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

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02月收治的101例行D2胃癌根治术的患者资料，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2天至术后9天服用肠内营养制剂，联合组在此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、住院天数、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天中医症候积分、血清白蛋白、前白蛋白、转铁蛋白，IgG、IgA、IgM、CD3+、CD4+、CD4+/CD8+水平。结果：联合组与对照组比较，中医症候积分降低、排气时间提前、拔引流管时间提前、下床活动提前、术后住院天数缩短、住院费用减少，对比有统计学意义（P＜0.05），两组患者术后第36、48及60h时间点的疼痛评分对比有统计学意义，（P＜0.05）；两组患者术后尿管拔除时间无差异（P＞0.05）。术后10天，联合组血清白蛋白、前白蛋白、转铁蛋白、IgG、IgA、IgM和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%和8.0%，恢复良好出院，1个月内定期随访。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症候积分、改善免疫功能及营养状态、减轻术后疼痛、肠道功能早期恢复、减少住院天数、减少住院费用、促进胃癌术后快速康复，与提高IgG、IgA、IgM、CD3+、CD4+、CD4+/CD8+、血清白蛋白、前白蛋白、转铁蛋白水平相关，安全可行。

Clinical observation of Sijunzi Decoction Combined with enteral- nutrition on rapid rehabilitation after operation of gastric cancer

Objective: To observe the clinical effect of Sijunzi Decoction Combined with enteral nutrition on 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 affiliated to Chenggong Hospital of Xiamen University from November 2019 to February 2021 were retrospectively analyzed. According to whether they took Sijunzi decoction after operation, they were divided into combined group (51 cases) and control group (50 cases). The control group took enteral nutrition from 2 days to 9 days after operation. On this basis, Sijunzi decoction was added to the combined group, The postoperative rehabilitation of the two groups were compared: exhaust time, catheter pulling time, drainage tube pulling time, out of bed time, hospitalization days, hospitalization expenses, postoperative pain score and postoperative complications. The TCM symptom score, serum albumin, prealbumin, transferrin, IgG, 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 days and hospitalization expenses in the combined group were significantly lower (P < 0.05). The pain scores at 36, 48 and 60H after operation in the two groups were statistically significant (P < 0.05); There was no difference in the time of catheter extraction 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. They recovered well and were discharged from the hospital. They were followed up regularly within one month.