生大黄液灌肠结合哌拉西林钠/他唑巴坦钠对手术后腹腔感染患者临床症状及胃肠功能的影响

Effect of raw rhubarb liquid enema combined with piperacillin sodium/tazobactam sodium on clinical symptoms and gastrointestinal functions of patients with postoperative abdominal infection

目的观察生大黄液灌肠结合哌拉西林钠/他唑巴坦钠对手术后腹腔感染患者临床症状及胃肠功能的影响。方法选取2019年1月—2023年8月在商丘市中医院进行腹部肠道相关手术后发生腹腔感染的70例患者纳入研究,采用随机数字表分为两组,每组35例。对照组术后在纠正酸碱和水电解质紊乱、胃肠减压等常规治疗基础上给予哌拉西林钠/他唑巴坦钠治疗,观察组术后在常规治疗基础上给予生大黄液灌肠结合哌拉西林钠/他唑巴坦钠治疗。比较两组临床症状改善时间、抗生素使用时间、胃肠功能恢复时间、疗效及炎症因子、肠黏膜屏障功能水平。结果观察组恶心呕吐和腹胀腹痛两项临床症状改善时间、胃肠功能恢复时间、抗生素使用时间均短于对照组,差异有统计学意义(P<0.05)。治疗前两组炎症因子、肠黏膜屏障功能比较,差异无统计学意义(P>0.05),观察组治疗3 d、7 d后白细胞计数(WBC)、血沉(ESR)、二胺氧化酶(DAO)、降钙素原(PCT)、肿瘤坏死因子-α(TNF-α)、内毒素脂多糖(LPS)降低,对照组治疗3 d后炎症因子降低,DAO、LPS与治疗前比较,差异无统计学意义(P>0.05)。对照组治疗7 d后炎症因子、肠黏膜屏障功能降低(P<0.05)。观察组治疗3 d后炎症因子低于对照组,治疗7 d后WBC、LPS、PCT、DAO、TNF-α低于对照组(P<0.05),ESR与对照组比较,差异无统计学意义(P>0.05)。观察组治愈14例,有效16例,总有效30例,总有效率为85.71%,高于对照组的62.86%,差异有统计学意义(P<0.05)。结论生大黄液灌肠结合哌拉西林钠/他唑巴坦钠可降低腹部肠道相关手术后腹腔感染患者感染相关指标的表达,改善肠黏膜屏障功能,促进胃肠功能的恢复和临床症状消失。

Objective To observe the effect of rhubarb liquid enema combined with piperacillin sodium/tazobactam sodium on clinical symptoms and gastrointestinal functions of patients with postoperative abdominal infection.Methods 70 patients with abdominal infection after abdominal and intestinal related surgeries at Shangqiu Hospital of Traditional Chinese Medicine from January 2019 to August 2023 were selected for the study.They were randomly divided into two groups by random number table,with 35 patients in each group.Control group were treated with piperacillin sodium/tazobactam sodium on the basis of routine treatment such as correction of acid-base and water-electrolyte disorders and gastrointestinal decompression,while observation group were treated with raw rhubarb liquid enema combined with piperacillin sodium/tazobactam sodium on the basis of routine treatment.And then,the improvement time of clinical symptoms,antibiotic use time,the recovery time of gastrointestinal functions,curative effects,inflammatory factors and the levels of intestinal mucosal barrier functions were compared between the two groups.Results The improvement time of nausea,vomiting,abdominal distension and pain,the recovery time of gastrointestinal functions and antibiotic use time in the observation group were shorter than those in the control group,and difference was statistically significant(P<0.05).Before treatment,there was no statistically significant difference in inflammatory factors and intestinal mucosal barrier functions between the two groups(P>0.05).White blood cell count(WBC),erythrocyte deposition rate(ESR),diamine oxidase(DAO),procalcitonin(PCT),tumor necrosis factor-α(TNF-α)and endotoxin lipolysaccharide(LPS)in the observation group decreased after 3 days and 7 days of treatment,while inflammatory factors in the control group decreased after 3 days of treatment.There was no statistically significant difference in DAO and LPS compared to those before treatment(P>0.05).In the control group,inflammatory factors and intestinal mucosal barrier functions decreased after 7 days of treatment(P<0.05).The inflammatory factors in the observation group were lower than those in the control group after 3 days of treatment,and WBC,LPS,PCT,DAO and TNF-αwere lower than those in the control group after 7 days of treatment(P<0.05).and there was no statistically significant difference in ESR compared to that of the control group(P>0.05).In the observation group,14 cases were cured,16 cases were effective,and 30 cases were total effective,the total effective rate was 85.71%,which was higher than that(62.86%)in the control group,and the difference was statistically significant(P<0.05).Conclusion Rhubarb enema combined with piperacillin sodium/tazobactam sodium can reduce the expression of infection related indicators in patients with abdominal infections after abdominal and intestinal related surgeries,improve intestinal mucosal barrier functions,promote the recovery of gastrointestinal functions and the disappearance of clinical symptoms.