甲泼尼龙治疗腹腔术后早期炎性肠梗阻的效果及对血清炎性因子水平的影响  

Effects of methylprednisolone on early inflammatory bowel obstruction after abdominal surgery and the serum levels of inflammatory factors

作　　者：许建多 刘云星 郑志刚 韩志勤 XU Jianduo;LIU Yunxing;ZHENG Zhigang(Department of General Surgery,The First Hospital of Shijiazhuang City,Hebei,Shijiazhuang 050011,China)

机构地区：[1]河北省石家庄市人民医院普外科一病区,050011 [2]中国人民解放军联勤保障部队第九八〇医院

出　　处：《河北医药》2020年第18期2814-2817,共4页Hebei Medical Journal

基　　金：河北省石家庄市科学技术研究与发展计划项目(编号:171201643)。

摘　　要：目的评估甲泼尼龙在治疗术后早期炎性肠梗阻(EPISBO)的疗效及其对血清炎性因子水平的影响。方法腹腔术后炎性肠梗阻患者共86例,依据入院顺序分为试验组和对照组,每组43例。对照组采用传统胃肠减压、抑制胃肠液分泌、营养支持、维持水电解质平衡、穴位按摩及封闭、理疗等。试验组在对照组治疗的基础上增加甲泼尼龙,疗程3周,观察2组患者治疗后的肠道功能恢复情况(IBS-SSS评分);2组患者3周内的痊愈率、痊愈患者的平均住院日及并发症的发生率;白细胞及血清炎性因子[白介素-2(IL-2)、IL-6、超敏C-反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)]水平。结果IBS-SSS评分显示:3周治疗期内,试验组较对照组在治疗的前2周差异有统计学意义(P<0.05)。3周治疗期内,试验组较对照组在痊愈率、平均住院时间等方面均有优势,差异有统计学意义(P<0.05)。2组患者均于2周内白细胞总数恢复至<10×10^9/L,但试验组患者的白细胞恢复速率较对照组快(P<0.05)。2周后试验组患者血清IL-2、IL-6、TNF-α和hs-CRP水平均低于对照组(P<0.05)。结论治疗方案中增加甲泼尼龙能增加腹腔术后EPISBO的治疗效果,缩短治疗周期。Objective To investigate the effects of methylprednisolone on early inflammatory bowel obstruction after abdominal surgery(EPISBO)and serum levels of inflammatory factors.Methods Eighty-six patients with inflammatory bowel obstruction after peritoneal surgery were divided into control group(n=43)and experimental group(n=43)according to their?order of hospitalization.The patients in control group were treated by gastrointestinal decompression,suppression of gastrointestinal fluid secretion,nutritional support,maintenance of water and electrolyte balance,point massage,sealing,physical therapy,etc while those in experimental group were,on the basis of control group,treated by methylprednisolone for 3 weeks.The recovery of intestinal function(IBS SSS score)of the patients after treatment in both groups,the cure rate of the patients in both groups within 3 weeks,the average hospitalization days of the cured patients and the incidence of complications,the levels of white blood cells and Serum inflammatory factor levels(IL-2,IL-6,hs-CRP,TNF)were observed and compared between the two groups.Results The IBS-SSS score showed there were significant differences at the first two weeks during treatment between the two groups(P<0.05).During the third week treatment,the cure rate and the average hospitalization days in experimental group were significantly higher or more than those in control group(P<0.05).Moreover,the total numbers of white blood cells in both groups recovered to below 10×109/L within 2 weeks,and the recovery rate of the white blood cells in experimental group was significantly higher than that in control group(P<0.05).In addition,the serum levels of IL-2,IL-6,TNF and hs-CRP at 2 week after treatment in experimental groupwere were significantly lower than those in control group(P<0.05).Conclusion Methylprednisolone combined with converntional drugs is more effective in treating early inflammatory bowel obstruction after abdominal surgery(EPISBO),with a shorter treatment course.

关 键 词：甲泼尼龙 EPISBO 腹腔术后 致炎因子 早期干预 激素治疗 

分 类 号：R619[医药卫生—外科学]