目的 探讨大承气汤灌肠治疗外科重症患者,预防全身炎症反应综合征的临床研究。方法 选取2009年7月-2014年12月天津市北辰区中医医院普外科病房外科重症患者60例,随机分为对照组和治疗组,每组30例。对照组患者给予西医综合治疗,治疗组患者在对照组治疗的基础上入院24 h内开始使用大承气汤,保留灌肠,100 mL/次,每次保留30 min,3次/d。两组均连续治疗7 d。计算两组全身炎症反应综合征发生率。分别在入院24 h内、治疗后第7天测定心率、呼吸频率、体温和外周血白细胞计数以及血循环D-乳酸、二胺氧化酶(DAO)、肿瘤坏死因子-α(TNF-α)。结果 治疗后,对照组和治疗组患者全身炎症反应综合征发生率分别为70%、30%,两组发生率比较差异具有统计学意义(P < 0.05)。治疗后,两组心率、呼吸频率、体温、白细胞均较治疗前明显下降,同组比较差异具有统计学意义(P < 0.01);且治疗组的改善程度优于对照组,两组比较差异具有统计学意义(P < 0.01)。治疗后,两组D-乳酸、TNF-α、DAO均较治疗前明显下降,同组比较差异具有统计学意义(P < 0.01、0.05)。治疗组的改善程度优于对照组,两组比较差异具有统计学意义(P < 0.01)。结论 早期应用大承气汤能够有效地预防全身炎症反应综合征的发生,减轻对重要器官的损害,降低细胞因子水平。

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.