增味小承气汤对胆道围手术期免疫功能的影响:随机对照研究

Effect of Modified Xiaochengqi Decoction on Immune Function in Perioperative Period of Biliary Tract Surgery: A Randomized Controlled Trial

目的通过前瞻性随机对照研究,评价增味小承气汤对胆道围手术期免疫功能的影响。方法选取滨州医学院附属医院肝胆外科2017年5—12月收治的120例胆道手术患者,运用随机对照表法将患者分为增味小承气汤组(42例)、小承气汤组(39例)和对照组(39例)。所有患者围手术期均采用术后加速康复(ERAS)流程,小承气汤组在此基础上增加小承气汤,增味小承气汤组增加增味小承气汤。分别检测3组患者术前,术后第1、2、5天CD3^+、CD4^+、CD8^+、CD4^+/CD8^+比值、CD19^+、NK细胞表达、淋巴细胞计数及百分比。统计住院天数、术后住院时间,住院费用、术后费用,观察手术后并发症发生情况及口服中药的不良反应。结果与对照组比较,术后第1、2天增味小承气汤组CD3^+、CD4^+、CD4^+/CD8^+、CD19^+、淋巴细胞计数及百分比增高(P<0.05)。同时,术后第1、2天增味小承气汤组CD3^+、CD4^+、CD4^+/CD8^+、淋巴细胞计数及术后第1天CD19^+表达高于小承气汤组(P<0.05)。与对照组比较,小承气汤组术后费用,恶心、呕吐,腹胀的发生率降低(P<0.05);增味小承气汤组术后住院时间、术后费用,恶心、呕吐,腹胀的发生率降低(P<0.05)。结论增味小承气汤改善了胆道围手术期的免疫功能,减少了术后住院时间、术后住院费用及术后恶心、呕吐、腹胀的发生率,无严重不良反应。

Objective To evaluate the immune function of Modified Xiaochengqi Decoction in the perioperative period of biliary tract by a prospective randomized controlled study.Methods 120 cases of biliary tract surgery in Binzhou Medical University Hospital from May 2017 to December 2017 were selected.Using random comparison table method,patients were randomly assigned into Modified Xiaochengqi Decoction group(42 cases),Xiaochengqi Decoction group(39 cases)and control group(39 cases).All patients underwent enhanced recovery after surgery(ERAS)process during perioperative period.On this basis,Xiaochengqi Decoction was added to Xiaochengqi Decoction group,and Modified Xiaochengqi Decoction was added to Modified Xiaochengqi Decoction group.The levels of CD3^+,CD4^+,CD8^+,CD4^+/CD8^+ratio,CD19^+,NK cell,lymphocyte count and percentage before operation and on the 1st,2nd and 5th day after operation were measured and compared.The hospitalization days,postoperative hospital stay,hospitalization expenses and postoperative costs were counted.The postoperative complications and the adverse reactions of oral Chinese medicine were observed.Results Compared with the control group,the expression of CD3^+,CD4^+,CD4^+/CD8^+,CD19^+,lymphocyte count and percentage were increased in the group of Modified Xiaochengqi Decoction on the 1st and 2nd postoperative days(P<0.05).At the same time,the expressions of CD3^+,CD4^+,CD4^+/CD8^+and lymphocyte count in the group of Modified Xiaochengqi Decoction were higher than that in the group of Xiaochengqi Decoction on the 1st and 2nd postoperative days(P<0.05).Finally,the expression of CD19^+in Modified Xiaochengqi Decoction group was higher than that of Xiaochengqi Decoction group on the 1st postoperative day(P<0.05).Compared with the control group,the postoperative hospital stay and incidence of nausea,vomiting,and abdominal distension were lower in the Xiaochengqi Decoction group(P<0.05).At the same time,the postoperative hospital stay,postoperative costs and incidence of nausea,vomiting,and abdominal distension were lower in the Modified Xiaochengqi Decoction group(P<0.05).Conclusions Modified Xiaochengqi Decoction improved the immune function in the perioperative period of biliary tract,reduced the postoperative hospital stay,postoperative costs and the incidence of of nausea,vomiting and abdominal distention after the operation.Moreover,there was no serious adverse reaction of Modified Xiaochengqi Decoction.