【目的】观察加味达原饮治疗气虚湿阻型剖宫产术后肠麻痹的临床疗效及其对胃肠功能和炎症因子水平的影响。【方法】 将2024 年5 月至2025 年5 月在广州中医药大学东莞医院（东莞市中医院）妇产科行子宫下段剖宫产横切口手术后诊断为气虚 湿阻型剖宫产术后肠麻痹的80 例患者，按完全随机法随机分为对照组和试验组，每组各40 例。2 组患者均给予剖宫产术后 常规护理和中医外治疗法，在此基础上，对照组不予干预胃肠动力药物治疗，试验组给予加味达原饮口服治疗，疗程为3 d。 比较2 组患者治疗后肠鸣音恢复时间和首次排气、排便时间，观察2 组患者治疗前后（术后即刻和术后72 h）中医证候积分、 腹痛数字评分法（NRS）评分及血清白细胞介素6（IL-6）、白细胞介素10（IL-10）、肿瘤坏死因子α（TNF-α）、干扰素γ（IFN-γ） 水平的变化情况，并评价2 组患者的临床疗效。【结果】（1）疗效方面，治疗3 d 后，试验组的总有效率为100.0%（40/40），对 照组为85.0%（34/40），组间比较（χ2 检验），试验组的疗效明显优于对照组（P＜0.05）。（2）胃肠功能恢复方面，试验组患者剖 宫产术后的肠鸣音恢复时间、首次排气时间、首次排便时间均较对照组明显缩短（P＜0.05 或P＜0.01）。（3）中医证候积分方 面，术后即刻（术后0 h）和术后6 h，2 组患者的中医证候积分比较，差异均无统计学意义（P＞0.05）；术后24、48、72 h， 2 组患者的中医证候积分均较术后即刻明显降低（P＜0.05），且试验组的降低幅度均明显优于对照组（P＜0.01）。（4）腹痛程度 评估方面，术后即刻（术后0 h），2 组患者的腹痛NRS 评分比较，差异无统计学意义（P＞0.05）；术后12、24 h，2 组患者的腹 痛NRS 评分均较术后即刻明显降低（P＜0.05），且试验组的降低幅度均明显优于对照组（P＜0.01）。（5）炎症因子方面，对照组 治疗3 d 后的血清IL-10、TNF-α、IFN-γ水平均较治疗前明显升高（P＜0.01），而血清IL-6 水平较治疗前有升高趋势，但差 异无统计学意义（P＞0.05）；试验组治疗3 d 后的血清IL-6、TNF-α、IFN-γ水平均较治疗前明显降低（P＜0.05），而血清IL-10 水平较治疗前有降低趋势，但差异无统计意义（P＞0.05）；治疗后组间比较，试验组的血清IL-6、IL-10、TNF-α、IFN-γ水 平均明显低于对照组（P＜0.05）。【结论】加味达原饮治疗气虚湿阻型剖宫产术后肠麻痹疗效显著，可有效改善胃肠功能、缓 解腹痛症状和调节血清炎症因子水平。

Objective To observe the clinical efficacy of Modified Dayuan Decoction in the treatment of post cesarean section paralytic ileus of qi deficiency and dampness obstruction type，and to assess its effects on gastrointestinal function and inflammatory factor levels. Methods A total of 80 patients diagnosed with post cesarean section paralytic ileus of qi deficiency and dampness obstruction type after undergoing lower uterine segment transverse incision cesarean section in the Department of Obstetrics and Gynecology，Dongguan Hospital of Guangzhou University of Chinese Medicine（Dongguan Traditional Chinese Medicine Hospital）from May 2024 to May 2025 were randomly divided into a control group and an trial group using a complete random method，with 40 cases in each group. Both groups received routine postoperative care and external traditional Chinese meidcine （TCM）therapies. On this basis，the control group was not given any prokinetic drug intervention，while the trial group was treated orally with Modified Dayuan Decoction for a course of 3 days. The recovery time of bowel sounds， time to first flatus，and time to first defecation were compared between the two groups after treatment. Changes in TCM syndrome scores，Numerical Rating Scale（NRS）scores for abdominal pain，and serum levels of interleukin-6（IL-6），interleukin-10（IL-10），tumor necrosis factor-alpha（TNF-α），and interferon-gamma （IFN-γ）were observed before and after treatment（immediately after surgery and 72 hours after surgery）in both groups，and the clinical efficacy was evaluated. Results（1）Regarding efficacy，after 3 days of treatment，the total effective rate was 100.0%（40/40）in the trial group and 85.0%（34/40）in the control group，and intergroup comparison（by chi-square test）showed that the efficacy of the trial group was significantly superior to that of the control group（P＜0.05）.（2）Regarding gastrointestinal function recovery，the recovery time of bowel sounds， time to first flatus，and time to first defecation after cesarean section were significantly shorter in the trial group than those in the control group（P＜0.05 or P＜0.01）.（3）Regarding TCM syndrome scores，there were no statistically significant differences between the two groups immediately after surgery（0 hour）and 6 hours after surgery（P＞0.05）. At 24，48 hours，and 72 hours after surgery，TCM syndrome scores in both groups were significantly decreased compared to immediately after surgery（P＜0.05），and the decreases were significantly greater in the trial group than in the control group（P＜0.01）.（4）Regarding abdominal pain assessment，no statistically significant difference was found in NRS abdominal pain scores between the two groups immediately after surgery（P＞0.05）. At 12 hours and 24 hours after surgery，NRS scores in both groups were significantly decreased compared to immediately after surgery（P＜0.05），and the decreases were significantly greater in the trial group than in the control group（P＜0.01）.（5）Regarding inflammatory factors，in the control group，serum levels of IL-10，TNF-α，and IFN-γ were significantly increased after 3 days of treatment compared to before treatment（P＜0.01），while serum IL-6 level showed an increasing trend but without statistical significance（P＞ 0.05）. In the trial group，serum levels of IL-6，TNF-α，and IFN-γ were significantly decreased after 3 days of treatment compared to before treatment（P＜0.05），while serum IL-10 level showed a decreasing trend but without statistical significance（P＞0.05）. After treatment，serum levels of IL-6，IL-10，TNF-α，and IFN-γ in the trial group were significantly lower than those in the control group（P＜0.05）. Conclusion Modified Dayuan Decoction demonstrates significant efficacy in treating post-cesarean section paralytic ileus of qi deficiency and dampness obstruction type，and is effective on improving gastrointestinal function，alleviating abdominal pain symptoms，and regulating serum inflammatory factor levels.

R271.9

广东省基础与应用基础研究基金省企联合基金面上项目（编号：2021A15150094）；东莞市社会发展科技项目高水平医院建设专项 （编号：20231800927372）