微生物制剂联合粘连松解汤治疗结直肠癌术后早期炎性肠梗阻的临床观察

Clinical Value of Sequential Application of Microbial Preparations and Nianlian Songjie Decoction in the Treatment of Early Inflammatory Bowel Obstruction After Colorectal Cancer Surgery

目的探究微生物制剂和中药序贯应用在结直肠癌术后早期炎性肠梗阻(EPISBO)治疗中的临床疗效。方法选取2017年9月—2019年3月期间结直肠癌手术后罹患EPISBO的患者60例,根据入院顺序随机分为治疗组和对照组,每组30例。对照组采用既往传统行之有效的综合治疗方案,治疗组在对照组治疗基础上加用肠道微生物制剂与中药粘连松解汤治疗,两组均治疗4周。应用肠道功能病情程度量表(IBS-SSS量表)观察比较两组患者治疗前后的肠道功能状况;应用WHO生存质量量表(WHOQOL-100量表)观察比较两组患者治疗4周后的身心情况;同时观察比较两组患者治疗前后降钙素原(PCT)、白细胞(WBC)、白介素2(IL-2)、白介素6(IL-6)、C反应蛋白(hs-CRP)、肿瘤坏死因子(TNF-α)的水平变化情况。结果两组患者治疗1、2、4周后IBS-SSS评分与本组治疗前比较均降低(P<0.05);且治疗组治疗1、2周后IBS-SSS评分与对照组比较显著降低(P<0.05),差异有统计学意义;治疗4周后两组患者病情逐渐痊愈及肠道菌群恢复,两组患者IBS-SSS评分变化不明显,两组比较差异无统计学意义(P>0.05)。治疗4周后两组患者WHOQOL-100评分与治疗前比较均升高(P<0.05);且治疗组WHOQOL-100量表评分优于对照组,两组比较差异有统计学意义(P<0.05)。两组患者治疗5、7、10d后,WBC和PCT检测值与本组治疗前比较均降低(P<0.05);且治疗组患者治疗5、7、10d后WBC和PCT检测值降低水平优于对照组(P<0.05)。治疗后两组患者炎性因子IL-2、IL-6、hs-CRP、TNF-α水平与治疗前比较均降低(P<0.05);且治疗组患者炎性因子IL-2、IL-6、hs-CRP、TNF-α水平恢复速度明显优于对照组(P<0.05)。结论微生物制剂联合中药粘连松解汤能有效改善患者的肠道菌群减轻炎症,缩短各项炎性指标的恢复时间,缩短恢复肠道功能恢复时间,患者的生活质量改善度高于传统治疗。

Objective To investigate the clinical efficacy of microbial preparations and traditional Chinese medicine in the treatment of early postoperative inflammatory small bowel obstruction( EPISBO) after colorectal cancer surgery.Methods Sixty patients with EPISBO after colorectal cancer surgery from September 2017 to March 2019 were enrolled.The patients were randomly divided into experimental group and control group,30 cases in each group,according to the order of admission. The control group used the traditional comprehensive treatment plan. The experimental group,was treated with intestinal microbial preparations and traditional Chinese medicine Nianlian Songjie Decoction on the basis of the treatment of the control group. Both groups were treated for 4 weeks. Use the Intestinal Function Severity Scale( IBS-SSS Scale) to observe and compare the intestinal function status of the two groups of patients before and after treatment. The WHO quality of life scale( WHOQOL-100 scale) was used to evaluate the physical and mental condition of patients after 4 weeks of treatment. PCT,WBC,IL-2,IL-6,hs-CRP,TNF-α were measured before and after 5,7 and 10 days treatment. Results The IBS-SSS scores of the two groups of patients after 1,2,and 4 weeks of treatment were reduced compared with the scores before treatment,the difference was statistically significant( P < 0. 05). The IBS-SSS scores of the treatment group were significant reduced after 1,2 weeks of treatment compared with the control group,the difference was statistically significant( P < 0. 05). After 4 weeks of treatment,the patients in the two groups gradually recovered and the intestinal flora recovered. The IBS-SSS scores of the two groups did not change significantly,and there was no significant difference between the two groups( P > 0. 05). After 4 weeks of treatment,the WHOQOL-100 scale Score,the score changes of the two groups increased compared with before treatment,the difference was statistically significant( P < 0. 05). The WHOQOL-100 score of the treatment group was better than the control group,and the difference between the two groups was statistically significant( P < 0. 05),suggesting that the quality of life of patients in the treatment group after surgery was significantly better than that of the control group. After 5,7,and 10 days of treatment,the WBC and PCT detection values of the two groups of patients decreased compared with those before treatment,and the difference was statistically significant( P< 0. 05);and the WBC and PCT of the treatment group were 5,7,and 10 days after treatment. The detection value reduction level was better than that of the control group,and the difference between the two groups was statistically significant( P< 0. 05). After treatment,the levels of inflammatory factors IL-2,IL-6,hs-CRP,and TNF-α decreased in the two groups compared with those before treatment,and the difference was statistically significant( P < 0. 05);and the inflammatory factor IL in the treatment group-2,IL-6,hs-CRP,TNF-α level recovery speed was significantly better than the control group,the difference between the two groups was statistically significant( P < 0. 05). Conclusion Microbial preparation combined with traditional Chinese medicine Nianlian Songjie Decoction can effectively improve the intestinal flora of patients,reduce inflammation,shorten the recovery time of various inflammatory indicators,and shorten the recovery time of intestinal function recovery. In view of the intestinal flora related to the whole body,statistics shows that patients’ quality of life improvement is higher than that of traditional treatment,which is worthy of clinical in-depth trials.