健脾活血方治疗肝豆状核变性并发脾功能亢进脾切除后血瘀证临床研究  

Clinical Effect of Jianpi Huoxue Prescription in Treatment of Blood Stasis Syndrome After Splenectomy for Hepatolenticular Degeneration with Hypersplenism

作　　者：龚雅琦 于庆生[1,2] 彭辉 魏肥生 郑州 经文善 刘名扬 GONG Yaqi;YU Qingsheng;PENG Hui;WEI Feisheng;ZHENG Zhou;JING Wenshan;LIU Mingyang(The First Affiliated Hospital of Anhui University of Chinese Medicine,Anhui Hefei 230031,China;Institute of Chinese Traditional Surgery,Anhui Academy of Chinese Medicine,Anhui Hefei 230031,China)

机构地区：[1]安徽中医药大学第一附属医院,安徽合肥230031 [2]安徽省中医药科学院中医外科研究所,安徽合肥230031

出　　处：《安徽中医药大学学报》2023年第2期8-12,共5页Journal of Anhui University of Chinese Medicine

基　　金：“十二五”国家临床重点专科建设项目(财社〔2013〕239号);“十二五”国家中医药管理局重点专科建设项目(国中医药医政发〔2012〕2号)。

摘　　要：目的观察肝豆状核变性并发脾功能亢进脾切除后血瘀证形成情况及健脾活血法的临床疗效。方法从脾功能亢进脾切除患者中选取术后发生血瘀证的患者,将其随机分为观察组和对照组。观察组予以术后健脾活血中药干预,对照组予以术后常规治疗。分别观察两组术后血瘀证、门静脉系统血栓(portal vein system thrombosis,PVST)发生率及其动态变化,并进一步观察血瘀证形成对术后肝功能恢复的影响。结果271例术后脾功能亢进脾切除患者中,术后3 d共有223例(82.29%)出现血瘀证,对照组111例,观察组112例。术后7、14、21 d时观察组血瘀证发生率以及术后4、7、14 d时观察组PVST发生率显著低于对照组(P<0.05)。术后14 d开始两组血瘀证和PVST发生率逐渐下降;术后21、28 d两组血瘀证和PVST发生率的差异无统计学意义(P>0.05)。术后1 d两组肝功能指标均显著升高;术后3 d,两组血清丙氨酸转移酶(alanine transaminase,ALT)、天冬氨酸转移酶(aspartate transaminase,AST)活性,血清间接胆红素(indirect bilirubin,IBIL)和血浆白蛋白(albumin,ALB)水平较术后1 d显著降低(P<0.05);术后7、14 d,两组血清ALT活性和血清IBIL、血浆ALB水平较术前明显降低(P<0.05);术后14 d观察组血清ALT、AST活性,血清IBIL、血浆ALB水平显著低于对照组(P<0.05);术后21、28 d,两组血清ALT、AST活性,血清IBIL和血浆ALB水平的差异无统计学意义(P>0.05)。结论肝硬化门静脉高压症合并脾功能亢进患者术后易于发生血瘀证和PVST,脾切除后序贯使用健脾活血中药可以有效防治血瘀证和PVST,有助于术后肝功能恢复。Objective To investigate the formation of blood stasis syndrome after splenectomy for hepatolenticular degeneration with hypersplenism and the clinical effect of spleen-invigorating and blood-activating therapy.Methods The patients who had blood stasis syndrome after splenectomy for hypersplenism were enrolled and randomly divided into observation group and control group.The patients in the observation group were given traditional Chinese medicine for invigorating the spleen and activating blood circulation after surgery,and those in the control group were given routine treatment after surgery.The two groups were observed in terms of the incidence rates of blood stasis syndrome and portal vein system thrombosis(PVST)after surgery,and the influence of blood stasis syndrome on postoperative liver function recovery was further observed.Results Among the 271 patients who underwent splenectomy for hypersplenism,223(82.29%)had blood stasis syndrome on day 3 after surgery,with 111 in the control group and 112 in the observation group.Compared with the control group,the observation group had a significantly lower incidence rate of blood stasis syndrome on days 7,14,and 21 after surgery and a significantly lower incidence rate of PVST on days 4,7,and 14 after surgery(P<0.05).There were gradual reductions in the incidence rates of blood stasis syndrome and PVST since day 14 after surgery,with no significant differences between the two groups on days 21 and 28 after surgery(P>0.05).On day 1 after surgery,both groups had significant increases in liver function parameters;for both groups,the activities of serum alanine aminotransferase(ALT)and aspartate aminotransferase(AST),the serum level of indirect bilirubin(IBIL),and the plasma level of albumin(ALB)on day 3 after surgery were significantly lower than those on day 1 after surgery(P<0.05);on days 7 and 14 after surgery,both groups had significant reductions in the activity of serum ALT,the serum level of IBIL,and the plasma level of ALB(P<0.05);compared with the control gr

关 键 词：肝豆状核变性 脾功能亢进 脾切除 血瘀证 健脾活血法 

分 类 号：R575.2.4[医药卫生—消化系统] R241[医药卫生—内科学]