益肺通络汤替代肺癌术后预防性抗生素治疗的研究  

Clinical Study of Yifei Tongluo Decoction as Alternative of Prophylactic Antibiotics After Lung Cancer Operation

作　　者：张颖[1] 朱佳[1] 王谦[1] 镇海文[1] 孙太旭 管仲 邹浩生[1] 殷明[1] 章斌 ZHANG Ying;ZHU Jia;WANG Qian;ZHEN Haiwen;SUN Taixu;GUAN Zhong;ZOU Haosheng;YIN Ming;ZHANG Bin(Jiangsu Province Hospital of Chinese Medicine,Affiliated Hospital of Nanjing University of Chinese Medicine,Nanjing 210029,China)

机构地区：[1]南京中医药大学附属医院,江苏南京210029

出　　处：《中医药学报》2022年第5期69-75,共7页Acta Chinese Medicine and Pharmacology

基　　金：第三批江苏省名老中医专家传承工作室建设项目(苏中医科教[2019]10号);江苏省中医院科主任提升专项课题(Y2021ZR08)。

摘　　要：目的:观察非小细胞肺癌患者口服益肺通络汤替代术后预防性抗生素治疗的安全性,以及对改善患者术后症状、促进康复的疗效。方法:选择行胸腔镜手术,证属肺虚络阻的非小细胞癌患者105例,随机分为对照组和研究组,所有患者围术期均采用快速康复外科治疗模式,对照组术前30 min给予头孢米诺1 g,同时术后24 h内给予头孢米诺1g bid预防感染;研究组术前30 min给予头孢米诺1 g静滴,术后第一天起口服益肺通络汤,每日2剂至出院。记录患者术前一般基线资料及术后恢复指标,中医证候积分、临床疗效指标及生活质量评分,以及围术期体温、血常规、炎症及免疫指标的变化情况。结果:研究组术后住院时间明显短于对照组(P<0.05),两组患者在术后感染并发症、胸引管留置时间以及住院费用方面差异无统计学意义。两组患者术后3日每日最高体温均在正常范围,两组差异无统计学意义。两组患者术后第3日证候积分显著低于术后第1日(P<0.01),且研究组术后第3日证候积分显著低于对照组(P<0.01),研究组总有效率高于对照组(P<0.01)。研究组术后第3日Karnofsky(KPS)功能状态评分显著高于对照组(P<0.01)。两组患者术后各时点白细胞计数、中性粒细胞计数未见显著性差异。研究组术后第3日C反应蛋白、白介素6显著低于对照组(P<0.01),IgG、IgA显著高于对照组(P<0.01)。结论:本研究发现肺癌患者口服益肺通络汤替代术后预防性抗生素治疗是安全可靠的。益肺通络汤能够减轻患者的炎症反应、调节机体免疫功能,显著改善患者术后的临床症状和生活质量,对临床合理减少抗生素使用,促进术后快速康复具有重要意义。Objective: To observe the safety of oral Yifei Tongluo Decoction as alternative of postoperative prophylactic antibiotics in patients with non-small cell lung cancer(NSCLC), and to explore its effect on improve postoperative symptoms and promote rehabilitation. Methods: 105 cases of NSCLC with Lung deficiency and collateral obstruction pattern undergoing thoracoscopic lobectomy were randomly divided into the control group and the study group. All patients were treated with fast track surgery protocols. The control group was given Cefminox(1 g) half an hour before operation and Cefminox(1 g, bid) within 24 hours after operation to prevent infection. The study group was given Cefminox(1 g) half an hour before operation, followed by Yifei Tongluo Decoction from the first day after operation until discharge. The preoperative baseline data, postoperative recovery indexes, TCM symptom score, clinical efficacy and quality of life, as well as the changes of perioperative body temperature, blood routine, inflammation and immune indexes were recorded in the two groups. Results: The postoperative hospital stay in the study group was significantly shorter than that in the control group(P<0.05). There were no significant differences in postoperative infection complications, indwelling time of thoracic catheter and hospitalization expenses between the two groups. The daily maximum body temperature of the two groups was within the normal range 3 days after operation, and there was no statistical difference between the two groups. The TCM symptom score on the third day after operation was significantly lower than that on the first day after operation in both groups(P<0.01), and the TCM symptom score on the third day after operation was significantly lower in the study group than that in the control group(P<0.01). The total effective rate of the study group was significantly higher than that of the control group(P<0.01). The score of Karnofsky(KPS) functional status was significantly higher in the study group than that in the con

关 键 词：肺癌 抗生素 快速康复外科 益肺通络汤 

分 类 号：R242[医药卫生—中医临床基础]