围手术期术后胃肠功能障碍的辨证论治策略

笔者通过总结文献和临床经验，分析术后胃肠功能的发病机制和中西医诊疗进展，提出术后胃肠动力障碍的主要原因是肠麻痹（动力不足），其病机主要为虚证，或者以虚证为主、虚实夹杂。根据中医“异病同治”的原则，围手术期术后胃肠功能障碍的辨证论治策略应以扶正补虚或者扶正祛邪为主要治法。而大承气汤等通里攻下方药尽管具有促进胃肠动力的作用，主要适用于以热结腑实为主症的急腹症或个别里热实证的术后患者，并不适用于择期手术导致胃肠功能障碍的绝大多数患者。

英文摘要:

By summarizing the literature and clinical experiences， the author analyzed the pathogenesis of gastrointestinal functions and the diagnosis and treatment progress of Chinese medicine and Western medicine. The author addressed the main reason for gastrointestinal dysfunction was enteroparalysis （lack of motive power）. Its pathogenesis was mainly due to deficiency syndrome， or to dominant deficiency syndrome with mingled deficiency and excess. According to the principle of treating different diseases by the same method， syndrome typing based strategies for treating postoperative gastrointestinal dysfunction in the perioperative phase should strengthen body resistance and supplement deficiency， or strengthen body resistance and dispel evil pathogens as the main principal method. Although pugations such as Dachengqi Decoction played a role in promoting gastrointestinal motive power， they were not suitable for major patients with selective surgeries induced gastrointestinal dysfunction. They were mainly suitable for acute abdomen patients with heat accumulation in Fu organs as main symptoms， or for individual patients with interior heat induced excess syndrome.

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