大承气汤大黄后下时间对阳明腑实证的临床疗效观察

目的:探讨大承气汤中大黄后下时间对阳明腑实证患者的临床治疗效果。方法:选择自2012年3月至2014年1月广东省中西医结合医院消化门诊或住院部的符合纳入标准的阳明腑实证便秘患者150例。按照口服大承气汤大黄后下时间的不同,随机分10 min组,20 min组,30 min组,每组50例,每组均煎煮10 min、20 min、30 min、60 min、90 min。各组给药1次/d,至排出大便通气时止。观察各组用药后肛门排气、排便时间;计算不同大承气汤煎液中各游离、结合、总蒽醌类衍生物的含量。统计分析后下大黄最佳煎煮时间,从而为大承气汤临床提供用药指导。结果:1)大黄后下时间相同,煎煮时间不同会对大承气汤中总蒽醌含量有影响,2)大黄中有效成分的回归方程分别为:芦荟大黄素Y=104 681X-39 806(r=0.999 9);大黄酸Y=54967X-23 089(r=0.999 9);大黄素Y=298 764X-90 874(r=0.999 9);大黄酚Y=188 096X-38 046(r=0.999 9);大黄素甲醚Y=83 997X-28 765(r=0.999 9);3)研究表明,20 min大黄后下,共煎煮30 min时大承气汤中结合蒽醌含量最高,结合蒽醌的泻下效应较强;4)20 min煎煮30 min时,大承气汤排便时间、次数、排气时间以及肛门直肠压力与各时间段比较差异有统计学意义(P0.05)。结论:大承气汤在煎煮20 min后加入大黄后共煎煮30 min的药液中结合蒽醌的含量高于其他后下时间,为其致泻作用提供物质基础,避免了中药煎煮时间过短或过长,防止了不良反应的发生,减轻了患者的痛苦。

Clinical Effect Observation on the Time of Large Chengqi Decoction Rheum Decocting Later in Patients with Yangmingfu-visceraexcess

To investigate the clinical effect of Large Chengqi decoction Rheum decocting later in patients with Yangmingfuvisceraexcess.Methods：1 50 patients with Yangmingfu-visceraexcess in Outpatients and In-patient Department of Gastroenterology in Integrated Chinese and Western Medicine Hospital of Guangdong Province from March 201 2 to January 201 4 were the research object,and they were divided into 1 0 minutes group,20 minutes group,30 minutes group with 50 cases in each group according to the time1 0 min,20 min,30 min,60 min and 90 min of decoction later,each group were treated with qd to the time of stool.Then the evacuation time,defecation time of all the groups were observed,and the free,binding,total anthraquinone derivatives of different Large Chengqi decoction were detected.And the best time of decoction later were analyzed,in order to provide guidance for the application of Large Chengqi decoction. Results：1 ）The different decocting time had influence for the total anthraquinone content at the same time of decoction later,2）the re-gression equation of active constituents in Rhubarb were respectively：aloe-emodin Y=1 04 681 X-39 806（r=0.999 9）;parietic acid Y=54 967X-23 089（r=0.999 9）;emodin Y=298 764X-90 874（r=0.999 9）;chrysophanic acid Y=1 88 096X-38 046（r=0.999 9）;physcione Y=83 997X-28 765（r=0.999 9）;3）The research showed that the binding anthraquinone derivatives of different Large Chengqi decoction at 20 minute of decoction later in 30 minutes together were highest,the purgative effect of binding anthraquinone derivatives were greater;4）At 20 minute of decoction later in 30 minutes together were highest（P〈0.05）.Conclusion：The binding anthraquinone derivatives content of different Large Chengqi decoction decoction 20 minute later at 60 minute are higher than other times,it provides the material foundation for its purgative effect and avoids the too long or too short decocting time itraditional Chinese medicine, so it prevents the toxicity and other adverse reaction