紅藤解毒湯對小兒闌尾膿腫的療效研究
發(fā)布時間：2019-06-08 08:37
【摘要】：研究背景： 小兒闌尾膿腫是小兒腹部外科常見的急腹癥之一,是小兒急性闌尾炎未及時就診而致炎癥擴(kuò)散,炎癥被大網(wǎng)膜及周圍腸管包裹局限化,或繼發(fā)于闌尾穿孔、壞死形成局限性腹膜炎所致。由Fitz等人于1886年首次文獻(xiàn)報道該病。由于小兒無法準(zhǔn)確表述病情和積極配合檢查等原因?qū)е录毙躁@尾炎尤其是嬰幼兒闌尾炎誤診率偏高,約為4%-10%的小兒急性闌尾炎發(fā)展成為闌尾膿腫。臨床上考慮闌尾膿腫后主要依賴于腹部B超來確診。腹部B超診斷小兒闌尾膿腫的正確率在90%以上。闌尾膿腫的治療采用手術(shù)或非手術(shù)尚存在分歧。有學(xué)者認(rèn)為闌尾膿腫應(yīng)早期積極手術(shù)切除闌尾并引流膿腫,這樣可防止炎癥擴(kuò)散蔓延,減輕全身中毒癥狀。但是手術(shù)難度比較大,而且腸瘺、粘連性腸梗阻等并發(fā)癥發(fā)生率高。有學(xué)者主張腹腔膿腫引流術(shù),但創(chuàng)傷性的治療極易出現(xiàn)腹腔內(nèi)臟損傷等并發(fā)癥。有學(xué)者主張采用幾種抗生素聯(lián)合的保守治療。但炎性包塊周圍組織的粘連,嚴(yán)重影響血液循環(huán),使得抗生素在局部難以達(dá)到有效濃度,致使西藥抗菌效果不佳。在當(dāng)患者的體溫和炎癥指標(biāo)都已恢復(fù)正常,而痛性膿腫遲遲無法消退,嚴(yán)重影響患兒的生活和生長發(fā)育。 近年來有報道認(rèn)為以內(nèi)服中藥為主的中西醫(yī)結(jié)合可以提高闌尾膿腫的治療療效。紅藤是傳統(tǒng)的中藥材,紅藤具有清熱解毒的功效。研究認(rèn)為大黃素和β-谷甾醇是大血藤中抗菌消炎的有效成分。鞣質(zhì)是紅藤的主要化學(xué)成分,對多種細(xì)菌、真菌、酵母菌都有明顯的抑制能力,鞣質(zhì)對金黃色葡萄球菌抑菌效果尤為明顯,且其抑菌活性與飲片中總皂苷、總鞣質(zhì)、游離葸醌及總綠原酸的含量密切相關(guān)。紅藤解毒湯是以紅藤為主料,輔以蒲公英、敗醬草、牡丹皮、赤芍、白芍、炒山楂和生甘草。臨床應(yīng)用較為廣泛,目前常用于治療婦科炎癥如盆腔炎、消化道潰瘍、胃腸炎癥、慢性痢疾及各種腫瘤等。 因此我們嘗試用紅藤解毒湯結(jié)合西醫(yī)來治療小兒闌尾膿腫。 目的： 觀察紅藤解毒湯結(jié)合西醫(yī)對比單純西醫(yī)治療小兒闌尾膿腫的臨床療效差別。 方法： 將100例患者隨機(jī)分為治療組和對照組,對照組50例采用西醫(yī)抗生素治療,治療組50例采用西醫(yī)基礎(chǔ)上,結(jié)合紅藤解毒湯治療。對兩組患者治療后主要癥狀、體征消退的平均時間、平均住院時間以及白細(xì)胞計數(shù)(WBC)、C反應(yīng)蛋白(CRP)和腹部B超等輔助檢查結(jié)果進(jìn)行比較。應(yīng)用SPSS17.0統(tǒng)計軟件對結(jié)果進(jìn)行t檢驗和卡方檢驗,P0.05則認(rèn)為差異具有統(tǒng)計學(xué)意義。 結(jié)果： 治療組的癥狀、體征消退平均時間和住院平均時間明顯短于對照組,P0.05,差異具有統(tǒng)計學(xué)意義。治療組在第3天、第6天、第9天、第12天的WBC和CRP比對照組有更明顯的下降,P0.05,差異具有統(tǒng)計學(xué)意義。治療組在第6天、第12天的腹部B超結(jié)果比對照組有更明顯的縮小,P0.05,差異具有統(tǒng)計學(xué)意義。 結(jié)論： 以紅藤解毒湯為主的中西醫(yī)結(jié)合治療小兒闌尾膿腫可顯著提高臨床療效。
[Abstract]:Study Background: Children's tail abscess is one of the most common acute abdominal diseases in the abdomen of children. It is the non-timely treatment of children's acute endophthalmitis. The inflammation is localized by the large omentum and the surrounding intestinal canal, or secondary to the perforation and necrosis of the tail of the body, and the localized peritonitis is formed. To........................................... The disease is due to the lack of accurate representation of the condition and the positive combination of the examination, etc., which leads to the high misdiagnosis rate of the acute endophthalmitis, especially the infant and the infant, and about 4% to 10% of the child's acute endophthalmitis has been developed into the purulent tail of the infant. Swelling. The clinical consideration of the tail abscess mainly depends on the abdominal B-ultrasound. The accuracy of abdominal B-ultrasound in the diagnosis of children's tail abscess was 90%. The treatment of the abscess of the tail of the tail is in the operation or non-surgical operation. Disambiguation. Some scholars believe that the tail abscess should be removed by the early and active operation and the abscess should be drained, so that the spread of the inflammation can be prevented, and the whole body poisoning can be reduced. but the operation difficulty is relatively large, and the incidence rate of complications such as intestinal obstruction and adhesion intestinal obstruction High. Some scholars advocate the drainage of abdominal abscess, but the traumatic treatment is very easy to have abdominal viscera injury and so on. . Some scholars advocate the use of a combination of several antibiotics. but the adhesion of the surrounding tissues of the inflammatory mass block can seriously affect the blood circulation, so that the antibiotic is difficult to reach the effective concentration in the local area, so that the antibacterial effect of the western medicine does not Good. The patient's body temperature and the index of inflammation have returned to normal, and the pain of the painful abscess can not be resolved, which seriously affects the life and the growth of the child. In recent years, it has been reported that the combination of the traditional Chinese and western medicine, which is the main part of the traditional Chinese medicine, can improve the treatment of the abscess of the tail of the The red vine is a traditional Chinese medicinal material, and the red vine has the functions of clearing away heat and toxic materials, The efficacy of the study is that the emodin and the p-glutanol are anti-bacterial and anti-inflammatory in the large intestine. the tannin is the main chemical component of the red vine, has obvious inhibitory capacity on various bacteria, fungi and yeasts, and the tannin has the obvious antibacterial effect on the staphylococcus aureus, and the antibacterial activity of the tannin is closely related to the total soap content, the total tannin, the free and total content of the total chlorogenic acid in the decoction pieces, The preparation method comprises the following steps: taking the red vine as a main material, and adding the dandelion, the Herba Patriniae, the Cortex Moutan, the Radix Paeoniae Rubra, the Radix Paeoniae Alba, and the Radix Saposhnikoviae; has wide clinical application and is used for treating gynecological inflammation such as pelvic inflammatory disease, digestive tract ulceration, gastrointestinal inflammation, chronic dysentery and various diseases The tumor and so on. So we try to use the red vine to detoxify the soup in combination with western medicine to treat small the tail of a child Abscess. Objective: To observe the treatment of the tail of the child by western medicine in combination with western medicine and western medicine. abscess Methods:100 patients were randomly divided into treatment group and control group. The mean time, mean hospital stay, and white blood cell count (WBC), C-reactive protein (CRP), and abdomen of the two groups of patients after treatment were treated with a combination of red-to-vine detoxification. The results of the auxiliary examinations such as B-ultrasound were compared. The results were t-test and chi-square test by using the SPSS17.0 statistical software. 5. The difference was statistically significant. Results: The symptoms, signs, mean time, and average hospital stay were significantly shorter in the treatment group than in the control group. The difference of WBC and CRP on day 3, day 6, day 9 and day 12 was significantly lower than that in the control group. The results of B-B ultrasound in the treatment group on day 6 and day 12 were more significant than that of the control group. Small, P 0.05. The difference is of statistical significance.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R272
本文編號：2495157
[Abstract]:Study Background: Children's tail abscess is one of the most common acute abdominal diseases in the abdomen of children. It is the non-timely treatment of children's acute endophthalmitis. The inflammation is localized by the large omentum and the surrounding intestinal canal, or secondary to the perforation and necrosis of the tail of the body, and the localized peritonitis is formed. To........................................... The disease is due to the lack of accurate representation of the condition and the positive combination of the examination, etc., which leads to the high misdiagnosis rate of the acute endophthalmitis, especially the infant and the infant, and about 4% to 10% of the child's acute endophthalmitis has been developed into the purulent tail of the infant. Swelling. The clinical consideration of the tail abscess mainly depends on the abdominal B-ultrasound. The accuracy of abdominal B-ultrasound in the diagnosis of children's tail abscess was 90%. The treatment of the abscess of the tail of the tail is in the operation or non-surgical operation. Disambiguation. Some scholars believe that the tail abscess should be removed by the early and active operation and the abscess should be drained, so that the spread of the inflammation can be prevented, and the whole body poisoning can be reduced. but the operation difficulty is relatively large, and the incidence rate of complications such as intestinal obstruction and adhesion intestinal obstruction High. Some scholars advocate the drainage of abdominal abscess, but the traumatic treatment is very easy to have abdominal viscera injury and so on. . Some scholars advocate the use of a combination of several antibiotics. but the adhesion of the surrounding tissues of the inflammatory mass block can seriously affect the blood circulation, so that the antibiotic is difficult to reach the effective concentration in the local area, so that the antibacterial effect of the western medicine does not Good. The patient's body temperature and the index of inflammation have returned to normal, and the pain of the painful abscess can not be resolved, which seriously affects the life and the growth of the child. In recent years, it has been reported that the combination of the traditional Chinese and western medicine, which is the main part of the traditional Chinese medicine, can improve the treatment of the abscess of the tail of the The red vine is a traditional Chinese medicinal material, and the red vine has the functions of clearing away heat and toxic materials, The efficacy of the study is that the emodin and the p-glutanol are anti-bacterial and anti-inflammatory in the large intestine. the tannin is the main chemical component of the red vine, has obvious inhibitory capacity on various bacteria, fungi and yeasts, and the tannin has the obvious antibacterial effect on the staphylococcus aureus, and the antibacterial activity of the tannin is closely related to the total soap content, the total tannin, the free and total content of the total chlorogenic acid in the decoction pieces, The preparation method comprises the following steps: taking the red vine as a main material, and adding the dandelion, the Herba Patriniae, the Cortex Moutan, the Radix Paeoniae Rubra, the Radix Paeoniae Alba, and the Radix Saposhnikoviae; has wide clinical application and is used for treating gynecological inflammation such as pelvic inflammatory disease, digestive tract ulceration, gastrointestinal inflammation, chronic dysentery and various diseases The tumor and so on. So we try to use the red vine to detoxify the soup in combination with western medicine to treat small the tail of a child Abscess. Objective: To observe the treatment of the tail of the child by western medicine in combination with western medicine and western medicine. abscess Methods:100 patients were randomly divided into treatment group and control group. The mean time, mean hospital stay, and white blood cell count (WBC), C-reactive protein (CRP), and abdomen of the two groups of patients after treatment were treated with a combination of red-to-vine detoxification. The results of the auxiliary examinations such as B-ultrasound were compared. The results were t-test and chi-square test by using the SPSS17.0 statistical software. 5. The difference was statistically significant. Results: The symptoms, signs, mean time, and average hospital stay were significantly shorter in the treatment group than in the control group. The difference of WBC and CRP on day 3, day 6, day 9 and day 12 was significantly lower than that in the control group. The results of B-B ultrasound in the treatment group on day 6 and day 12 were more significant than that of the control group. Small, P 0.05. The difference is of statistical significance.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R272
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，本文編號：2495157
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