新斯的明与大承气汤灌胃治疗老年肠梗阻临床疗效观察

Observation of therapeutic effect of Neostigmine and Da Cheng Qi Decoction by intragastric administration on elderly patients with intestinal obstruction

目的观察新斯的明、大承气汤灌胃治疗老年肠梗阻的临床疗效。方法前瞻性选择2015年9月至2017年6月石家庄市中医院收治的178例老年肠梗阻患者作为研究对象,将其按照随机数字表法分为对照组(n=89)和研究组(n=89)。对照组行保守治疗,研究组患者在对照组患者的基础上予以新斯的明、大承气汤灌胃治疗。比较2组间临床疗效、症状改善时间、肠黏膜屏障功能相关指标[D-乳酸、二胺氧化酶(DAO)、肠脂肪酸结合蛋白(IFABP)]、血清细胞因子[白细胞介素(IL)-6、肿瘤坏死因子-α(TNF-α)、IL-1β和C反应蛋白(CRP)]及细胞免疫功能水平。结果研究组患者治疗7 d后临床有效率(91.01%)显著优于对照组(79.77%),差异有统计学意义(P<0.05)。研究组患者肛门排气、症状消失及气液平消失时间均显著短于对照组,差异均有统计学意义(P<0.05)。治疗7 d后,研究组患者血浆中D-乳酸、IFABP和DAO水平,血清TNF-α、IL-6、IL-1β、CRP水平以及CD8^(+)T淋巴细胞水平均显著低于对照组,而外周血CD4^(+)T淋巴细胞、CD4^(+)/CD8^(+)水平则显著高于对照组,差异均有统计学意义(P<0.05)。结论新斯的明、大承气汤灌胃治疗能有效改善老年肠梗阻患者的临床症状,抑制机体炎症反应,促进患者肠黏膜屏障功能恢复,改善细胞免疫功能,提高疗效。

Objective To investigate the therapeutic effect of Neostigmine and Da Cheng Qi Decoction by intragastric administration on elderly patients with intestinal obstruction.Methods One hundred and seventy-eight cases of elderly patients with intestinal obstruction in TCM Hospital of Shijiazhuang City were selected and divided into control group(n=89)and study group(n=89)according to the random number table method.The control group received conservative treatment,while the patients in study group were given neostigmine and Da Cheng Qi Decoction on the basis of the patients in control group.Clinical efficacy,symptom improvement time,intestinal mucosal barrier function related indexes[D-lactic acid,diamine oxidase(DAO),intestinal fatty acid binding protein(IFABP)],serum cytokines[interleukin(IL)-6,tumor necrosis factor-α(TNF-α),IL-1βand C-reactive protein(CRP)]and cellular immune function levels were compared.Results The clinical effective rate(91.01%)of patients in the study group was significantly better than that of the control group(79.77%)after 7 days of treatment,and the difference was statistically significant(P<0.05).The time of anal exhaust,disappearance of symptoms,and disappearance of gas-liquid level in the study group were significantly shorter than those in the control group,and the differences were statistically significant(P<0.05).After 7 days of treatment,the plasma D-LA,DAO,IFABP levels,serum TNF-α,IL-6,IL-1β,CRP levels and CD8^(+) T lymphocyte levels of the study group were significantly lower than those of the control group,while the peripheral blood CD4^(+) T lymphocyte and CD4^(+)/CD8^(+) levels of the study group were significantly higher than those of the control group,and the differences were statistically significant(P<0.05).Conclusion Treatment of Neostigmine and Da Cheng Qi Decoction by intragastric administration can effectively improve the clinical symptoms of elderly patients with intestinal obstruction,promote the recovery of intestinal mucosal barrier function,inhibit the inflammatory reaction,improve the cellular immune function and improve the curative effect.