四君子汤加减联合肠内营养对胃癌术后快速康复的临床疗效观察

肖林峰; 温志坚; 刘斌; 陈洪标; 林茜; 陈战

文章摘要

肖林峰，温志坚，刘斌，陈洪标，林茜，陈战.四君子汤加减联合肠内营养对胃癌术后快速康复的临床疗效观察[J].实用中西医结合临床,2023,23(10):7-12

四君子汤加减联合肠内营养对胃癌术后快速康复的临床疗效观察

DOI：

中文关键词: 胃癌术后快速康复四君子汤肠内营养

英文关键词: Postoperative gastric cancer Rapid rehabilitation Sijunzi decoction Enteral nutrition

基金项目:2021年福建省厦门市医疗卫生指导性项目（编号：3502Z20214ZD1190）

作者	单位
肖林峰，温志坚，刘斌，陈洪标，林茜，陈战	厦门大学附属成功医院

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中文摘要:

目的：观察四君子汤方加减联合肠内营养对促进D2胃癌术后快速康复的临床疗效。方法：回顾性分析厦门大学附属成功医院普外二区2019年11月至2021年2月收治的101例行D2胃癌根治术患者的临床资料，根据术后是否服用中药汤剂四君子汤分为联合组（51例）及对照组（50例）。对照组从术后第2~9天服用肠内营养制剂，联合组在对照组基础上加用四君子汤。比较两组患者术后康复情况：排气时间、拔尿管时间、拔引流管时间、下床时间、住院时间、住院费用、术后疼痛评分及术后并发症情况；比较两组患者术后10 d中医证候积分、血清白蛋白、前白蛋白、转铁蛋白，免疫球蛋白（Ig）G、IgA、IgM、CD3+、CD4+、CD4+/CD8+水平。结果：与对照组比较，联合组中医证候积分降低、排气时间提前、拔引流管时间提前、下床活动提前、术后住院时间缩短、住院费用减少，差异有统计学意义（P＜0.05）；两组患者术后36 h、48 h及60 h疼痛评分对比，差异有统计学意义（P＜0.05）；两组患者术后尿管拔除时间比较，差异无统计学意义（P＞0.05）；术后10 d，联合组血清白蛋白、前白蛋白、转铁蛋白、IgG、IgA、IgM及CD3+、CD4+、CD4+/CD8+水平均比对照组显著提升（P＜0.05）；联合组和对照组并发症发生率分别为3.9%、8.0%。术后1个月门诊随访复查，均恢复较好。结论：胃癌根治术后四君子汤加减联合肠内营养可以显著降低术后中医证候积分，改善免疫功能及营养状态，减轻术后疼痛，促进肠道功能早期恢复，减少住院时间及住院费用，促进胃癌术后快速康复，安全可行。

英文摘要:

Objective: To observe the clinical effects of adjusted Sijunzi decoction combined with enteral nutrition in promoting the rapid rehabilitation of D2 gastric cancer after operation. Methods: The data of 101 patients who underwent D2 radical gastrectomy in the second district of general surgery of Chenggong Hospital affiliated to Xiamen University from November 2019 to February 2021 were retrospectively analyzed. According to whether to take Sijunzi decoction after operation, they were divided into combined group (51 cases) and control group (50 cases). The control group took enteral nutrition from the 2 th to 9 th after operation. On this basis, Sijunzi decoction was added to the combined group. The postoperative rehabilitation status of the two groups were compared: exhaust time, catheter pulling time, drainage tube pulling time, out of bed time, hospitalization time, hospitalization expenses, postoperative pain score and postoperative complications. The TCM symptom score, serum albumin, prealbumin, transferrin, immunoglabulin(Ig)G, IgA, IgM, CD3+, CD4+, CD4+/CD8+ levels of the two groups were compared 10 days after operation. Results: Compared with the control group, the scores of TCM symptoms, exhaust time, drainage tube pulling time, getting out of bed activity, postoperative hospitalization time and hospitalization expenses in the combined group were significantly lower, the differences were statistically significant (P＜0.05). The pain scores at 36 h, 48 h and 60 h after operation in the two groups were statistically significant (P＜0.05). There was no difference in the catheter pulling time between the two groups (P＞0.05). 10 days after operation, the levels of serum albumin, prealbumin, transferrin, IgG, IgA, IgM, CD3+, CD4+, CD4+/CD8+ in the combined group were significantly higher than those in the control group (P＜0.05). The incidence of complications in the combined group and the control group were 3.9% and 8.0% respectively. One month after surgery, the outpaitient followup and re-examination showed good recovery. Conclusion: Adjusted sijunzi decoction combined with enteral nutrition after radical gastrectomy can significantly reduce the scores of postoperative TCM symptoms, improve immune function and nutritional status, reduce postoperative pain, promote early recovery of intestinal function, reduce hospitalization time and hospitalization expenses, and promote the rapid recovery of gastric cancer with is safe and feasible.

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