胆舒胶囊联合柴胡疏肝散治疗肝胆管结石术后的疗效及术后并发症影响因素分析

目的探究胆舒胶囊联合柴胡疏肝散治疗肝胆管结石术后的疗效以及分析术后并发症的影响因素。方法收集2017年4月—2019年4月期间行肝胆管结石手术患者134例。采用随机数字法将134例术后患者分为治疗组和对照组,每组各67例。所有患者术后均予以消炎镇痛、纠正水电解质平衡、营养支持等常规治疗。在此基础上,对照组口服胆舒胶囊。治疗组在对照组基础上,加用柴胡疏肝散。治疗14 d。记录两组患者药物治疗前和治疗14 d后的临床体征,以及治疗期间发生术后并发症情况。药物治疗前和治疗14 d后,分别检测两组患者血清总胆红素(TBIL)、总胆汁酸(TBA)、胆固醇(CHO)、直接胆红素(DBIL)、间接胆红素(IBIL)水平。采用单因素分析和Cox多因素回归模型分析影响患者预后的因素。结果治疗14 d后,两组患者各项症状发生率均较药物治疗前下降,且治疗组患者肝区叩击痛和发热寒战症状发生率低于对照组,差异有统计学意义(P<0.05)。治疗14 d后,两组患者血清TBIL、TBA、CHO、DBIL、IBIL水平均低于药物治疗前,且治疗组各项指标水平均低于对照组,差异有统计学意义(P<0.05)。治疗组并发症发生率4.48%低于对照组10.45%,差异有统计学意义(P<0.05)。患者术后并发症的发生与术前白蛋白水平、既往胆道手术史、术中出血、手术方式、手术时间、术后药物联合治疗有关(P<0.05)。多因素分析显示,既往胆道手术史、手术方式、手术时间、术后联合药物治疗是影响患者发生术后并发症的独立危险因素。结论胆舒胶囊联合柴胡疏肝散对于改善肝胆管结石术后临床症状和肝功能,降低术后并发症有显著作用,具有临床参考价值。

Effect of Danshu Capsules combined with Shugan Chaihu Powder on the prognosis of postoperative patients with cholelithiasis and influencing factors of postoperative complications

Objective To explore the clinical effect of Danshu Capsules combined with Shugan Chaihu Powder on the prognosis of postoperative patients with cholelithiasis and influencing factors of postoperative complications.Methods A total of 134 patients with cholelithiasis who underwent procedure between April,2017 to April,2019 were included and randomly divided into an observation group and a control group by using random number table,with 67 cases in each group.All patients were given conventional treatment such as anti-inflammatory,analgesic,restoring water-electrolyte balance,nutrition support etc.The control group was orally given Danshu Capsules,while the observation group was given Shugan Chaihu Powder on the basis of the control group.The treatment lasted for 14 days.The clinical signs and postoperative complications of the two groups were recorded before and after treatment.The levels of total bilirubin(TBIL),total bile acid(TBA),cholesterol(CHO),direct bilirubin(DBIL)and indirect bilirubin(IBIL)were measured before and 14 days after drug treatment.Single factor analysis and Cox multiple factor regression model were used to analyze the factors influencing the prognosis of patients.Results After 14 days of treatment,the incidence of symptoms in the two groups was lower than that before drug treatment,and the incidence of percussion pain,fever and shivering in the liver area in the observation group was lower than that in the control group,with statistical significance(P<0.05).After 14 days of treatment,the levels of TBIL,TBA,CHO,DBIL and IBIL in the two groups was lower than those before drug treatment,and the level of each index in the observation group was lower than that in the control group,with statistical significance(P<0.05).The incidence of complications in the observation group(4.48%)was lower than that in the control group(10.45%),with statisticalsignificance(P<0.05).The incidence of postoperative complications was related to preoperative albumin level,previous operation history of biliary tract,intraoperative bleeding,operation mode,operation time and postoperative drug combination therapy(P<0.05).Multivariate analysis showed that the history of biliary tract operation,operation method,operation time and combined drug therapy after procedure were independent risk factors for postoperative complications.Conclusion Danshu Capsules combined with Shugan Chaihu Powder has a significant effect on improving the clinical symptoms and liver function and reducing the postoperative complications of cholelithiasis.