大承气汤保留灌肠联合足三里穴按摩在促进重症急性胰腺炎胃肠动力中的应用  

Application of Dachengqi Decoction retention enema combined with Zusanli acupoint massage in promoting gastrointestinal motility in severe acute pancreatitis

作　　者：王桂春[1] 孔晔宏[1] 张雪乔[2] 刘艳霞[3] 高翠[1] 周婧 Wang Guichun;Kong Yehong;Zhang Xueqiao;Liu Yanxia;Gao Cui;Zhou Jing(Department of Hepatobiliary Surgery,the Second Hospital of Hebei Medical University,Shijiazhuang 050000,Hebei,China;Internal Medicine of Traditional Chinese Medicine,the Second Hospital of Hebei Medical University,Shijiazhuang 050000,Hebei,China;Department of Emergency Surgery,the Second Hospital of Hebei Medical University,Shijiazhuang 050000,Hebei,China)

机构地区：[1]河北医科大学第二医院肝胆外科,河北石家庄050000 [2]河北医科大学第二医院中医内科,河北石家庄050000 [3]河北医科大学第二医院急诊外科,河北石家庄050000

出　　处：《中国中西医结合急救杂志》2022年第2期183-186,共4页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：河北省医学科学重点课题(20170627)。

摘　　要：目的观察大承气汤保留灌肠联合足三里穴按摩在促进重症急性胰腺炎(SAP)患者胃肠动力中的应用效果。方法采用前瞻性研究方法。选择河北医科大学第二医院2017年7月至2020年12月收治130例SAP患者作为研究对象。将患者按随机数字表法分为西医常规治疗对照组和中西医治疗组,每组65例。西医常规治疗对照组给予禁食禁水、行胃肠减压术、吸氧、使用抗菌药物控制感染、抑制胰腺及胃酸分泌、补充营养与体液、止痛等常规治疗和护理方法;中西医治疗组在西医常规治疗对照组基础上联合大承气汤保留灌肠(组成:大黄15 g、芒硝15 g、枳实12 g、厚朴12 g,随症加减),每日1次,连续7 d;同时按摩足三里穴,每日3次,连续7 d。观察两组患者肠鸣音恢复时间、首次自然排气时间、首次自然排便时间、住院时间、生化指标恢复时间及患者满意度的变化。结果中西医治疗组肠鸣音恢复时间、首次自然排气时间、首次自然排便时间、住院时间均较西医常规治疗对照组明显缩短〔肠鸣音恢复时间(d):2.75±0.87比4.09±1.13,首次自然排气时间(d):3.52±0.94比5.02±1.20,首次自然排便时间(d):4.09±1.10比6.09±1.66,住院时间(d):29.26±6.38比32.63±6.63,均P<0.05〕;在监测的生化指标中,中西医治疗组血淀粉酶、尿淀粉酶、白细胞计数(WBC)恢复时间均较西医常规治疗对照组明显缩短〔血淀粉酶恢复时间(d):6.63±2.25比9.40±2.66,尿淀粉酶恢复时间(d):11.65±2.02比13.66±1.92,WBC恢复时间(d):11.35±2.58比13.62±2.58,均P<0.05〕;中西医治疗组护理满意度明显高于西医常规治疗对照组〔95.38%(62/65)比70.77%(46/65),P<0.05〕。结论SAP患者在常规治疗的基础上加用大承气汤保留灌肠联合足三里穴按摩,能有效增强胃肠动力,恢复胃肠功能,促进康复,缩短住院时间,提高患者对护理的满意度。Objective To observe the effect of Dachengqi Decoction retention enema combined with Zusanli acupoint massage in promoting gastrointestinal motility in patients with severe acute pancreatitis(SAP).Methods A prospective research study was conducted.A total of 130 patients with SAP treated in the Second Hospital of Hebei Medical University from July 2017 to December 2020 were selected as the research objects.The patients were randomly divided into a western medicine routine treatment control group and a combined traditional Chinese medicine(TCM)and western medicine treatment group,with 65 cases in each group.The western medicine routine treatment control group was given western medical routine treatment and nursing methods such as fasting and water prohibition,gastrointestinal decompression,oxygen inhalation,use of antibiotics to control infection,inhibition of pancreatic and gastric acid secretion,supplement of nutrition and body fluid,analgesia and so on;the combined TCM and western medicine treatment group was treated with the same western medicine and nursing as those in the western medicine routine treatment control group,and additionally Dachengqi Decoction retention enema was applied(composition of TCM decoction:Rhubarb 15 g,Mirabilite 15 g,Fructus aurantii 12 g,Magnolia officinalis 12 g,plus or minus according to the symptoms),once a day for consecutive 7 days;at the same time,Zusanli acupoint massage was performed 3 times a day for consecutive 7 days.The recovery time of bowel sounds,the first natural exhaust time,the first natural defecation time,the length of hospital stay,the recovery time of biochemical indexes and the changes of patients'satisfaction were observed in the two groups.Results The recovery time of bowel sounds,the first natural exhaust time,the first natural defecation time and the time of hospital stay in combined TCM and western medicine treatment group were significantly shorter than those in western medicine routine treatment control group[recovery time of bowel sounds(days):2.75±0.8

关 键 词：大承气汤 保留灌肠 足三里穴按摩 重症急性胰腺炎 

分 类 号：R47[医药卫生—护理学]