中西医结合治疗术后早期炎性肠梗阻30例临床观察

【作者】 黄斌；

【导师】 吴伟；

【作者基本信息】 北京中医药大学 ， 中西医结合外科学， 2008， 硕士

【摘要】 目的:术后早期炎性肠梗阻(early postoperative inflammatory ileus , EPII)系指腹部手术后早期由于手术创伤或腹腔内炎症等原因导致肠壁水肿和渗出,形成的一种机械性与动力性同时存在的粘连性肠梗阻。绝大多数可采用非手术疗法治愈,少数病例往往因处理不当导致不必要的手术,术后可能出现肠瘘、重症感染、短肠综合征等严重并发症。因此,正确认识此类肠梗阻具有重要意义。目前多数学者认为积极采取非手术保守治疗是术后早期炎性肠梗阻较为可行的有效方法。我科采用复方大承气汤自胃管注入的中西医结合治疗方法,旨在观察复方大承气汤治疗术后早期炎性肠梗阻的疗效,并探讨该方治疗术后早期炎性肠梗阻的相关作用机制。资料与方法:回顾性分析我科自2005年12月～2007年12月两年间诊治的58例术后早期炎性肠梗阻患者病历资料,将患者分为中西医结合治疗组(简称治疗组)30例和西医对照治疗组(简称对照组)28例。其中中西医结合治疗组中药运用复方大承气汤自胃管注入的方法,并配合西医保守治疗措施;对照组则采用单纯西医治疗。比较两组研究对象的肠鸣音恢复时间、肛门恢复排气时间、两组5天内胃肠减压量的变化、症状完全消失时间及发病后治疗时间等情况;同时将胃肠减压液清亮程度、大便便质情况作为症状缓解的指标,比较两组症状缓解情况,从而证实两组疗效的差异。结果:58例患者经不同方法治疗后,共治愈41例,占总病例数的70.69%,显效4例,占6.90%,有效5例,占8.62%,无效8例,占13.79%,总有效率为86.21%。治疗组采用中西医结合方法治愈25例,占本组83.33%,显效2例,占本组6.67%,有效2例,占本组6.67%,无效1例,占本组3.33%;对照组治愈16例,占本组57.14%,显效2例,占本组7.14%,有效3例,占本组10.71%,无效7例,占本组25.0%,其中1例后来中转开腹手术而愈。两组相比,总有效率治疗组29例(96.67%),明显高于对照组21例(75.0%)。两组比较有显著差异性(P<0.05)。治疗组在恢复肠鸣音时间、恢复排气时间、症状完全消失时间、治疗时间等方面明显优于对照组,两组比较有显著差异性(P<0.05)。两组症状缓解情况比较,治疗组在胃肠减压液变清亮时间、排稀水样便时间方面明显优于对照组,两组比较有显著差异性,(P<0.05)。两组患者自发病之日起均采用持续胃肠减压,治疗组加用复方大承气汤自胃管注入的方法,记录第1～5天胃肠减压量的变化,结果发现两组无明显差异,P>0.05。结论:应用复方大承气汤自胃管注入的中西医结合治疗方法,对术后早期炎性肠梗阻有明显的治疗作用,有利于腹腔内炎症的消退和渗出液的吸收,可促使肠壁水肿逐渐减轻,促进肠功能恢复,从而使肠梗阻得以缓解,并能降低并发症的发生率,缩短住院时间,是一种较为理想的治疗方法。复方大承气汤具有通里攻下、理气止痛、活血化瘀、软坚消结等功效,对于术后早期炎性肠梗阻以气胀为主症者疗效尤为显著。总之,复方大承气汤加减治疗术后早期炎性肠梗阻疗效肯定,中西医结合治疗效果满意,值得临床上推广使用。更多还原

【Abstract】 Objective: Early postoperative inflammatory ileus (EPII) occurs in the early stage after abdominal surgery, mainly because bowel wall edema and exudation caused by trauma after abdominal surgery or intra-abdominal inflammation, which leads to the adhesive ileus both mechanically and dynamically. The majority of such patients could be cured by non-surgical therapy. Improper management often leads to unnecessary surgery, sometimes such severe complications as intestinal fistula, severe infection, short bowel syndrome could also occur. Therefore, correct understanding of such obstruction is of great significance. Nowadays, a number of scholars have believed that current conservative non-surgical treatment is the most effective method. We introduce the integrated treatment of the Compound Dachengqi Decoction (CDD) by means of nasogastric tube influx to observe its effect in treating EPII, which may promote the recovery of intestinal function and advance the relief of ileus. Meanwhile, we attempt to explore the relative mechanism of such management in the treatment of EPII.Materials and Methods: Retrospective analysis of fifty-eight patients who were diagnosed EPII since December 2005 to December 2007 was conducted. Patients were divided into two groups: 30 cases in the Integrated traditional and western medicine group (the Treatment Group) and 28 cases in the Western medicine group (the Control Group). The Treatment Group applied the CDD through nasogastric tube influx, combined with the conservative treatment of the Western medicine, while the Control Group adopted the Western medicine alone. Our study compared the recovery time of bowel sound, anus exhaust, also the time of complete disappearance of symptoms and the time of therapy in the two groups. Looser stools and cleaner liquid of gastrointestinal decompression were defined as mitigative indicators of the curative effect. Alleviation of symptoms, the change of the volume of gastrointestinal decompression and the efficiency were compared between the two groups.Results: After treatment, 41 of 58 patients (70.69%) were cured, 4 of 58 (6.90%) were effectual, 5 of 58 (8.62%) were effective, 8 of 58 (13.79%) was ineffective,the overall efficiency was 50 of 58 (86.21%). In the Treatment Group, 25 of 30 (83.33%) patients were cured, 2 of 30 (6.67%) were effectual, 2 of 30 (6.67%) were effective, 1 of 30 (3.33%) was ineffective. In the Control Group, 16 of 28 (57.14%) patients were cured, 2 of 28 (7.14%) were effectual, 3 of 28 (10.71%) were effective, 7 of 28 (25.0%) were ineffective. One case was turned to surgery and was cured by conservative treatment postoperatively. The total efficiency was 29 of 30 (96.67%) in the Treatment Group, which was significantly higher than 21 of 28 (75.0%) in the Control Group (p<0.05). Compared the recovery time of bowel sound, anus exhaust, the time of complete disappearance of symptoms and the time of therapy, the two groups were significantly different (p<0.05). As for the curative effect, the Treatment Group was better than the Control Group with significant difference (p<0.05). From the beginning of the hospitalization, patients in the two groups were all adopted continuing gastrointestinal decompression treatment, while CDD was applied through nasogastric tube influx in the Treatment Group. We found no significant difference in the change of the volume of gastrointestinal decompression compared with the two groups (p>0.05).Conclusions: Application of the Integrated traditional and western medicine of the CDD through nasogastric tube influx has obvious therapeutic effect in the treatment of EPII, which could profit the regression of the intra-abdominal inflammation and the absorption of the exudate, reduce the bowel wall edema gradually and promote the intestinal function. That could relieve the ileus, lower the incidence of complications and shorten hospitalization time. So we suggest it be an ideal management, especially for the patient of EPII with abdominal distension. The CDD has the effect of Tongli Gongxia, Liqi Zhitong, Huoxue Huayu, Ruanjian Sanjie and so on.In short, the curative effect of the CDD in treating EPII is positive. We are satisfied with the therapeutic efficacy of Integrated traditional and western medicine treatment. It is worthy of expansive usage.更多还原