本文選題：大承氣湯加味 + 非胃腸手術(shù)��； 參考：《北京中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：一、文獻(xiàn)綜述術(shù)后早期胃腸功能障礙在術(shù)后患者中有著較高的發(fā)病率。SICU非胃腸手術(shù)術(shù)后患者的胃腸功能障礙,不但增加了患者滯留SICU時(shí)間,加重患者家庭的經(jīng)濟(jì)負(fù)擔(dān),也影響患者術(shù)后整體機(jī)能的恢復(fù)。解決這一問題很有現(xiàn)實(shí)意義。目前西醫(yī)對(duì)術(shù)后早期胃腸功能障礙的認(rèn)識(shí),主要包括病因、發(fā)病機(jī)制、分型、診斷、治療這個(gè)方面。由于目前的西醫(yī)治療并沒有一種可以主動(dòng)來干預(yù)胃腸功能障礙的措施,而中醫(yī)治療在此方面可能發(fā)揮自己獨(dú)特的優(yōu)勢(shì)。目前的中醫(yī)研究,一般將術(shù)后胃腸功能障礙歸入不同的中醫(yī)疾病范疇,對(duì)其病因、病機(jī)及治療方法也有不少研究。這些研究為本次臨床研究提供了理論基礎(chǔ)。二、臨床研究目的:觀察中藥口服、中藥灌腸兩種方法,對(duì)氣機(jī)壅滯型SICU非胃腸手術(shù)后患者,胃腸功能恢復(fù)的療效;并比較兩種方法的療效差異。方法:對(duì)SICU非胃腸手術(shù)患者,進(jìn)行中醫(yī)辨證,選取45位證屬氣機(jī)壅滯證的患者,隨機(jī)分為3組:口服中藥組、中藥灌腸組和對(duì)照組。所有45位病人均給予術(shù)后常規(guī)治療:如吸氧、心電監(jiān)護(hù)、禁食、應(yīng)用抗生素預(yù)防感染、補(bǔ)液、抑酸、止痛、維持電解質(zhì)平衡治療。自術(shù)后6h起,所有患者恢復(fù)自主進(jìn)食,術(shù)后12h起,在上述治療基礎(chǔ)上,口服中藥組加用厚樸三物湯加味(生厚樸24g、生大黃10g、黨參20g、炒枳實(shí)9g)治療;中藥灌腸組加用大承氣湯加味(生厚樸30g、焦檳榔40g、生大黃30g、白芍30g、炒枳實(shí)30g、炙甘草10g、芒硝30g、炒萊菔子40g)治療。中藥口服組每次口服中藥200ml,中藥灌腸組每次灌腸100ml,兩組給藥頻率均為2次/天,直至術(shù)后排氣、排便恢復(fù)(若患者在術(shù)后12h內(nèi)出現(xiàn)排氣排便,則剔除該病例),觀察時(shí)限至術(shù)后第48h。記錄每位患者的首次排氣排便時(shí)間,腸鳴音恢復(fù)的時(shí)間,并根據(jù)每位患者治療前后的癥狀體征進(jìn)行評(píng)分,計(jì)算療效指數(shù)。結(jié)果:①.術(shù)后腸鳴音恢復(fù)時(shí)間,對(duì)照組為34.32±3.64小時(shí),口服中藥組為28.92±3.92小時(shí),中藥灌腸組為29.13±3.62小時(shí),對(duì)照組與兩個(gè)治療組相比,均有顯著差異,P值0.01。兩個(gè)治療組之間沒有明顯差異,P=0.8780.05。②.首次排氣時(shí)間,對(duì)照組為37.05±4.55小時(shí),口服中藥組為29.97±4.12小時(shí),中藥灌腸組為31.78±5.22小時(shí),對(duì)照組與兩個(gè)治療組相比,均有顯著差異,P值0.01。兩個(gè)治療組之間沒有明顯差異,P=0.3290.05。③.首次排便時(shí)間,對(duì)照組為41.45±3.59小時(shí),口服中藥組為32.17±4.08小時(shí),中藥灌腸組為32.03±5.11小時(shí),對(duì)照組與兩個(gè)治療組相比,均有顯著差異,P值0.01。兩個(gè)治療組之間沒有明顯差異,P=0.7690.05。④.在療效指數(shù)方面,對(duì)照組為24.84%±0.10,口服中藥組為69.47%±0.28,中藥灌腸組為75.02%±0.28,對(duì)照組與兩個(gè)治療組相比,均有顯著差異,P值0.01。兩個(gè)治療組之間沒有明顯差異,P=0.2250.05。⑤.對(duì)照組、中藥口服組、中藥灌腸組總有效率分別為30.77%、82.35%、86.67%。結(jié)論:厚樸三物湯加味口服、大承氣湯加味灌腸均可促進(jìn)SICU非胃腸手術(shù)術(shù)后病人早期胃腸功能恢復(fù),改善患者胃腸道的癥狀體征。
[Abstract]:First, the early gastrointestinal dysfunction after the literature review has a higher incidence of postoperative gastrointestinal dysfunction in patients with.SICU non gastrointestinal surgery, which not only increases the time of the patient's retention of SICU, aggravates the economic burden of the patients, but also affects the recovery of the overall function after the operation. The understanding of the early gastrointestinal dysfunction in the former western medicine mainly includes the etiology, pathogenesis, classification, diagnosis, and treatment. Because of the current western medicine treatment, there is no initiative to intervene in gastrointestinal dysfunction, and traditional Chinese medicine may play its own unique advantages in this respect. The postoperative gastrointestinal dysfunction was classified into different categories of traditional Chinese medicine, and the etiology, pathogenesis and treatment methods were also studied. These studies provided a theoretical basis for this clinical study. Two, clinical research aims: To observe the two methods of oral administration of traditional Chinese medicine and traditional Chinese medicine enema, and the recovery of gastrointestinal function in patients with qi stagnation type SICU after non gastrointestinal surgery. The curative effect of the two methods was compared. Methods: the patients with SICU non gastrointestinal surgery were treated with TCM syndrome differentiation and 45 patients with qi stagnation syndrome were randomly divided into 3 groups: Oral Chinese medicine group, Chinese medicine enema group and control group. All 45 patients were given routine treatment after operation: such as oxygen inhalation, ECG monitoring, fasting, and antibiotics Prevention of infection, fluid infusion, acid suppression, analgesic and electrolyte balance treatment. From 6h after operation, all patients resumed self-feeding, after 12h, on the basis of the above treatment, oral Chinese medicine group plus Magnolia three material soup added (raw Magnolia 24g, rhubarb 10g, 20g, frying orange 9g); Chinese Medicine enema group added with Dachengqi Decoction plus flavor (raw Magnolia officinalis 30g, Coke areca 40g, raw rhubarb 30g, Paeonia lactiflora 30g, stir fry Fructus aurantii trifoliate 30g, Radix Glycyrrhiza 10g, mirabilite 30g, stir fried semen Raphani 40g). Oral Chinese medicine oral group oral traditional Chinese medicine 200ml, traditional Chinese medicine enema group each enema 100ml, the two groups are 2 times per day, until postoperative exhaust, defecation recovery (if patients in 12h after the operation of the exhaust defecation, then elimination of the case), outlook, then reject the case) view The time of the first exhaust and defecation of each patient was recorded at the time of 48h., and the recovery time of the bowel sounds was recorded, and the curative effect index was calculated according to the symptoms and signs of each patient before and after treatment. Results: (1) the recovery time of the postoperative bowel sounds was 34.32 + 3.64 hours in the control group, and the oral Chinese medicine group was 28.92 + 3.92 hours, the Chinese medicine enema group was 29.13 + 3.62 hours, the control group compared with the two treatment groups, there were significant differences, P value 0.01. two treatment groups, there was no significant difference, P=0.8780.05.. The first exhaust time, the control group was 37.05 + 4.55 hours, the oral Chinese medicine group was 29.97 + 4.12 hours, the Chinese medicine enema group was 31.78 + 5.22 hours, the control group compared with the two treatment groups, all of them were all There was no significant difference between the two treatment groups of the P value 0.01., P=0.3290.05. (3). The first defecation time, the control group was 41.45 + 3.59 hours, the oral Chinese medicine group was 32.17 + 4.08 hours, the Chinese medicine enema group was 32.03 + 5.11 hours, the control group was significantly different from that of the two treatment groups, and there was no significant difference between the 0.01. and the two treatment groups of the P value. The control group was 24.84% + 0.10, the control group was 24.84% + 0.10, the oral Chinese medicine group was 69.47% + 0.28, the traditional Chinese medicine enema group was 75.02% + 0.28, and the control group was significantly different from the two treatment groups. There was no significant difference between the P value 0.01. two treatment groups, and the control group, the control group, the Chinese medicine oral group and the Chinese medicine enema group were all effective. The rate of 30.77%, 82.35%, 86.67%. conclusion: Magnolia officinalis three soup plus orally, Dachengqi Decoction added enema can promote the recovery of early gastrointestinal function in patients with SICU after non gastrointestinal surgery, and improve the symptoms and signs of the gastrointestinal tract.
【學(xué)位授予單位】：北京中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R269

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