四磨汤联合中药热奄包在促进先天性肠闭锁术后胃肠功能恢复中的作用

Simo decoction combined with hot package of traditional Chinese medicine in promoting recovery of gastrointestinal function after operation for congenital intestinal atresia

目的 探讨四磨汤联合中药热奄包的中医内外兼治通腑法在促进先天性肠闭锁术后胃肠功能恢复中的作用。方法 选择2015年1月至2018年12月本院收治的先天性小肠闭锁患儿80例,随机分为四组:对照组(G1)、四磨汤组(G2)、中药热奄包组(G3)和四磨汤联合中药热奄包组(G4),各20例,Grosfeld分型均为Ⅲa型,手术方式均采用肠闭锁切除+近端裁剪端斜吻合术,术后予禁食、胃肠减压及静脉营养支持治疗。观察组(四磨汤组、中药热奄包组、四磨汤联合中药热奄包组)于术后7d开始在常规治疗(继续禁食、胃肠减压及静脉营养支持治疗)的基础上分别加用单纯四磨汤治疗、单纯中药热奄包治疗和四磨汤联合中药热奄包治疗。对照组则仅予常规治疗(继续禁食、胃肠减压及静脉营养支持治疗)。比较各组术后胃肠功能恢复情况(肠鸣音恢复时间、术后肛门排便时间、术后开始进食时间、足量喂养时间、术后静脉营养时间),住院时间、住院费用及术后并发症、不良反应等指标。结果 四组患儿中,术前基本资料比较,差异均无统计学意义(均P>0.05);G4组术后肠鸣音恢复时间、术后肛门排便时间、术后开始进食时间、足量喂养时间、术后静脉营养持续时间分别为(35.83±16.7)h、(5.02±0.8)d、(5.25±0.6)d、(13.55±1.0)d、(12.96±0.8)d,均低于G1组,差异均有统计学意义(均P<0.05);G4组住院时间、住院费用分别为(14.90±1.33)d、(42958.50±2431.98)元,均低于G1组,差异均有统计学意义(均P<0.05);四组患儿无1例死亡,均未出现肠吻合口梗阻、吻合口瘘等并发症,无不良反应,预后良好。结论 新生儿Ⅲa型先天性小肠闭锁术后应用四磨汤口服液联合中药热奄包的中医内外兼治通腑法,可促进胃肠功能恢复,缩短住院时间,减少住院费用,且无明显不良反应,是一种值得推广的改善先天性肠闭锁术后疗效的中医治疗方法。

Objective To explore the effect of traditional Chinese medicine (TCM) internal and extemal treatment of Simo decoction combined with TCM hot package in promoting the recovery of gastrointestinal function after operation for congenital intestinal atresia.Methods 80 infants diagnosed with congenital intestinal atresia treated at our hospital from January,2015 to December,2018 were randomly divided into a control group (G1),a Simo decoction group (G2),a TCM hot package group (G3),and a Simo decoction group combined with TCM hot package group (G4),20 cases for each group.All the patients were type Ⅲ a in Grosfeld classification,and treated with surgical procedures of intestinal atresia resection and proximal cut end oblique anastomosis,postoperative fasting,gastrointestinal decompression,and parenteral nutrition support.In addition of routine treatment,such as fasting,gastrointestinal decompression,and parenteral nutrition support,group G2,G3,and G4 were treated with Simo decoction,TCM hot package,and combination of Simo decoction with TCM hot package,respectively.The postoperative gastrointestinal function recovery (bowel sound recovery time,postoperative defecation time,postoperative feeding time,sufficient feeding time,and postoperative parenteral nutrition time),hospitalization time,hospitalization cost,postoperative complications,and adverse reactions were compared between each two groups.Results There were no statistical differences in the preoperative data among the four groups.The bowel sound recovery time,postoperative defecation time,postoperative feeding time,and sufficient feeding time were (35.83±16.7) h,(5.02±0.8) d,(5.25±0.6) d,(13.55±1.0) d,and (12.96±0.8) d in group G4,which were shorter than those in group G1 (all P < 0.05).The hospital stay was (14.90±1.33) d and the hospitalization cost was (42 958.50±2 431.98) yuan in group G4,which were lower than those in group G1 (P < 0.05).None died,no complications such as intestinal anastomotic obstruction or anastomotic fistula and no adverse reactions occurred,and the prognosis was good in all the four groups.Conclusion TCM internal and external treatment of Simo decoction combined with TCM hot package can promote the recovery of gastrointestinal function after operation for congenital intestinal atresia of type Ⅲa in neonates,so it can reduce hospital stay and hospitalization cost.It is an effective TCM treatment for congenital intestinal atresia after operation.