厚朴排气合剂联合甲泼尼龙治疗结直肠癌术后早期炎性肠梗阻临床研究

Clinical Study on Houpo Paiqi Mixture Combined with Methylprednisolone for Early Postoperative Inflammatory Small Bowel Obstruction of Colorectal Cancer

目的:观察在常规疗法基础上予厚朴排气合剂联合甲泼尼龙治疗结直肠癌术后早期炎性肠梗阻(EPISBO)的效果。方法:选取168例气滞型腹腔镜结直肠癌切除术后EPISBO患者,随机分为对照组和观察组,每组84例。2组均予纠正水、电解质紊乱等常规疗法,对照组予注射用甲泼尼龙琥珀酸钠治疗,观察组予厚朴排气合剂联合注射用甲泼尼龙琥珀酸钠治疗,2组均连续治疗6 d。治疗前后检测血清神经-炎性机制相关指标[生长抑素(SS)、血管活性肠肽(VIP)、一氧化氮(NO)、单核细胞趋化因子-1 (MCP-1)、超敏C-反应蛋白(hs-CRP)]及粪便生物标志物[钙卫蛋白(FC)、乳铁蛋白(LF)]。观察2组患者的的胃肠道功能恢复情况,评估临床疗效。结果:治疗后,观察组临床疗效总有效率高于对照组,整体疗效优于对照组,差异均有统计学意义(P<0.05)。观察组的腹痛缓解时间、腹胀缓解时间均较对照组缩短,肠鸣音恢复时间、首次通气时间及首次排便时间均早于对照组,差异均有统计学意义(P<0.05)。2组血清SS水平均较治疗前升高(P<0.05),观察组血清SS水平高于对照组(P<0.05);2组血清VIP、NO、MCP-1、hs-CRP水平均较治疗前下降(P<0.05),观察组4项指标值均低于对照组(P<0.05)。2组粪便FC、LF水平均较治疗前下降(P<0.05),观察组2项指标值均低于对照组(P<0.05)。结论:在常规疗法基础上予厚朴排气合剂联合甲泼尼龙治疗气滞型结直肠癌术后EPISBO患者临床疗效显著,能有效纠正胃肠神经激素紊乱,减轻炎症反应,促进胃肠道功能恢复。

Objective:To observe the effect of Houpo Paiqi Mixture combined with Methylprednisolone for early postoperative inflammatory small bowel obstruction(EPISBO) of colorectal cancer based on routine therapy. Methods: A total of 168 cases of patients with EPISBO of qi stagnation type after laparoscopic resection of colorectal cancer were randomly divided into the control group and the observation group,with 84 cases in each group. Both groups were given routine therapies including the correction of water and electrolyte disturbances;the control group was treated with Methylprednisolone Sodium Succinate of Injection, and the observation group was treated with Houpo Paiqi Mixture combined with Methylprednisolone Sodium Succinate of Injection. Both groups were continuously treated for 6 days. Serum neuroinflammatory mechanism-related indicators [somatostatin(SS), vasoactive intestinal peptide(VIP),nitric oxide(NO),monocyte chemoattractant protein-1(MCP-1),hypersensitive C-reactive protein(hsCRP)] and fecal biomarkers [calprotectin(FC),lactoferrin(LF)] were detected before and after treatment.The recovery of gastrointestinal function in the two groups was observed, and clinical effects were evaluated. Results:After treatment,the total effective rate in the observation group was higher than that in the control group,and the overall curative effect was better than that in the control group,differences being significant(P<0.05). The remission time of abdominal pain and abdominal distention in the observation group were shorter than those in the control group,the recovery time of bowel sound,the first ventilation time and the first defecation time were earlier than those in the control group(P<0.05). The levels of SS in serum in the two groups were increased when compared with those before treatment(P<0.05),and the SS level in the observation group was higher than that in the control group(P<0.05);the levels of VIP,NO,MCP-1 and hs-CRP in serum in the two groups were decreased when compared with those before treatment(P<0.05),and the above 4 indexes in the observation group were lower than those in the control group(P<0.05). The levels of FC and LF in faeces in the two groups were decreased when compared with those before treatment(P<0.05),and the 2 indexes in the observation group were lower than those in the control group(P<0.05) Conclusion: Based on routine therapy, Houpo Paiqi Mixture combined with Methylprednisolone has significant clinical effects in treating EPISBO of qi stagnation type after the surgery of colorectal cancer, and can effectively correct gastrointestinal neurohormonal disorders,reduce inflammatory reactions,and promote gastrointestinal function recovery.