目的 探討大承氣湯灌腸治療外科重癥患者,預防全身炎癥反應綜合征的臨床研究。方法 選取2009年7月-2014年12月天津市北辰區(qū)中醫(yī)醫(yī)院普外科病房外科重癥患者60例,隨機分為對照組和治療組,每組30例。對照組患者給予西醫(yī)綜合治療,治療組患者在對照組治療的基礎上入院24 h內開始使用大承氣湯,保留灌腸,100 mL/次,每次保留30 min,3次/d。兩組均連續(xù)治療7 d。計算兩組全身炎癥反應綜合征發(fā)生率。分別在入院24 h內、治療后第7天測定心率、呼吸頻率、體溫和外周血白細胞計數(shù)以及血循環(huán)D-乳酸、二胺氧化酶(DAO)、腫瘤壞死因子-α(TNF-α)。結果 治療后,對照組和治療組患者全身炎癥反應綜合征發(fā)生率分別為70%、30%,兩組發(fā)生率比較差異具有統(tǒng)計學意義(P < 0.05)。治療后,兩組心率、呼吸頻率、體溫、白細胞均較治療前明顯下降,同組比較差異具有統(tǒng)計學意義(P < 0.01);且治療組的改善程度優(yōu)于對照組,兩組比較差異具有統(tǒng)計學意義(P < 0.01)。治療后,兩組D-乳酸、TNF-α、DAO均較治療前明顯下降,同組比較差異具有統(tǒng)計學意義(P < 0.01、0.05)。治療組的改善程度優(yōu)于對照組,兩組比較差異具有統(tǒng)計學意義(P < 0.01)。結論 早期應用大承氣湯能夠有效地預防全身炎癥反應綜合征的發(fā)生,減輕對重要器官的損害,降低細胞因子水平。

Objective To investigate the effect of Dachengqi Decoction in treatment of surgical patients, and to prevent systemic inflammatory response syndrome. Methods Surgical patients (60 cases) in Department of Surgery of Tianjin Beichen District Traditional Chinese Medicine Hospital from July 2009 to December 2014 were randomly divided into control and treatment groups. Each group had 30 cases. Patients in control group were treated by combined therapy of modern medicine. On the basis of control group, patients in treatment group were given Dachengqi Decoction during 24 h after being admitted to hospital, 100 mL/time, retention enema for 30 min/time, three times daily. Two groups were treated for 7 d. Systemic inflammatory response syndrome incident rates in two groups were calculated. Pulse, respiratory rate, temperature, and WBC were measured, and levels of D-lactic acid, TNF-α, and DAO were also determined during 24 h after being admitted to hospital and treated for 6 d. Results After treatment, systemic inflammatory response syndrome incident rates in the control and treatment groups were 70% and 30%, respectively, and there was difference between two groups (P < 0.05). After treatment, pulse, respiratory rate, temperature, and WBC in two groups were significantly decreased, and the difference was statistically significant in the same group (P < 0.01). The reduced degree in the treatment group was better than that in the control group, with significant difference between two groups (P < 0.01). After treatment, levels of D-lactic acid, TNF-α, and DAO in two groups were obviously decreased, and the difference was statistically significant in the same group (P < 0.01, 0.05). The reduced degree in the treatment group was better than that in the control group, with significant difference between two groups (P < 0.01). Conclusion Early application of Dachengqi Decoction in treatment of surgical patients can prevent systemic inflammatory response syndrome, alleviate injury to important organs, and decrease cytokine levels.