第一临床医学院知识库

目的：观察加味枳术散敷贴治疗乙肝肝硬化胃肠功能不全患者治疗前后症状及胃动素、胃泌素和胃排空时间等指标的变化，探讨加味枳术散敷贴治疗乙肝肝硬化胃肠功能不全的临床有效性及安全性。

方法：选取2015.11-2017.01兰州大学第一医院肝病科收治的乙肝肝硬化患者34名，以随机数表法随机分为治疗组及对照组；每组患者在治疗前均行胃动素、胃泌素、放射性核素胃排空及肝功能检查，以上述结果为治疗基线数据；入组患者均给予常规保肝、抗病毒、降酶及退黄等基础治疗。治疗组在基础治疗上应用加味枳术散敷贴治疗，每日1次，每次6h，10天为1疗程；对照组继续基础治疗；治疗疗程结束后每组患者再次行胃动素、胃泌素、放射性核素胃排空及肝功检查；整理治疗前后两组数据，应用统计学方法分析数据，得出结论。

结果：(1)乙肝肝硬化胃肠功能不全患者治疗后疗效评估，治疗组有效率94%，明显优于对照组（58.8%），结果有统计学意义（P<0.05）；(2)乙肝肝硬化胃肠功能不全患者治疗前后肝功能指标变化情况对比，两组均较治疗前降低，对照组(P<0.05)，但治疗组降低更明显 (P<0.01)；(3)乙肝肝硬化胃肠功能不全患者治疗前后胃动素、胃泌素及胃排空的变化，治疗前两组患者三指标均明显增高，经治疗治疗组三指标均明显减低，有统计学意义（P均<0.05）；对照组均降低不明显，无统计学意义（P>0.05）；(4)Child B、C级乙肝肝硬化胃肠功能不全患者胃动素、胃泌素及胃排空的变化，胃排空时间与患者Child分级呈正相关性，胃泌素及胃动素则无相关性；(5)Child B、C级乙肝肝硬化患者胃动素、胃泌素均与胃排空时间无相关。 结论：加味枳术散对改善乙肝肝硬化胃肠功能不全患者胃动力疗效明显，安全性高，可操作性强，值得推广。

Objective: To study the effectiveness and security of modified Zhizhu Powder application therapy on gastrointestinal dysfunction caused by hepatitis B related-cirrhosis, we observed the changes of symptoms and motilin, gastrin and gastric emptying time in patients with gastrointestinal dysfunction caused by hepatitis B related-cirrhosis before and after modified Zhizhu Powder application therapy.

Methods: thirty-four patients with hepatitis B liver cirrhosis,who were admitted to The First Hospital of Lanzhou University from November 2015 to January 2017,were randomly selected and divided into treatment group and control group by random number table method.Each group of patients needs to check motilin, gastrin, radionuclide gastric emptying and liver function tests before treatment, and these test results will serve as baseline data for treatment.Each group of patients were given conventional liver, anti-virus, reducing enzyme and other basic treatment.The patients of treatment group were increased the modified Zhizhu Powder application therapy.Treat once a day, each treatment time for 6 hours, 10 days for a course of treatment.The control group continued basic treatment.At the end of the treatment course, each group of patients needs to check motilin, gastrin, radionuclide gastric emptying and liver function tests once again.We collected two sets of data before and after treatment, used statistical methods to analyze the data,and finally come to the conclusion.

Results:(1)evaluated the efficacy of patients with gastrointestinal dysfunction caused by hepatitis B related-cirrhosis after treatment, we concluded that the treatment group was 94% effective, significantly better than the control group (58.8%), and the results were statistically significant (P<0.05).(2)Compared the changes in liver function before and after treatment in patients with gastrointestinal dysfunction caused by hepatitis B related-cirrhosis, we concluded that both groups were lower than before treatment, but the treatment group decreased more significantly(the control group P<0.05,the treatment group was P<0.01).(3)We compared the changes of motilin, gastrin and gastric emptying before and after treatment in patients with gastrointestinal dysfunction caused by hepatitis B related-cirrhosis, the three indexes were significantly higher in the two groups before treatment, but after treatment the three indexes in the treatment group were significantly decreased (P<0.05), in control group the three indexes were not significantly reduced and no statistically significant (P>0.05).(4)We compared the changes of motilin, gastrin and gastric emptying in patients with hepatitis B related-cirrhosis compounded child B or C grade, and the gastric emptying time was positively correlated with the Child's grade. There was no correlation between gastrin and motilin.(5)Motilin and gastrin were not associated with gastric emptying in patients with hepatitis B related-cirrhosis compounded child B or C grade.

Conclusion:The effect in improve gastric motility of modified Zhizhu Powder application therapy on gastrointestinal dysfunction caused by hepatitis B related-cirrhosis was obvious, At the same time it had a high security, highly operational and worthy of clinical promotion.