厚朴排气合剂治疗重型颅脑损伤并胃瘫患者的临床研究

Clinical research of houpu paiqi mixture in treatment of patients with serious craniocerebral trauma complicated with gastroparesis

目的探讨中成药厚朴排气合剂治疗重型颅脑损伤并胃瘫患者的有效性。方法选取2012年1月至2016年6月入住解放军第一八〇医院的重型颅脑损伤并胃瘫患者125例,按随机数字表法将患者分为研究组(63例)和对照组(62例)。研究组患者于确诊并发胃瘫后予以经胃管注入厚朴排气合剂50 m L,每天2次,连续治疗1~3 d;对照组患者于确诊并发胃瘫后予以经胃管注入莫沙必利片5 mg,每天3次,连续治疗1~3 d。两组患者的其他治疗如脱水、预防感染、营养支持等措施均基本相同。记录两组患者用药前及用药后72 h的腹内压、腹围变化,用药后首次排便时间及用药后72 h亚甲蓝排泄试验尿液变蓝色的时间。用药后72 h评价两组患者胃肠功能恢复总体情况。观察两组患者治疗前后生命体征的变化及治疗过程中的毒副作用。对数据进行t检验和χ~2检验。结果治疗前两组患者腹内压、腹围差异均无统计学意义(P值均大于0.05);用药后72 h研究组患者的腹内压为(1.75±0.50)k Pa,对照组为(2.08±0.54)k Pa,两组比较差异有统计学意义(t=3.55,P<0.05);用药后72 h研究组患者的腹围为(115.6±11.4)cm,对照组为(121.8±12.6)cm,两组比较差异有统计学意义(t=2.89,P<0.05);用药后首次排便时间研究组为(39.3±10.7)h,要明显早于对照组(52.8±13.4)h,比较差异有统计学意义(t=6.26,P<0.05);用药后72 h,研究组亚甲蓝排泄试验尿液变蓝色时间为(4.3±1.2)h,明显短于对照组(5.9±1.7)h,两组比较差异有统计学意义(t=6.09,P<0.05);用药后72 h研究组胃肠功能恢复总有效率为88.89%(56/63),对照组为72.58%(45/62),比较差异有统计学意义(χ~2=5.36,P<0.05)。两组治疗前后患者生命体征无变化,均未见毒副作用。结论厚朴排气合剂可以明显促进重型颅脑损伤并胃瘫患者的胃肠功能恢复,且临床使用安全。

Objective To explore the efficacy of houpu paiqi mixture in treatment of patients with serious craniocerebral trauma complicated with gastroparesis. Methods One hundred and twenty five patients with serious craniocerebral trauma complicated with gastroparesis were admitted to the 180 th Hospital of People's Liberation Army from January 2012 to June 2016. They were randomly divided into study group( 63 cases) and control group( 62 cases) according to the random number table method. After diagnosis of gastric paralysis complicated,patients in study group were injected with houpu paiqi mixture 50 m L twice a day for 1 to 3 days. Patients in the control group were given 5 mg of mosapride tablets via gastric tube 3 times a day for 1 to 3 days. Other treatment measures as dehydration,prevention of infection,nutrition nerves,nutritional support,inhibition of gastric acid and etc. were basically the same in both groups. Intraabdominal pressure,abdominal circumference changes before and 72 h after treatment,first defecation time after treatment were recorded in both groups. The time of urine turning blue by methylene blue excretion test,gastrointestinal function to restore the situation 72 h after treatment of the two groups were recorded.The changes of vital signs before and after the treatment and the toxic and side effects in the course of treatment of the two groups were observed. Data were processed with t test and Chi-square test.Results There were no significant differences in intra-abdominal pressure and abdominal circumference between the two groups before treatment( with P values above 0. 05). The patients of the intra-abdominal pressure 72 h after treatment was( 1. 75 ± 0. 50) k Pa in the study group,which was( 2. 08 ± 0. 54) k Pa in the control group,the difference between the two groups was statistically significant( t = 3. 55,P < 0. 05).The abdominal circumference of the study group 72 h after treatment was( 115. 6 ± 11. 4) cm,the control group was( 121. 8 ± 12. 6) cm,the difference between the two groups was statistically significant( t = 2. 89,P < 0. 05). The first defecation time after treatment was( 39. 3 ± 10. 7) h in the study group,significantly earlier than the control group( 52. 8 ± 13. 4) h,the difference between the two groups was statistically significant( t = 6. 26,P < 0. 05). The time of urine turning blue by the methylene blue excretion test( 4. 3 ± 1. 2) h in the study group was significantly earlier than the control group( 5. 9 ± 1. 7) h,the difference between the two groups was statistically significant( t = 6. 09,P < 0. 05). The total effective rate of gastrointestinal function recovery was 88. 89%( 56/63) in the study group,which was 72. 58%( 45/62)in the control group,the difference was statistically significant( χ~2= 5. 36,P < 0. 05). There were no changes in vital signs before and after the treatment in the two groups,and no toxic or side effects were observed. Conclusion Houpu paiqi mixture can significantly promote gastrointestinal function in patients with serious craniocerebral trauma complinicated with gastroparesis,and it is safe to clinical application.