摘要
目的:研究恶性梗阻性黄疸患者围手术期血浆内毒素(PE)动态水平及中西医结合肠道清洁去污的临床意义。方法:选恶性梗阻性黄疸患者48例,随机分为治疗组(A组,n=24)和对照组(B组,n=24),A组除予常规术前准备外,每日服中药茵陈小承气汤并用0.9%氯化钠碘伏灌肠,B组行常规术前准备。监测两组术前、术后PE水平变化、呼气氢试验(HBT)结果以及术后并发症、胃肠功能恢复时间、住院天数。结果:入院时A、B两组PE水平分别为0.72±0.18EU.mL-1和0.70±0.22EU.mL-1(P>0.05),至术前分别降至0.55±0.21EU.mL-1和0.67±0.13EU.mL-1(P<0.05)。入院时A、B两组HBT阳性率分别为87.5%和83.3%(P>0.05),至术前分别降至50.0%和75.0%(P<0.05)。A组术后并发症全身炎症反应综合征、肾功能不全发生率分别为8.3%和12.5%,较B组有明显降低(P<0.05);A组术后胃肠功能恢复时间(78.3±21.2)h较B组(138.4±42.5)h明显缩短(P<0.05),住院天数(18.7±4.5)d亦较B组(30.3±3.7)d有明显缩短(P<0.05)。结论:恶性梗阻性黄疸患者存在肠道细菌移位及内毒素血症。术前应用稀碘伏灌肠联合中药治疗能降低恶性梗阻性黄疸患者内毒素血症。
Objective： To study the dynamic level of plasma endotoxin（PE）levels in the patients with malignant obstructive jaundice during the perioperative period and clinical significance of cleaning intestinal tract by using the method of integrated traditional and western medicine. Methods： Forty-eight patients with malignant obstructive jaundice were prepared for operation were randomly divided into treatment group A （n = 24） and control group B（n = 24）. Besides general preoperative preparation, Chinese herbs-Xiao-Cheng-qi decoction of orintal wormwood were taken and normal saline iodophor diluent enema were carried out in group A. Routine preoperative preparation were excuted in group B only. The kinetic changes of PE levels during the perioperartive period, hydrogen breath test （HBT） were examined and the incidence of postoperative complications, postoperative duration of ventilation, hospital day. Results：The PE baseline levels in two groups were 0.72 ± 0.18 EU. mL ^-1 and 0.70 ± 0.22 EU. mL ^-1 respectively（P〉0.05）, and decreased to 0.55 ± 0.21EU. mL ^-1 and 0.67 ± 0. 13 EU. mL^-1 after preoperative preparation （P〈0.05）. The positive rates of HBT in two groups were 87.5% and 83.3% （P〉0.05）, and decreased to 50. 0% and 75.0% after preoperative preparation （P〈0.05）. The incidence of SIRS, renal inadequacy in group A were 8.3%and 12.5%, lower than group B （P〈0. 05）. Postoperative duration of ventilation in group A （78.3 ± 21.2）h were more abbreviated obviously than group B（ 138.4± 42.5）h, and hospital during in group A （18.7 ± 4. 5） d were more abbreviated obviously than group B （30. 3 ± 3.7） d, too. Conclusion：The patients with malignant jaundice all have bacterial translocation from intes tine and endotoxemia. The use of the therapy with dilute Povidone Iodine coloclysis and taking traditional herbal drug before operation can decrease the rate of endotoxemia and conduce to recovery of patients after operation.
出处
《中国临床医学》
2009年第1期87-89,共3页
Chinese Journal of Clinical Medicine
关键词
梗阻性黄疸
内毒素血症
呼气氢试验
灌肠
中药
治疗
Obstructive jaundice
Endotoxernia
Hydrogen breath test
Traditional
Chinese medicine
Treatment
