善宁、大黄附子汤及喜能三联疗法治疗术后急性粘连性肠梗阻45例  

Efficacy of triple therapy with Sandostatin,Dahuang Fuzi Decoction and XiNeng in the treatment of postoperative acute adhesive intestinal obstruction:an analysis of 45 cases

作　　者：康新[1] 杨亮[1] 路小光[1] 王小周[1] 姜磊[1] 范治伟[1] 郭帅[1] 董云[1] 吕春雨[1] 

机构地区：[1]大连大学附属中山医院急诊医学科,辽宁省大连市116001

出　　处：《世界华人消化杂志》2012年第1期79-83,共5页World Chinese Journal of Digestology

基　　金：国家自然科学基金资助项目;No.30672767;辽宁省教育厅高等学校科研计划基金资助项目;No.20060046~~

摘　　要：目的:探讨醋酸奥曲肽(善宁)、大黄附子汤及N(2)-L-丙氨酰-L-谷氨酰胺(喜能)三联疗法治疗术后急性粘连性肠梗阻的作用和意义.方法:采用前瞻性、单中心、随机对照临床试验,将大连大学附属中山医院2009-05/2011-01收治的85例术后急性粘连性肠梗阻患者,采用随机数字法分为对照组(n=40)和治疗组(n=45).对照组采用常规治疗,包括禁食,胃肠减压,肥皂水保留灌肠,补液及抗感染治疗等.治疗组在常规治疗的基础上,大黄附子汤保留灌肠替代对照组温皂水灌肠;加用善宁,起始0.1mg静脉注射,后以0.6mg分24h静脉泵入;喜能静点(20g/d),均给药至梗阻解除.观察两组患者临床表现恢复情况、临床疗效、手术中转例数及住院时间.结果:对照组与治疗组相比,两组患者排气时间(70.7±10.4hvs45.3±9.8h,P<0.05),排便时间(112.4±16.8hvs70.5±12.7h,P<0.05),胃管留置时间(135.8±26.7hvs91.5±14.1h,P<0.05),饮食恢复时间(158.8±26.4hvs109.4±15.7h,P<0.05),住院时间(13.9±3.4dvs8.2±2.6d,P<0.05).对照组治愈19例,好转13例,无效8例,治疗组治愈31例,好转11例,无效3例;治疗组总有效率93.3%,而对照组仅为80.0%;对照组中转手术例数8例,治疗组仅为3例,差异均有统计学意义(P<0.05).结论:善宁、大黄附子汤及喜能三联疗法可明显改善术后急性粘连性肠梗阻患者的临床症状,促进肠道功能的恢复,降低手术中转率,缩短住院天数,值得临床应用推广.AIM： To evaluate the efficacy of triple therapy with octreotide acetate （Sandostatin）, Dahuang Fuzi Decoction and N（2）-L-alanyl-L-glutamine （XiNeng） in the treatment of postoperative acute adhesive intestinal obstruction.METHODS： This was a prospective, single-center, randomized controlled clinical trial. Eighty-five patients with postoperative acute adhesive intes- tinal obstruction who were treated at the Affiliat- ed Zhongshan Hospital of Dalian University from May 2009 to January 2011 were randomly divided into control group （n = 40） and treatment group （n = 45）. The control group received conventional treatment, including fasting, gastrointestinal decompression, soapy water enema, rehydration and anti-infection, while the treatment group received triple therapy on the basis of conven- tional therapy. Both the two groups were treated until the obstruction relieved. Clinical manifes- tations, the clinical curative effect, the number of cases of conversion to surgery, and the length of hospital stay were compared between the two groups RESULTS： Compared to the control group, the treatment group had a shorter time to first anal exhaust （70.7 ± 10.4 h vs 45.3 ± 9.8 h, P 〈 0.05）, time to first defecation （112.4 ± 16.8 h vs 70.5 ± 12.7 h, P 〈 0.05）, stomach tube retention time （135.8 ± 26.7 h vs 91.5 ± 14.1 h, P 〈 0.05）, eating recovery time （158.8 ± 26.4 h vs 109.4 ± 15.7 h, P 〈0.05）, and length of hospital stay （13.9 ± 3.4 d vs 8.2 ± 2.6 d, P 〈 0.05）. In the control group, 19 cases were cured, 13 cases were improved, and 8 cases showed no improvement. In the treatment group, the corresponding figures were 31, 11 and 3, respectively. The total response rate was 93.3% for the treatment group and 80.0% for the control group. The number of cases of conver- sion to surgery was significantly fewer in the treatment group than in the control group （3 vs 8, P 〈 0.05）. CONCLUSION： Triple therapy with Sandostatin, Dahuang Fuzi Decoction and XiNeng cou

关 键 词：肠梗阻 醋酸奥曲肽 大黄附子汤 谷氨酰胺:粘连 

分 类 号：R269[医药卫生—中西医结合]