大柴胡汤加味对胆囊结石术后胃肠功能恢复的影响

Effect of Modified Dachaihu Tang on Recovery of Gastrointestinal Function After Cholecystolithiasis Operation

目的:观察大柴胡汤加味对胆囊结石术后患者胃肠功能恢复的影响。方法:选取124例胆囊结石择期手术患者,按随机数字表法分为观察组和对照组各62例。2组均行腹腔镜胆囊切除术治疗,对照组术后给予禁食、抗感染、抑酶、胃肠道减压等常规治疗至术后7 d,观察组术前3 d给予大柴胡汤加味治疗,手术当天停药,术后2 d继续给药至术后7 d。比较2组手术及术后相关指标、术后并发症发生率;比较2组术前3 d、术后8 d外周血中T淋巴细胞亚群表达、炎症因子及胃肠激素水平。结果:2组术中出血量、手术时间比较,差异均无统计学意义(P>0.05)。观察组术后肠鸣音恢复时间、首次排气时间、首次排便时间、切口疼痛消失时间及住院时间均短于对照组(P<0.05)。术后8 d,2组CD3^(+)、CD4^(+)水平及CD4^(+)/CD8^(+)值均较术前3 d升高(P<0.05),观察组CD3^(+)、CD4^(+)水平及CD4^(+)/CD8^(+)值均高于对照组(P<0.05);2组CD8^(+)水平均较术前3 d降低(P<0.05),观察组CD8^(+)水平低于对照组(P<0.05)。术后8 d,2组血清白细胞介素-1(IL-1)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)及血浆血管活性肠肽(VIP)水平均较术前3 d降低(P<0.05),观察组血清IL-1、IL-6、TNF-α及血浆VIP水平均低于对照组(P<0.05);2组血浆胃动素(MLT)、生长抑素(SS)水平均较术前3 d升高(P<0.05),观察组血浆MLT、SS水平均高于对照组(P<0.05)。结论:大柴胡汤加味可促进胆囊结石术后患者胃肠功能恢复,其作用机制与调节术后外周血T淋巴细胞亚群表达、炎症因子及胃肠激素水平有关。

Objectives:To observe the effect of modified Dachaihu tang on the recovery of gastrointestinal function in patients after cholecystolithiasis operation.Methods:A total of 124 cases of patients with selective cholecystolithiasis operation were selected and divided into the observation group and the control group according to the random number table method,with 62 cases in each group.Both groups were treated with laparoscopic cholecystectomy.The control group was treated with fasting,anti-infection,enzyme inhibition,gastrointestinal decompression,and other routine treatments after the operation,and the observation group was treated with modified Dachaihu tang three days before operation.The medication was stopped on the day of operation,and continued two days after operation until seven days after operation.The operation and postoperative related indexes,as well as the incidence of postoperative complications in the two groups were compared;the expressions of T lymphocyte subsets in peripheral blood and levels of inflammatory factors and gastrointestinal hormones in the two groups three days before operation and eight days after operation were compared.Results:There was no significant difference being found in the comparison of intraoperative blood loss and operation time between the two groups(P>0.05).The recovery time of bowel sounds,the first exhaust time,the first defecation time and disappearance time of postoperative pain in the observation group were earlier than those in the control group,and hospitalization time was shorter(P<0.05).Eight days after operation,the levels of CD3^(+),CD4^(+)and values of CD4^(+)/CD8^(+)in the two groups were increased when compared with those three days before operation(P<0.05),and the above levels and values in the observation group were higher than those in the control group(P<0.05);the levels of CD8^(+)in the two groups were decreased when compared with those three days before operation(P<0.05),and the level of CD8^(+)in the observation group was lower than that in the control group(P<0.05).Eight days after operation,the levels of interleukin-1(IL-1),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)in serum and plasma vasoactive intestinal peptide(VIP)in the two groups were decreased when compared with those three days before operation(P<0.05),and the above levels in the observation group were lower than those in the control group(P<0.05);the levels of plasma motilin(MTL)and somatostatin(SS)in the two groups were increased when compared with those three days before operation(P<0.05),and the above levels in the observation group were higher than those in the control group(P<0.05).Conclusion:Modified Dachaihu tang can promote the recovery of gastrointestinal function in patients after cholecystolithiasis operation,and its mechanism is related to regulating the expression of T lymphocyte subsets in peripheral blood and levels of inflammatory factors and gastrointestinal hormones.