加味桃核承气汤对胃肠道穿孔患者术后炎症性肠梗阻的干预效果

Intervention Effect of Modified TaoheChengqi Decoction on Postoperative Inflammatory Ileus in Patients with Gastrointestinal Perforation

目的探讨加味桃核承气汤对胃肠道穿孔患者术后早期炎症性肠梗阻(Early postoperative inflammatory ileus,EPII)的干预效果。方法选取2019年1月—2021年1月期间于长沙市中医医院胃肠乳甲科接受胃肠道穿孔术治疗后发生炎症性肠梗阻的108例患者,随机分为观察组与对照组,每组各54例。两组患者均进行胃肠减压、调节水电解质紊乱和酸碱平衡及补液、抗感染等基础治疗,对照组注射生长抑素,静脉滴注头孢他啶,肌肉注射甲硫酸新斯的明注射液,观察组在对照组的基础上使用加味桃核承气汤行胃管注入和灌肠。治疗7 d后观察比较两组患者临床疗效,术后恢复情况[腹胀缓解时间、腹痛改善时间、肠鸣音恢复时间、首次排便时间、首次通气时间、胃管留置时间及住院时间];治疗前后血管活性肠肽(Vasoactive Intestinal peptide,VIP)、降钙素原(Procalcitonin,PCT)、胃动素(Motilin,MOT)、胃泌素(Gastrin,GAS)水平及血清炎症因子水平[白介素(Interleukin-6,IL-6)、肿瘤坏死因子(Tumor necrosis factor,TNF-α)、超敏C反应蛋白(Hypersensitive C-reactive protein,Hs-CRP)]。结果治疗后观察组总有效率为92.59%(50/54),明显高于对照组75.93%(41/54),两组比较,差异有统计学意义(P<0.05)。治疗后观察组腹胀缓解、腹痛改善、肠鸣音恢复、首次排便、首次通气、胃管留置、住院时间均明显低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者VIP、PCT水平明显低于治疗前,MOT、GAS水平明显高于治疗前,差异有统计学意义(P<0.05);且观察组VIP、PCT水平明显低于对照组,MOT、GAS水平明显高于对照组,差异有统计学意义(P<0.05)。治疗后两组患者IL-6、TNF-α、Hs-CRP水平均明显低于治疗前,差异有统计学意义(P<0.05);且观察组IL-6、TNF-α、Hs-CRP水平均明显低于对照组,差异有统计学意义(P<0.05)。结论在西医治疗的基础上,采用加味桃核承气汤治疗胃肠道穿孔患者术后EPII可显著提高治疗疗效,减少EPII症状改善时间及术后恢复时间,减轻机体炎症反应。

Objective To investigate the intervention effect of modified TaoheChengqi Decoction on early postoperative inflammatory ileus(EPII)in patients with gastrointestinal perforation.Methods A total of 108 EPIIpatients with gastrointestinal perforation treated in the Department of Gastroenterology,Thyropathy and Mastopathy,Changsha Hospital of Traditional Chinese Medicinefrom January 2019 to January 2021 were randomly assigned into an observation group and a control group,with 54 patients in each group.Both groups received basic treatments such as gastrointestinal decompression,regulation of water,electrolyte,and acid-base balance,fluid infusion,and anti-infection.The control group was administrated with somatostatin(injection)for three days,ceftazidime(intravenous infusion)for seven days,and neostigmine mesylate(intramuscular injection)for seven days.On the basis of the control group,the observation group was additionally treated with modified TaoheChengqi Decoction through gastric tube and coloclysis for seven days.After seven days of treatment,the clinical efficacy and the postoperative recovery(time to abdominal distension relief,abdominal pain relief,bowelsounds recovery,first defecation,first ventilation,gastric tube indwelling,and hospitalization)werecompared between the two groups.The levels of vasoactive intestinal peptide(VIP),procalcitonin(PCT),motilin(MOT),and gastrin(GAS),as well as theserum levels of inflammatory cytokines[interleukin-6(IL-6),tumor necrosis factor-alpha(TNF-α),and hypersensitive C-reactive protein(hs-CRP)],were measured before and after treatment.Results The observation group had higher total effective rate[92.59%(50/54)vs.75.93%(41/54),P<0.05]than the control group.In addition,the observation group had shorter time to abdominal distension relief,abdominal pain relief,bowel soundsrecovery,first defecation,first ventilation,gastric tube indwelling,and hospitalization than the control group(P<0.05).The treatments in both groups lowered theVIP and PCT levels and elevated the MOT and GAS levels(P<0.05).Furthermore,the observation group had lower VIP and PCT levels and higher MOT and GAS levels than the control group(P<0.05).After treatment,the levels of IL-6,TNF-α,and hs-CRP in both groups declined compared with those before treatment and were lower in the observation group than in the control group(P<0.05).Conclusion On the basis of western medicine treatment,modified TaoheChengqi Decoction can significantly improve the therapeutic effect,shorten the time to symptom relief and postoperative recovery,reduce the body inflammatory reactions in the treatment of EPII in patients with gastrointestinal perforation.