大承气汤联合皮内针治疗胃、十二指肠穿孔修补术后肠麻痹临床观察  

Clinical Efficacy of Dachengqi Decoction Combined with Intradermal Needling on Postoperative Ileus after Gastric and Duodenal Perforation Repair

作　　者：梁立雪 霍景山 杨志林 梁梓宁 陈文丽 黄少娟 Liang Lixue;Huo Jingshan;Yang Zhilin;Liang Zining;Chen Wenli;Huang Shaojuan(Foshan Traditional Chinese Medicine Hospital Affiliated to Guangzhou University of Traditional Chinese Medicine,Guangdong,Foshan 528000,China)

机构地区：[1]广州中医药大学附属佛山中医院,广州中医药大学第八临床医学院,广东佛山528000

出　　处：《中国中医急症》2024年第4期702-705,共4页Journal of Emergency in Traditional Chinese Medicine

基　　金：广东省佛山市科技局医学攻关项目(2220001004602)。

摘　　要：目的观察大承气汤灌肠联合皮内针用于胃、十二指肠溃疡穿孔术后肠麻痹(POI)的疗效及对炎症因子和胃肠激素的影响。方法将60例胃、十二指肠溃疡穿孔术后POI患者随机分为两组。对照组采用常规术后康复联合皮内针治疗;观察组在对照组治疗基础上给予大承气汤灌肠治疗,疗程3 d。记录肛门首次排气、排便时间,肠鸣音恢复时间和正常进食时间,治疗前后进行湿热壅滞证评分和术后胃肠动力评分;记录腹胀、腹痛和恶心、呕吐消失时间。检测治疗前后血清胃动素(MTL)、胃泌素(GAS)、血管活性肠肽(VIP)、肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)、白细胞介素-1(IL-1)、IL-6水平。进行安全性评价。结果治疗后,观察组首次排气、排便时间,肠鸣音恢复时间、正常进食时间及腹胀、腹痛和恶心、呕吐消失时间均短于对照组(P<0.05);观察组湿热壅滞证评分低于对照组(P<0.05),术后胃肠动力评分高于对照组(P<0.05);治疗后,观察组TNF-α、CRP、IL-1、IL-6、VIP水平低于对照组(P<0.05),MTL、GAS水平高于对照组(P<0.05);观察组总有效率93.33%,高于对照组的63.33%(P<0.05)。结论大承气汤灌肠联合皮内针用于胃、十二指肠溃疡穿孔术后POI,能调节胃肠激素,抑制过度的肠道炎症反应,促进胃肠动力恢复,加速症状、体征的消失,缩短病程,提高临床治疗效果,促进患者术后的康复。Objective:To evaluate the efficacy of Dachengqi Decoction enema combined with intradermal needling for postoperative ileus(POI)in patients after gastric and duodenal perforation repair,and its impact on inflammatory factors and gastrointestinal hormones.Methods:A total of 60 patients with POI after gastric and duodenal perforation repair were randomly divided into a control group(30 cases)and an observation group(30 cases).The control group received routine postoperative rehabilitation measures combined with intradermal needling,while the observation group was given Dachengqi Decoction enema on the basis of the control group for 3 days.The time of first anal discharge and defecation,recovery time of bowel sounds,and normal eating time,and evaluate the score of dampness heat stagnation syndrome before and after treatment,the postoperative gastrointestinal motility score,the disappearance time of abdominal distension,pain,nausea,and vomiting were recorded;the serum motilin(MTL),gastrin(GAS),vasoactive intestinal peptide(VIP),and tumor necrosis factor-α(TNF-α),c-reactive protein(CRP),interleukin-1(IL-1),and IL-6 levels before and after treatment were detected and the safety evaluation was estimated.Results:After treatment,the observation group had shorter first exhaust and defecation times,recovery time of bowel sounds,normal eating time,and disappearance time of abdominal distension,abdominal pain,nausea,and vomiting compared with the control group(P<0.05);the score of dampness heat stagnation syndrome in the observation group was lower than that in the control group(P<0.05),and the postoperative gastrointestinal motility score was higher than that in the control group(P<0.05);after treatment,the levels of TNF-α,CRP,IL-1,IL-6 and VIP in the observation group were lower than those in the control group(P<0.05),while the levels of MTL and GAS were higher than those in the control group(P<0.05);the total effective rate of clinical efficacy in the observation group was 93.33%,which was higher than 63.33%in the contro

关 键 词：胃十二指肠溃疡 穿孔 术后肠麻痹 大承气汤 灌肠 皮内针 炎症因子 胃肠激素 

分 类 号：R565.6[医药卫生—呼吸系统]