中药保留灌肠治疗溃疡性结肠炎最佳灌肠温度及速度探讨

Discussion on the Optimum Enema Temperature and Speed During Treatment of Ulceraive Colitis with TCM Retention Enema

为探讨中药保留灌肠治疗溃疡性结肠炎(UC)的最佳灌肠温度及速度,以期为保留灌肠治疗UC的护理技术规范化提供依据,选择2017年1月至2020年3月拟于我院接受中药保留灌肠治疗的160例UC患者作为研究对象,患者均采用同一药方进行点滴式保留灌肠,随机分为4组,控制灌肠液温度(ET)和灌肠速度(ES),分别命名为低温-低速组(ET 37.0~38.9℃,ES 10~14mL/min)、低温-高速组(ET 37.0~38.9℃,ES 15~20mL/min)、高温-低速组(ET 39.0~41.0℃,ES 10~14mL/min)和高温-高速组(ET 39.0~41.0℃,ES 15~20mL/min),每组40例。每天灌肠1次,连续治疗4周。比较4组患者灌肠后灌肠液保留时间(ERT)、药液外溢情况、不适症状及临床总体疗效。结果显示,1)灌肠后ERT:低速的2组(低温-低速组和高温-低速组)灌肠后ERT明显长于高速的2组(低温高速组和高温高速组),P<0.05;低速的2组间比较,灌肠后ERT差异无统计学意义,P>0.05;高速的2组间比较,低温高速组灌肠后ERT明显长于高温高速组,P<0.05。2)药液外溢情况:4组患者药液外溢发生率比较差异无统计学意义,P>0.05。3)不适症状:腹痛评分方面,高温的2组(高温-低速组和高温-高速组)腹痛情况评分高于低温的2组(低温-低速组和低温-高速组),P<0.05;高温的2组间比较,差异无统计学意义,P>0.05;低温的2组间比较,低温-高速组评分高于低温-低速组,P<0.05。即刻便意和肛门坠胀感情况方面,高速的2组(低温-高速组和高温-高速组)评分高于低速的2组(低温-低速组和高温-低速组),P<0.05;高温的2组间及低温的2组间比较,差异均无统计学意义,P>0.05。4)临床总体疗效:4组临床总有效率比较差异无统计学意义,P>0.05。结果表明,灌肠液温度和速度在一定范围内,对UC治疗总体疗效无明显影响,但ET 37.0~38.9℃、ES 10~14mL/min灌肠后ERT最长,且腹痛、即刻便意和肛门坠胀感程度轻,患者耐受性好。故中药保留灌肠治疗UC时以ET 37.0~38.9℃、ES 10~14mL/min为宜。

This study was to explore the optimum enema temperature(ET)and enema speed(ES)during treatment of ulcerative colitis(UC)with TCM retention enema,so as to provide basis for normalization of nursing skills in this treatment;enrolled 160 UC patients to be subject to above therapy in author’s hospital(2017-01-2020-03)and randomly divided them into four groups:in way of same formula and instillation,as well as controlling ET and ES,resopectively,low ET-low ES group(1)(37.0-38.9℃,10-14 mL/min),low ET-high ES group(2)(37.0-38.9℃,15-20 mL/min),high ET-low ES group(4)(39.0-41.0℃,10-14 mL/min),and high ET-high ES group(3)(39.0-41.0℃,15-20 mL/min);40 cases for each group,1 time/day,for 4 weeks continously.Then,compared ERT,drug-solution over-flow status,unwell symptoms and clinical whole effect.As results,1)ERT after enema:in group(1)and(4)ERT was significantly prolonged than in group(2)and(3)(P<0.05);between group(1)and group(4)there was no significantly difference(P>0.05);in group(2)ERT was significantly longer than in group(3)(P<0.05).2)durg-solution overflow status:there was no statistical difference between the four groups(P>0.05).3)unwell symptoms:in the score ratings on abdominal pain group(3)and(4)were high than group(1)and(2)(P<0.05);between group(3)and(4)there was no statistical difference(P>0.05);while group(2)higher than group(1)(P<0.05);in the score ratings on(immediate)fecal urgency and anal tenesmus:group(2)and(3)were higher than group(1)and(4)(P<0.05);between group(3)and group(4),and between group(1)and group(2)there all was no significant difference(P>0.05).4)clinical whole effect:in total effective rate there was no statistical difference between the four groups(P>0.05).Results show that at certain ranges ET and ES have no significant influence on whole effect,but when ET 37.0-38.9℃,ES 10-14 mL/min,after enema ERT is most long,and patients have slight pain symptoms,(immediate)fecal urgency and anal tenesmus,as well as good tolerance,therefore,TCM retention enema’s potimun ET,ES are respectively 37.0-38.9℃,10-14 mL/min.