正交设计筛选大黄煎剂保留灌肠治疗肝性脑病最佳方案的研究  

Orthoplan to Screen the Optimum Scheme of Retention Enema in Treatment of Hepatic Encephalopathy with Rhubarb Decoction

作　　者：邱华[1] 黄古叶[1] 毛德文[1] 韦艾凌[1] 

机构地区：[1]广西中医学院第一附属医院肝病治疗中心、广西壮族自治区南宁市园湖路2号,530023

出　　处：《中医杂志》2010年第11期990-992,共3页Journal of Traditional Chinese Medicine

基　　金：广西科学研究与技术开发计划资助项目(桂科攻0993003A-25)

摘　　要：目的筛选大黄煎剂保留灌肠治疗肝性脑病的最佳方案,形成规范化操作过程,提高临床疗效及稳定性。方法选择肝性脑病级患者54例为研究对象,按照插管深度(15cm、20cm、30cm)、保留时间(30min、60min、120min)、药液温度(36℃、40℃、45℃)、灌肠后体位(左侧卧位、平卧位、右侧卧位)4因素3水平,利用L9(34)正交表安排试验,将患者分为9组,以肝性脑病患者的平均苏醒时间(h)为观察指标,筛选出最佳的组合方案。结果大黄煎剂保留灌肠治疗肝性脑病的最佳方案为大黄煎剂(醋制大黄30g,乌梅30g)加温至40℃,患者取左侧卧位抬高臀部,将肛管轻柔插入直肠30cm以上,缓慢注入药液,拔管后用手掐住臀部向肛门挤压,压迫肛门括约肌5min,操作完毕后患者转为右侧卧位,使药物在肠内尽量保持120min以上。结论大黄煎剂保留灌肠治疗肝性脑病的最佳条件为:灌肠液保留时间120min,插管深度为30cm,保留灌肠药液温度为40℃,灌肠后右侧卧位;其中灌肠药液保留时间为影响临床疗效的最主要因素。Objective To screen the optimum scheme of retention enema with Rhubarb decoction for hepatic encephalopathy,to form the standard manipulation process,to strengthen the effect and its stability.Methods The subjects were those 54 cases of hepatic encephalopathy in grade Ⅲ. Four factors and three levels in the treatment including inserting depth （15cm,20cm,30cm）,retention time （30min,60min,120min）,decoction temperature （36℃,40℃,45℃）,position after retention enema （left side-lying,supine,right side-lying） were scheduled in accordance with the L9 （34） orthogonal table. Patients were randomized into 9 groups. The optimum scheme was screened according to the average recovery time （hour） of patients.Results The orthoplan makes the optimum scheme screened out. The retention enema with Rhubarb decoction （vinegar processed Rhubarb 30g,Ebony 30g） for hepatic encephalopathy at the temperature 40℃,left side-lying position with the hips raised,gentle insertion of anal tube to a depth of over 30cm,slow injection of the decoction,pressing the hips to the anal direction after the tube removed to make the sphincter ani pressed for 5min,changing to the right side-lying position,and maintaining the decoction in the intestine for over 120min.Conclusion The optimum scheme was：retention time over 120min,insertion depth over 30cm,decoction temperature at 40℃,and right side-lying after retention enema. The retention time was the most important factor affecting the effect.

关 键 词：大黄煎剂 保留灌肠 肝性脑病 治疗方案 

分 类 号：R277.7[医药卫生—中医学]