交、天枢、合谷、阳陵泉、中脘、下脘、大肠腧等穴，用30号毫针直刺，平补平泻，留针30min，每日1次，共治疗72h。观察患者腹痛、腹胀、恶心呕吐、停止排气排便、肠鸣音减弱或消失、腹部X线异常例数，以及首次排便时间、肠鸣音恢复时间、症状消失时间，并统计临床疗效。结果两组治疗后腹痛、腹胀、恶心呕吐、停止排气排便、肠鸣音减弱或消失、腹部X线异常例数均较治疗前明显减少，除恶心呕吐外上述其余指标的减少程度均以研究组更显著（腹痛为7例比44例，腹胀为6例比45例，停止排气排便为3例比48例，肠鸣音减弱或消失为11例比43例，腹部x线异常为12例比48例）；研究组首次排便时间（h：22．65±6．72比34．35±5．38）、肠鸣音恢复时间（h：40．36±6．99比51．33±5．80）、症状消失时间（h：51．44±9．41比60．10±5．48）均较对照组明显缩短（均P〈0．05），总有效率较对照组明显提高[93．75％（45／48）比87．37％（37／47），P〈0．05]。结论中西医结合四联疗法治疗麻痹性肠梗阻疗效显著。

Objective To observe the clinical effect of the quadruple therapy of integrated traditional Chinese and western medicine for treatment of patients with paralytic ileus. Methods A prospective randomized control trial was conducted. Ninty-five patients with paralytic ileus diagnosed by Tianjin First Central Hospital from January 2015 to February 2016 were randomly divided into a control group （47 cases） and a research group （48 cases）. Routine western medical treatment was given to the patients in control group; on the basis of western medical routine treatment, quadruple therapy was applied to the patients in the research group, including alprostadil injection 10 p,g, intravenous drip, once a day; Xuebijing injection 40 mL, intravenous drip, twice a day; liangge powder with modification （ingredients or their dosages being added and/or subtracted） composed of rhubarb 10 g, mirabilite 10 g, gardenia 15 g, weeping forsythia 20 g, scutellaria 15 g, glycyrrhiza 6 g, mint 6 g, bamboo leaves 10 g, honey 10 g. administered by gastric tube; point selection principle： zusanli （ST36）, sanyinjiao （SP6）, tianshu （S25）, hegu （L14）, yanglingquan （GB34）, zhongwan （CV12）, xiawan （CV10）, dachangshu （CO7）etc. No.30 filiform needle was used to be perpendicularly inserted by moderate and equi-librious acupuncture technique, needle retaining being 30 minutes, once a day for 72 hours. The numbers of the patients with abdominal pain, abdominal distension, nausea and vomiting, absence of exhausting and defecation, gurgling sound attenuation or disappearance, abdominal X-ray abnormality, and the first defecation time, gurgling reappearance time, disappearance time of main symptoms were observed. The clinical effects of these two groups were statistically analyzed. Results After treatment in the two groups, the numbers of patients with abdominal pain, abdominal distension, nausea and vomiting, absence of exhausting and defecation, gurgling sound attenuation or disappearance, abdominal X-ray abnormality were all significantly reduced compared with those before treatment, except the nausea and vomiting symptom, the degrees of descent of other indexes were more remarkable in the research group （abdominal pain： 7 cases vs. 44 cases, abdominal distension： 6 cases vs. 45 cases, absence of exhausting and defecation： 3 cases vs. 48 cases, gurgling sound attenuation or disappearance： 11 cases vs. 43 cases, abdominal X-ray abnormality： 12 cases vs. 48 cases）, the time of first defecation in research group （hours： 22.65 ± 6.72 vs. 34.35 ± 5.38）, gurgling reappearance time （hours： 40.36 ± 6.99 vs. 51.33 ± 5.80）, symptom disappearance time （hours： 51.44 ± 9.41 vs. 60.10 ± 5.48） in research group were all shorter significantly than those in control group （all P 〈 0.05）. The total effective rate in the research group was obviously higher than that of the control group [93.75% （45/48） vs. 87.37% （37/47）, P 〈 0.05]. Conclusions The therapeutic effects of the quadruple therapy of integrated traditional Chinese and western medicine are remarkable for treatment of paralytic ileus.