桃核承气汤对腰椎术后瘀热互结证的疗效  

Clinical study of Taohe Chengqi decoction in the treatment of Syndrome of stasis and heat binding after lumbar surgery

作　　者：严佳宝 刘秉新 郭俊彪[2] 潘宗奇[2] 王慧敏[2] YAN Jia-bao;LIU Bing-xin;GUO Jun-biao;PAN Zong-qi;WANG Hui-min(The Second Clinical School of Guangzhou University of Chinese Medicine,Guangzhou 510405,Guangdong,China;不详)

机构地区：[1]广州中医药大学第二临床医学院,广东广州510405 [2]广东省中医院骨科,广东广州510120

出　　处：《广东医学》2023年第7期838-841,共4页Guangdong Medical Journal

基　　金：广东省中医院中医药科学技术研究专项(YN2022GK09)。

摘　　要：目的评估桃核承气汤对腰椎椎间融合术后瘀热互结证患者的疗效和安全性。方法纳入因腰椎管狭窄症接受微创经椎间孔腰椎椎间融合术的患者。在术后第1天对患者进行辨证,选择60例辨证为瘀热互结证的患者,按随机数字分为两组。对照组使用抗感染、护胃、术口换药等常规治疗,观察组在常规治疗的基础上服用桃核承气汤,疗程为3 d。结局指标为中医证候评分及术后体温、大便情况和炎症因子水平的变化。结果除去脱落病例后,观察组和对照组各纳入29例。完成治疗后,观察组的中医证候评分改善程度优于对照组(P<0.05);观察组的发热改善优于对照组(P<0.05);观察组的首次大便时间早于对照组,且大便次数多于对照组(P<0.05);观察组的C反应蛋白(CRP)、红细胞沉降率(ESR)、肿瘤坏死因子-α(TNF-α)等炎症因子水平低于对照组(P<0.05)。在安全性方面,两组均无不良事件。结论桃核承气汤能改善腰椎融合术后患者发热、便秘及疼痛等证候并减轻炎症反应,安全性较高。Objective To evaluate the efficacy and safety of Taohe Chengqi Decoction in patients with stasis-heat mutual constriction pattern after lumbar interbody fusion surgery.Methods Patients who underwent minimally invasive lumbar interbody fusion surgery for lumbar spinal stenosis were included.On the first day after surgery,the patients were diagnosed according to traditional Chinese medicine patterns,and 60 patients with the stasis-heat mutual constriction pattern were selected and randomly divided into two groups.The control group received routine treatments such as anti-infection,gastric protection,and wound dressing changes,while the observation group received Taohe Chengqi Decoction in addition to routine treatment for 3 days.The outcome measures included traditional Chinese medicine syndrome scores and changes in postoperative body temperature,bowel movements,and levels of inflammatory factors.Results After excluding dropout cases,29 patients were included in each group.After completion of treatment,the observation group showed greater improvement in traditional Chinese medicine syndrome scores compared to the control group(P<0.05).Fever resolution was better in the observation group than in the control group(P<0.05).The observation group had an earlier first bowel movement and more frequent bowel movements compared to the control group(P<0.05).Levels of inflammatory factors such as CRP,ESR,and TNF-αwere lower in the observation group than in the control group(P<0.05).Both groups demonstrated good safety without any adverse events.Conclusion Taohe Chengqi Decoction can improve postoperative fever,constipation,and pain in patients undergoing lumbar fusion surgery and reduce inflammatory reactions,with a relatively high level of safety.

关 键 词：腰椎管狭窄症 围手术期 瘀热互结证 桃核承气汤 随机对照试验 

分 类 号：R247.9[医药卫生—中医临床基础] R274[医药卫生—中医学]