中药方剂“肠粘连方”治疗新生儿肠道疾病的效果评价  

Efficacy of traditional Chinese medicine “intestinal adhesion prescription” for neonatal intestinal diseases

作　　者：魏楠楠 苏艳伟[3] 容志惠[4] 陈玲[4] 蔡保欢[4] 魏明发[1] 冯杰雄[1] 赵小利 王果[1] 杨继鑫[1] Wei Nannan;Su Yanwei;Rong Zhihui;Chen Ling;Cai Baohuan;Wei Mingfa;Feng Jiexiong;Zhao Xiaoli;Wang Guo;Yang Jixin(Department of Pediatric Surgery,Affiliated Tongji Hospital,Tongji Medical College,Huazhong University of Science & Technology;Wuhan Children's Hospital,Tongji Medical College,Huazhong University of Science & Technology,Wuhan Maternal and Child Health Hospital;School of Nursing,Tongji Medical College,Huazhong University of Science & Technology,Wuhan 430030,China;Department of Neonatology,Affiliated Tongji Hospital,Tongji Medical College,Huazhong University of Science & Technology)

机构地区：[1]华中科技大学同济医学院附属同济医院小儿外科,湖北省武汉市430030 [2]华中科技大学同济医学院附属武汉儿童医院,武汉市妇幼保健院,湖北省武汉市430015 [3]华中科技大学同济医学院护理学院,湖北省武汉市430030 [4]华中科技大学同济医学院附属同济医院新生儿科,湖北省武汉市430030

出　　处：《临床小儿外科杂志》2019年第8期664-669,共6页Journal of Clinical Pediatric Surgery

基　　金：国家自然科学基金青年项目(编号:81401240);国家自然科学基金青年项目(编号:81601330)

摘　　要：目的评价中药方剂“肠粘连方”在新生儿肠道疾病的外科及保守治疗中的作用,并讨论此方剂治疗新生儿肠道疾病的作用机制。方法回顾性分析2012年1月1日至2017年1月1日由华中科技大学同济医学院附属同济医院收治的41例新生儿肠道疾病患儿。其中30例行腹部手术后出现肠梗阻(手术组),14例为中药组,除予以禁食、胃肠减压等常规治疗外,加服中药方剂“肠粘连方”治疗,余16例予以常规治疗,为对照组;11例为坏死性小肠结肠炎(未手术组),入院时均出现呕吐、腹胀,喂养后反复便血、炎症指标上升,但无手术指征,其中5例加服中药治疗,为中药组,6例予常规治疗,为对照组。分析患儿口服中药后,肠梗阻症状及消化道功能恢复情况。结果手术组:中药组、对照组肠梗阻后至全量喂养时间分别为(10.6±0.7)d和(12.8±0.6)d,中药组明显短于对照组(t=2.23,P=0.03);中药组及对照组二次手术率分别为7.1%(1/14)和25%(4/16),病死率分别为7.1%(1/14)和18.8%(3/16),差异均无统计学意见(P>0.05)。未手术组:中药组患儿经反复禁食、抗炎治疗无效,停止给予或降级给予抗生素后,炎症指标上升,治疗期间均未出现肠穿孔、大量便血或腹膜炎体征,加服中药方剂后症状均逐渐好转,大便隐血均转为阴性,炎症指标恢复正常,服用中药后全量喂养时间为(17.4±2.5)d;对照组中2例经常规治疗好转出院,全量喂养时间为(29.5±0.5)d,2例出现肠穿孔予手术治疗,其余2例死亡。结论中药方剂“肠粘连方”不仅对新生儿术后粘连性肠梗阻具有显著疗效,而且对新生儿早期NEC也是安全有效的。Objective To evaluate the efficacy of Chinese herbal medicine prescription Intestinal Adhesion Prescription (IAP) for surgery and conservative treatment of neonatal intestinal diseases and discuss its mechanism in the treatment of neonatal intestinal diseases. Methods From January 1,2012 to January 1,2017,41 neonates with intestinal diseases were retrospectively analyzed.Thirty neonates with postoperative intestinal ileus after abdominal surgery were enrolled into operative group while another 14 cases received IAP plus food fasting and gastrointestinal decompression.And 16 cases received conventional treatment without IAP.In non-operative Group,11 neonates of early-stage necrotizing enterocolitis (NEC) presented vomiting,repeated abdominal distension after feeding,hematochezia and heightened inflammation.In this control group,5 cases received IAP while the remainders were treated routinely.Symptoms of intestinal obstruction and recovery of digestive tract function were analyzed after oral intake of IAP. Results In operative group,the duration from intestinal obstruction to total enteral feedingwas (10.6±0.7) and (12.8±0.6) days in IAP and control groups respectively.There were significant statistical differences ( t=2.23,P=0.03 ).In two groups,the re-operative rate was 7.1%(1/14) and 25%(4/16) and the mortality rate 7.1%(1/14) and 18.8%(3/16) respectively.In non-operative group,all 5 IAP-treated patients had a negative conversion of fecal occult blood with lower inflammatory parameters.There was no sign of intestinal perforation,hematochezia or sign of peritonitis after withdrawing or degrading antibiotics.In control group,2 cases of intestinal perforation were operated while another 2 cases died and 2 recovering children were discharged.The duration from intestinal obstruction to total enteral feedingwas (17.4±2.5) days and (29.5±0.5) days in IAP and control groups respectively. Conclusion Chinese herbal medicine prescription IAP not only has marked efficacy for patients with postoperative adhesive intestin

关 键 词：婴儿 新生儿 胃肠疾病/治疗 方剂 

分 类 号：R289.5[医药卫生—方剂学] R656.9[医药卫生—中药学]