术前服用大承气冲剂对肿瘤患者炎症介质的影响

目的：寻找一种使用方便，效果显著，副作用小的用于腹部恶性肿瘤手术前肠道预洁方法。方法：以传统中医通里攻下法的代表方剂大承气汤的新剂型———大承气冲剂为研究对象，选择了３５例腹部恶性肿瘤手术的患者，按入院的时间随机分组，分为用大承气冲剂做肠道预洁的中药组和采用口服抗生素、肥皂水灌肠的西药组，观察手术前及手术后１、３、７天血清一氧化氮（ＮＯ）、肿瘤坏死因子（ＴＮＦ）、细胞间粘附分子－１（ＩＣＡＭ－１）的变化，以及手术后肠功能恢复情况。结果：中药组的肠鸣音恢复时间与排气时间均早于西药组（Ｐ＜００５）。两组患者术后血清ＮＯ均升高，术后３天为高峰，与术前比两者均有明显差异（Ｐ＜００５）；中药组术后血清ＮＯ水平与西药组之间无明显差异。两组患者血清ＴＮＦ术后均降低；中药组降低更明显（术后第１天，Ｐ＜００５）。中药组患者血清ＩＣＡＭ－１术后３天明显降低，与术前比较有明显差异（Ｐ＜００５）。西药组患者血清ＩＣＡＭ－１水平手术前后无明显变化；两组间均数比较术后３天中药组明显低于西药组（Ｐ＜００５）。结论：大承气冲剂用于术前肠道预洁与常规服用抗生素和肥皂水灌肠相比较，能明显降低手术对恶性肿瘤患者产生的炎症反应，减少炎性?

英文摘要:

Objective: To find a simple, effective, with few side effect method of pre cleaning intestine for surgical operation of abdominal malignancy. Methods: Thirty five patients of abdominal malignant tumor were divided into two groups randomly and treated with Dachengqi Granule (DCQG) and routine western management (including oral taking antibiotics and enema with soap solution) respectively. Serum level of nitric oxide (NO), tumor necrosis factor (TNF), intercellular adhesive molecule 1 (ICAM 1), and enteric function recovering of patients were observed before operation, and 1, 3 and 7 days after operation. Results: Time of borborygmus recovering and gas discharging after operation in the DCQG group was earlier than that of the control group, P<0 05. Serum NO level was raised in both groups after operation, and reaching peak level at 3rd day post operationally, as compared with pre operation, P<0 05, the difference between the two groups was insignificant. Serum TNF level lowered in both groups, but more apparent in the DCQG group, the inter group difference was significant at the first day of operation, P<0 05. Serum ICAM 1 level in the DCQG group decreased at the day 3 after operation with significant difference in comparison with pre operational level, P<0 05, but in the control group, change of ICAM 1 before and after operation was insignificant. The mean ICAM 1 level of the DCQG group at the day 3 post operationally was significantly lower than that of the control group, P<0 05. Conclusions: Compared with the routine management of western medicine, using DCQG for intestine pre cleaning before operation could obviously lower the operation induced inflammatory reaction of tumor patients, reduce the secretion of inflammatory mediator, improve the recovery of enteric function and reduce the post operational complication. Therefore, applying DCQG for pre operational enteric preparing could provide a satisfactory effect in surgical operation of abdominal malignancy.

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