术尔泰联合医用几丁糖预防腹盆腔术后肠粘连的效果评价

The Effect of Combination of Shuertai and Chitosan on Preventing Intestinal Adhesion after Abdominal or Pelvic Surgery

目的探讨术尔泰联合医用几丁糖预防腹盆腔术后肠粘连的临床效果。方法选择2016年8月—2017年7月行腹盆腔手术治疗的188例,按照随机数字表法分为观察组和对照组,每组各94例。两组关腹前均予术尔泰清洗腹腔,观察组在此基础上加用医用几丁糖。观察两组术后胃肠功能恢复情况,比较术后药物不良反应发生率,检测术前、术后3 d炎性因子水平变化,记录肠粘连发生情况。结果两组术后均未发生药物不良反应。观察组术后肠鸣音恢复时间、排气恢复时间和排便恢复时间均显著短于对照组,比较差异有统计学意义(P<0.001)。与本组术前比较,两组术后白细胞介素(IL)-6、IL-10及肿瘤坏死因子-α(TNF-α)水平均升显著升高,差异有统计学意义(P<0.05);与对照组比较,观察组术后IL-6、IL-10及TNF-α水平降低,差异有统计学意义(P<0.001)。观察组、对照组肠粘连发生率分别为6.38%(6/94)、15.96%(15/94),差异有统计学意义(χ2=4.342,P=0.037)。结论术尔泰联合医用几丁糖可以更好地促进腹盆腔术后患者胃肠功能恢复,减轻炎症反应,预防肠粘连的发生,安全性高。

Objective To explore the clinical effect of combination of Shuertai and chitosan on preventing intestinal adhesion after abdominal or pelvic surgery. Methods A total of 188 patients who underwent abdominal or pelvic surgery from August 2016 to July 2017 were divided into observation group （ n =94） and control group （ n =94） according to random number table. Both groups were treated with Shuertai to clean the abdominal cavity before it was closed. On this basis, the observation group was coated with medical chitosan. The recovery of gastrointestinal function and adverse drug reactions after operation were compared between the two groups. The changes in inflammatory cytokines were measured before and at 3 d after the operation, and the occurrence of intestinal adhesions was recorded. Results No serious adverse reactions occurred in two groups after operation. The recovery time of bowel sound, the first exhaust time and the first defecation time were significantly shorter in the observation group than in the control group （ P 〈0.001）. The levels of IL-6, IL-10 and TNF-alpha in the two groups after operation were all increased, as compared with those before operation, and the differences were statistically significant （ P 〈0.05）. The levels of IL-6, IL-10 and TNF- alpha after operation were lower in the observation group than in the control group, and there were significant differences （ P 〈0.001）. The incidence of intestinal adhesion in the observation group and the control group was 6.38% （6/94） and 15.96% （15/94） respectively, suggesting significant differences （χ 2=4.342, P =0.037）. Conclusion The combined usage of Shuertai and chitosan can promote the recovery of gastrointestinal function of patients undergoing abdominal or pelvic surgery, alleviate the inflammatory response and prevent the occurrence of intestinal adhesion, which has high safety.