CAJ | 학술논문

目的：探讨NO在改良复方大承气汤治疗粘连性肠梗阻时的变化规律及可能机制。方法将40例良性病变性粘连性肠梗阻作为研究对象及10例非肠梗阻病人作为服药前对照，检测服药前后肠梗阻症状和体征与外周血中NO变化，同时观察传统中医诊察手段之一的舌象变化与NO变化之间的关系。结果术前肠梗阻与非肠梗阻患者外周血中NO值有明显的差别（P<0.05）；服用中药后缓解组与未缓解组除了有临床症状变化差别外，血中NO值前者逐渐下降而后者仍持续高位（P<0.05）；缓解组服药后先有肠鸣音的增强、但病理音减少、NO值也随着下降，而未缓解组肠鸣音和病理音同时增强，不伴有NO值的下降（P<0.05），缓解组与未缓解组舌象变化值也与NO值的高低相平行。结论外周血中NO值能反映肠梗阻的严重程度，服通里攻下药物后NO值仍保持在高位提示为完全性肠梗阻，有肠缺血、肠绞窄倾向，为是否中转手术提供参考。NO值也能反映梗阻以上肠段的多少，即高位或低位梗阻。
목적：탐토NO재개량복방대승기탕치료점련성장경조시적변화규률급가능궤제。방법장40례량성병변성점련성장경조작위연구대상급10례비장경조병인작위복약전대조，검측복약전후장경조증상화체정여외주혈중NO변화，동시관찰전통중의진찰수단지일적설상변화여NO변화지간적관계。결과술전장경조여비장경조환자외주혈중NO치유명현적차별（P<0.05）；복용중약후완해조여미완해조제료유림상증상변화차별외，혈중NO치전자축점하강이후자잉지속고위（P<0.05）；완해조복약후선유장명음적증강、단병리음감소、NO치야수착하강，이미완해조장명음화병리음동시증강，불반유NO치적하강（P<0.05），완해조여미완해조설상변화치야여NO치적고저상평행。결론외주혈중NO치능반영장경조적엄중정도，복통리공하약물후NO치잉보지재고위제시위완전성장경조，유장결혈、장교착경향，위시부중전수술제공삼고。NO치야능반영경조이상장단적다소，즉고위혹저위경조。
Objective To investigate the NO variation rule and possible mechanism during the treatment of adhesive intestine obstruction with modified Dachengqi decoction. Methods Forty cases of benign adhesive intestine obstruction patients and ten cases non-intestine obstruction as control group were admitted. The symptoms,borborygmus and NO variation in peripheral circu-lation were observed. The relation of tongue picture change s,which was one of the important diagnosis method of the traditional chinese medicine,with NO was also been investigated. Results The value of NO in peripheral blood before operation have signifi-cant difference between obstruction and no-obstruction patients(P<0.05). Besides the difference of clinical symptoms between the relieve group and no-relieve group after taking modified Dachengqi decoction,the NO value in relieve group gradually decreased, but in no-relieve group kept in higher altitude (P<0.05). The borborygmus first enhanced after taking modified Dachengqi decoc-tion, and pathological sound decreased,the NO value also decreased along with in relieve group,but borborygmus and pathological sound enhanced at the same time,and the NO value did not drop in no-relieve group(P<0.05). The change of tongue picture val-ue was also positively parallel with the NO change tendency in relieve and no-relieve group. Conclusion The NO value in the peripheral circulation is able to mirror the degree of severity of the intestine obstruction. If the NO value keep in high value after taking modified Dachengqi decoction we can double that the obstruction is complete and has the tendency of ischemia and stran-gulation of bowel,which can be used as one of references for operation decision. The value of NO may also reflect how much in-testine above the obstruction site,in other words the obstruction point is higher or lower,and judge other pathological and physio-logical changes which may be induced by intestine obstruction.