| 摘要: |
| 目的:研究复方大承气汤联合经鼻型肠梗阻导管对恶性肠梗阻(MBO)的治疗效果、损伤的肠黏膜屏障修复和免疫紊乱的影响。方法:选择2018年7月—2019年8月我院收治的MBO患者30例，随机数表法分成对照组和中药组，各15例，两组均给予常规治疗，对照组在此基础上急症放置经鼻型肠梗阻导管，24 h后开始口服温开水100 mL，每天2次，连服7 d，中药组在对照组基础上，将温开水改为口服复方大承气汤，服法同对照组，对比两组疗效、临床指标、肠屏障损伤指标及免疫指标情况。结果:中药组的有效率(86.7%)明显高于对照组(53.3%)，恢复排气排便时间明显早于对照组(P<0.05)。放置导管后第4~6天，中药组的每日消化液引流量少于对照组，差异有统计学意义(P<0.05)。放置导管后3 d，两组复查立位腹平片，大部分患者气液平面消失，两组差异无统计学意义(P>0.05)。治疗后7 d，两组血清中二胺氧化酶(DAO)和D-乳酸(D-LC)均下降，中药组明显低于对照组(P<0.05)；两组IgA、IgG、IgM水平均有所升高，中药组IgG水平明显高于对照组(P<0.05)；两组C3、C4均有所升高，中药组明显高于对照组(P <0.05)；两组CD3+、CD4+、CD8+均有所升高，中药组明显高于对照组(P<0.05)。结论:复方大承气汤联合经鼻型肠梗阻导管能够提高MBO的疗效，促进MBO患者肠黏膜屏障损伤的修复，调节MBO患者的机体免疫功能紊乱，值得临床推广应用。 |
| 关键词: 复方大承气汤 肠梗阻导管 恶性肠梗阻 |
| DOI：10.3969/j.issn.1007-6948.2021.01.003 |
| 投稿时间：2020-06-28 |
| 基金项目:天津市卫生和计划生育委员会中医中西医结合科研课题(2017041) |
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| Clinical Study of Compound Dachengqi Decoction Combined with Ileus Tube on the Treatment of Malignant Bowel Obstruction |
| YANG Shi-min,XIANG Qi,CHANG Yan |
| Department of First Gastrointestinal Surgery, Tianjin Nankai Hospital, Tianjin 300100, China |
| Abstract: |
| Objective To study the effect, the repair of damaged intestinal barrier and immune disorders of compound Dachengqi decoction combined with transnasal ileus tube on the treatment of malignant bowel obstruction (MBO). Methods Totally 30 cases of MBO treated in our hospital from July 2018 to August 2019 were studied. The patients were divided into control group (n=15) and the traditional Chinese medicine (TCM) group (n=15) according to random number table method. The patients in two groups were treated with regular treatment. The control group placed the transnasal ileus tube in emergency on this basis and began to take 100ml warm boiled water twice a day for 7 days after 24 hours. On the basis of the control group, the TCM group changed the white boiled water into the oral compound Dachengqi Decoction, taking the same method as the control group. The curative effect, clinical indicators, intestinal barrier damage indicators and immune indicators were compared between the two groups. Results The effective rate of TCM group (86.7%) was significantly higher than that of the control group (53.3%) (P<0.05). The recovery time of exhaust and defecation in TCM group was earlier than that in the control group (P<0.05). For 7 days after placement of transnasal ileus tube, the daily flow of ileus tube in the TCM group was less than that in the control group, especially 4 to 6 days after placement of ileus tube, which the difference was significant difference (P<0.05). Three days after placement of ileus tube, the abdominal plain film was reexamined in the two groups. Most of the patients’gas-liquid plane disappeared and there was no significant difference between the two groups (P>0.05). On the 7th day after treatment, the levels of Diamine oxidase (DAO) and D-lactate (D-LC) in the serum of the two groups decreased, and the level of DAO and D-LC in the TCM group was signi?cantly lower than that in the control group (P<0.05). The levels of IgA, IgG and IgM in the two groups were all increased. The level of IgG in the TCM group was signi?cantly higher than that in the control group (P<0.05). The C3 and C4 were increased in both groups, and the level in the TCM group was signi?cantly higher than that in the control group (P<0.05). The CD3+, CD4+, CD8+ were increased in both groups, and the levels of CD3+, CD4+ and CD8+ in the TCM group were signi?cantly higher than those in the control group (P<0.05). Conclusion Compound Dachengqi Decoction combined with transnasal ileus tube can improve the curative effect of MBO. Compound Dachengqi Decoction can also promote the repair of intestinal mucosal barrier injury of MBO and regulate the immune function disorder of patients with MBO, which is worthy of clinical promotion. |
| Key words: Compound Dachengqi Decoction ileus tube malignant bowel obstruction |
