大柴胡汤联合常规疗法促进急性胆囊炎胆囊切除术后康复临床研究

Clinical Study on Dachaihu Tang Combined with Routine Therapy in Promoting Postoperative Rehabilitation for Acute Cholecystitis after Cholecystectomy

目的:观察在常规疗法基础上加用大柴胡汤促进急性胆囊炎胆囊切除术后患者康复的效果。方法:将94例胆腑郁热型急性胆囊炎胆囊切除术后患者分成对照组和观察组各47例。2组患者均行腹腔镜胆囊切除术,术后均给予禁食、补液、持续胃肠减压,维持水、电解质平衡,抗感染(注射用哌拉西林钠他唑巴坦钠)等常规治疗,疗程7~10 d。观察组加用大柴胡汤加减方治疗,疗程10 d。治疗前后检测谷丙转氨酶(ALT)、谷草转氨酶(AST)和总胆红素(TBil)水平;分别于治疗0、1、2、3、7和10 d进行血常规检测,记录白细胞(中性粒细胞)恢复正常的时间;记录体温恢复正常时间、疼痛减轻时间、肛门排气时间、进食时间和住院时间;评定胆腑郁热证评分。结果:治疗后,观察组证候疗效优于对照组(P<0.05)。2组TBil、ALT和AST水平均较治疗前下降(P<0.01);观察组TBil、ALT和AST水平均低于对照组(P<0.01)。观察组白细胞恢复正常时间、体温恢复正常时间、疼痛减轻时间均快于对照组,肛门排气时间、进食时间均较对照组提前,住院时间短于对照组,差异均有统计学意义(P<0.01)。结论:大柴胡汤加减方具有保肝、护肝作用,联合常规疗法治疗可有效减轻疼痛等症状,促进术后胃肠功能恢复,疗效显著,有利于术后患者的康复。

Objective:To observe the effect of Dachaihu tang based on routine therapy in promoting postoperative rehabilitation for patients with acute cholecystitis after cholecystectomy.Methods:Divided 94 cases of patients with cholecystitis of heat stagnation in gallbladder type after cholecystectomy into the control group and the observation group,47 cases in each group.Both groups received laparoscopic cholecystectomy.After operation,both groups received such routine treatments as fasting,fluid infusion,continuous gastrointestinal decompression,maintenance of water and electrolytes balance and anti-infection(piperacillin sodium and tazobactam sodium for injection),the course being 7 to 10 days.The observation group additionally received modified Dachaihu tang,the course being 10 days.Before and after treatment,detected the levels of alanine transaminase(ALT),aspartate transaminase(AST)and total bilirubin(TBiI).On 0,1,2,3,7 and 10 days of the treatment,conducted blood routine examination,recorded the recovery time of leukocyte(neutrophil);recorded the recovery time of body temperature,the time of pain relief,anal exsufflation,taking food and hospitalization;assessed the scores of heat stagnation in gallbladder syndrome.Results:After treatment,the curative effect of syndrome in the observation group was better than that in the control group(P<0.05).The levels of TBil,ALT and AST in the two groups were declined when compared with those before treatment(P<0.01);the levels of TBil,ALT and AST in the observation group were lower than those in the control group(P<0.01).The recovery time of leukocyte,the recovery time of body temperature and the time of pain relief,anal exsufflation,taking food in the observation group were faster than those in the control group(P<0.01),hospitalization in the observation group was respectively shorter than that in the control group(P<0.01).Conclusion:Modified Dachaihu tang prescription has effect in protecting and nourishing liver.When combined with routine therapy,it can effectively alleviate such symptoms as pain,promote the postoperative recovery of gastrointestinal function and enhance the postoperative rehabilitation.