摘要
目的探讨肠梗阻导管对结核性腹膜炎合并肠梗阻患者的临床疗效及对炎性因子的影响。方法前瞻性选取解放军总医院第八医学中心普通外科于2015年6月至2020年1月收治的结核性腹膜炎合并肠梗阻患者62例,按照随机数字表法分为对照组和治疗组,每组各31例。对照组患者给予常规治疗,治疗组患者在常规治疗基础上实施肠梗阻导管治疗。比较两组患者腹痛缓解时间、退热时间、排气时间、气液平消失时间及住院时间等临床指标。根据C反应蛋白(C-reactive protein,CRP)、白细胞介素6(interleukin-6,IL-6)、白细胞介素8(interleukin-8,IL-8)、干扰素γ等指标水平,对比两组患者治疗前后机体炎性应激状态。比较两组患者治疗前、后胃泌素、胃动素、血管活性肠肽(vasoactine intrestinal peptide,VIP)等胃肠激素的变化。结果治疗组患者腹痛缓解时间(2.08±1.17)d、退热时间(3.36±1.89)d、排气时间(2.12±1.45)d、气液平消失时间(2.58±1.61)d、住院时间(9.22±2.13)d,对照组分别为(6.26±2.52)、(5.68±2.44)、(6.18±2.24)、(7.34±2.23)、(17.49±3.46)d,两组比较差异均有统计学意义(P值分别为0.013、0.024、0.035、0.014、0.002)。对照组患者治疗前CRP为(105.62±11.96)mg/L、IL-6为(657.31±49.67)ng/L、IL-8为(463.53±31.74)ng/L、干扰素γ(47.24±9.66)ng/L;治疗组患者治疗前分别为(106.07±12.03)mg/L、(678.46±51.19)ng/L、(471.68±32.03)ng/L、(46.84±9.28)ng/L,治疗前两组各项指标比较差异均无统计学意义(P均>0.05)。治疗后对照组患者CRP为(86.25±9.16)mg/L、IL-6为(373.25±24.18)ng/L、IL-8为(211.26±20.83)ng/L、干扰素γ为(35.42±7.52)ng/L;治疗后治疗组患者分别为(53.72±7.68)mg/L、(184.27±16.92)ng/L、(82.51±11.35)ng/L、(19.65±3.46)ng/L,两组患者治疗后各项指标比较差异均有统计学意义(P值分别为0.021、0.015、0.029、0.011)。治疗前治疗组患者胃泌素为(180.89±21.17)ng/L、胃动素为(336.73±7.23)ng/L、VIP为(102.87±13.49)pg/L,对照组分别为(192.32±21.69)ng/L,(357.46±7.29)ng/L,(109.31±13.53)pg/L,两组比较差异均无统计学意义(P均>0.05);治疗后治疗组患者胃泌素为(65.57±8.72)ng/L、胃动素为(135.71±14.38)ng/L、VIP为(55.07±7.15)pg/L,对照组分别为(110.35±13.86)ng/L、(231.93±21.95)ng/L、(81.56±10.59)pg/L,两组比较差异均有统计学意义(P值分别为0.013、0.021、0.014)。结论肠梗阻导管可有效提高结核性腹膜炎合并肠梗阻患者的临床效果,降低机体炎性应激反应,促进胃肠功能恢复。
Objective To explore the clinical effect of intestinal obstruction catheter in patients with tuberculous peritonitis complicated with intestinal obstruction and its influence on inflammatory factors.Methods Sixty-two patients of tuberculous peritonitis with intestinal obstruction were admitted to the general surgery department of the Eighth Medical Center of Chinese PLA General Hospital from June 2015 to January 2020 in this prospective study.According to the method of digital table,cases were randomly divided into control group and treatment group,31 cases in each group.The control group was given conventional treatment,while the treatment group was treated with intestinal obstruction catheter on the basis of conventional treatment.The clinical indexes such as abdominal pain relief time,antipyretic time,exhaust time,gas-liquid level disappearance time and hospitalization time were compared between the two groups.According to the levels of C-reactive protein(CRP),Interleukin-6(IL-6),Interleukin-8(IL-8)and Interferon-γ(IFN-γ),the inflammatory stress state of the two groups before and after treatment was compared.The changes of gastrin,motilin,vasoactine intrestinal peptide(VIP)were compared between the two groups before and after treatment.Results The time to relieve abdominal pain(2.08±1.17)d,the time to reduce fever(3.36±1.89)d,the time to exhaust gas(2.12±1.45)d,the time to disappear gas-liquid level(2.58±1.61)d and the time to stay-in-hospital(9.22±2.13)d in the observation group,and those in the control group were(6.26±2.52),(5.68±2.44),(6.18±2.24),(7.34±2.23),(17.49±3.46)d,respectively.The difference between the two groups was statistically significant(P=0.013,0.024,0.035,0.014 and 0.002,respectively).Before treatment,CRP,IL-6,IL-8,IFN-γin the control group were(105.62±11.96)mg/L,(657.31±49.67)ng/L,IL-8(463.53±31.74)ng/L and(47.24±9.66)ng/L,and(106.07±12.03)mg/L,(678.46±51.19)ng/L,(471.68±32.03)ng/L and(46.84±9.28)ng/L in the observation group respectively,and there were no significant differences between the two groups before treatment(P>0.05).After treatment,CRP,IL-6,IL-8,IFN-γwere(86.25±9.16)mg/L,(373.25±24.18)ng/L,(211.26±20.83)ng/L and(35.42±7.52)ng/L in the control group,and(53.72±7.68)mg/L,(184.27±16.92)ng/L,(82.51±11.35)ng/L and(19.65±3.46)ng/L in the observation group,respectively.After treatment,there were significant differences in the indicators between the two groups(P=0.021,0.015,0.029,0.011,respectively).There was no difference in the levels of gastrin((180.89±21.17)vs(192.32±21.69)ng/L),motilin((336.73±7.23)vs(357.46±7.29)ng/L)and VIP((102.87±13.49)vs(109.31±13.53)pg/L)between the observation and control group before treatment(P>0.05,respectively).After treatment,the levels of gastrin(65.57±8.72)ng/L,motilin(135.71±14.38)ng/L and VIP(55.07±7.15)pg/L in the observation group were lower than those in the control group((110.35±13.86)ng/L,(231.93±21.95)ng/L,(81.56±10.59)pg/L,respectively),and the differences were statistically significant(P=0.013,0.021 and 0.014,respectively).Conclusion Intestinal obstruction catheter can effectively improve the clinical effect,reduce the inflammatory stress response,and promote the recovery of gastrointestinal function in patients with tuberculous peritonitis complicated with intestinal obstruction.
作者
崔科英
邱啸臣
翁剑锋
何建苗
Cui Keying;Qiu Xiaochen;Weng Jianfeng;He Jianmiao(Department of General Surgery,the Eighth Medical Center of Chinese PLA General Hospital,Beijng 100091,China)
出处
《中国综合临床》
2020年第6期520-524,共5页
Clinical Medicine of China
基金
军队后勤科研重点项目(BWS19J009)。
关键词
结核性腹膜炎
肠梗阻
肠梗阻导管
炎性反应
Tuberculous peritonitis
Intestinal obstruction
Ileus catheter
Inflammatory response
