大黄牡丹汤在胆囊结石术后肠功能恢复和炎症状态改善的作用研究  

Effect of Dahuang Mudan Decoction(大黄牡丹汤)on Intestinal Function Recovery and Inflammation Improvement after Cholelithiasis Surgery

作　　者：支飞虎[1] 刘国涛[2] 赵雄碧[1] 张建宇[1] 张澍漾 ZHANG Hua;JIANG Lisheng(Jiangxi University of Chinese Medicine,Nanchang 330004,Jiangxi,China)

机构地区：[1]绍兴市中医院,浙江绍兴321000 [2]浙江省中医院,浙江杭州310000

出　　处：《中华中医药学刊》2023年第9期234-238,共5页Chinese Archives of Traditional Chinese Medicine

基　　金：浙江省医药卫生科技计划项目(2019ZH062)。

摘　　要：目的探究大黄牡丹汤辅助用于胆囊结石术后肠功能恢复和炎症状态改善的作用。方法选取住院行腹腔镜下胆囊切除术患者200例,采用单双号法均分为两组。对照组予经验丰富的副主任医师行腹腔镜下胆囊切除术,术后予禁食、胃肠减压、营养支持等常规治疗并予肥皂温开水灌肠,治疗组将肥皂温开水替换为大黄牡丹汤,其余一致。观察两组疗效指数、急性胃肠损伤(AGI)分级、胃肠功能障碍评分、通气、排便、食欲恢复情况、术后炎症状态及肝功能[C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、降钙素原(PCT)、白介素-6(IL-6)、总胆红素(TBIL)、谷氨酰转移酶(GGT)]、术后不良反应。结果治疗组总有效率(92%,92/100)显著高于对照组(68%,68/100)(P<0.05),治疗后,治疗组AGI分级I期多于对照组,III期明显少于对照组;胃肠功能评分低于对照组,第1次排便时间、不排便天数、使用灌肠剂比例、肠鸣音恢复时间、肛门排气时间、食欲恢复时间、不良反应发生率均小于对照组,每日排便次数多于对照组(P均<0.05)。治疗后治疗组CRP(2.14±1.24)mg/L、TNF-α(2.41±0.34)ng/L、PCT(12.10±3.01)mg/L、IL-6(0.69±0.19)ng/L、TBIL(14.17±1.93)μmol/L、GGT(16.75±5.11)U/L含量均显著高于对照组,P<0.05。进一步采用Kendall分析炎症因子、大黄牡丹汤使用、肝功能与患者胃肠道AGI分级的关系,发现炎症因子TNF-α、CRP、PCT以及肝功能TBIL、GGT与胃肠道AGI分级均呈正相关关系(OR=0.689,0.712,0.648,0.736,0.704;P均=0.000),大黄牡丹汤使用与胃肠道AGI分级呈负相关关系(OR=-0.708,P=0.000)。结论大黄牡丹汤直接灌肠在腹腔镜下胆囊切除术后应用具有较好的疗效,一方面可以改善患者术后胃肠功能,帮助缩短患者的术后肠道功能恢复时间,另一方面发挥了较好的炎症改善作用,该组方的应用在患者术后胃肠功能的恢复方面起到了关键作用,且不良反应低,具有较Objective To explore the auxiliary effect of Dahuang Mudan Decoction(大黄牡丹汤)on the recovery of intestinal function and improvement of inflammatory state after cholecystolithiasis operation.Methods A total of 200 hospitalized patients undergoing laparoscopic cholecystectomy were selected and divided into two groups by single and even numbers.The control group was given laparoscopic cholecystectomy by experienced sub-senior physician,after which routine treatments such as fast-ing,gastrointestinal decompression,nutritional support and enema with soap and warm water were given.The treatment group re-placed soap and warm water with Dahuang Mudan Decoction,and the rest treatments were the same as those in the control group.Efficacy index,acute gastrointestinal injury(AGI)grade,gastrointestinal dysfunction score,ventilation,defecation,recovery of ap-petite,postoperative inflammatory status and liver function[C-reactive protein(CRP),tumor necrosis factor-α(TNF-α),pro-calcitonin(PCT),interleukin-6(IL-6),total bilirubin(TBIL),glutamyltransferase(GGT)]and postoperative adverse effects of two groups were observed.Results The total effective rate of the treatment group(92%)was significantly higher than that of the control group(P<0.05).After treatment,the AGI stage I of the treatment group was more than that of the control group,and the AGI stage III of the treatment group was significantly less than that of the control group.The gastrointestinal function score of the treatment group was lower than that of the control group.The first defecation time,the number of days without defecation,the pro-portion of enema use,the recovery time of bowel sounds,the time of anal exhaust,the time of appetite recovery and the incidence of adverse reactions in the treatment group were lower than those of the control group,and the number of defecation times per day in the treatment group was higher than that of the control group(all P<0.05).After treatment in the treatment group,CRP was(2.14±1.24)mg/L,TNF-αwas(2.41±0.34)ng/L,PCT

关 键 词：大黄牡丹汤 胆囊结石 腹腔镜下胆囊切除术 胃肠功能 

分 类 号：R284.1[医药卫生—中药学]