针药并用外治肿瘤腹部手术后胃瘫的疗效评价

发布时间：2018-01-07 09:32

本文关键词：针药并用外治肿瘤腹部手术后胃瘫的疗效评价　出处：《北京中医药大学》2017年硕士论文　论文类型：学位论文

【摘要】：[研究背景]腹部手术后胃瘫综合征(postsurgical gastroparesis syndrome,PGS)是腹部手术后继发的非机械性梗阻因素引起的以胃排空障碍为核心的胃动力紊乱综合征,PGS是困扰腹部手术后患者尤其是肿瘤患者的一种术后早期并发症。目前针对PGS患者常用的西医治疗方法种类繁多,却往往存在矛盾之处,缺乏强效、可迅速改善患者症状的有力措施。中医中药在治疗术后胃瘫综合征上方法多样,具有一定的优势,遗憾的是现有研究样本量少。同时由于患者胃排空功能减弱,中药内服的治疗方式可能会加重患者的胃肠道负担,加重恶心、呕吐等腹部症状,影响患者依从性,处方中亦多含有苦寒之品,易伤胃气,对肿瘤腹部手术后胃瘫患者亦应慎重;针灸、中药外敷、中药灌肠等中医外治法虽然在治疗腹部术后胃瘫方面发挥了一定的作用,但是单一的治疗方法疗效有限。因此,将行之有效的中医外治法相联合,治疗肿瘤腹部手术后胃瘫综合征,探索和完善现有治疗模式,充分发挥中医药治疗优势和特色,具有重要意义。[研究目的]采用前瞻性、随机对照的研究设计,以针刺疗法结合外用中药穴位贴敷作为干预手段,对肿瘤腹部手术后常见并发症——胃瘫综合征患者进行干预,并与西医常规治疗方法进行比较,评价中医外治法治疗胃瘫的客观疗效及其特点,在此基础上,探索中医外治法治疗肿瘤腹部手术后胃瘫综合征的技术方案。[研究方法]纳入2013年7月1日-2016年8月30日在首都医科大学附属北京中医医院及中国医学科学院肿瘤医院住院的符合术后胃瘫综合征诊断标准及研究纳入标准的患者共106例,随机数字表法进行随机分组,用不透光的信封进行分配隐藏,将患者分为治疗组(针刺+外敷中药)和对照组(常规治疗组)。两组均采用同等的西医基本治疗,对照组在基本治疗的基础上加用甲氧氯普胺注射液10mg/次,肌注,每日2次;治疗组在基本治疗的基础上加用针刺联合中药穴位贴敷,针刺穴以"老十针"加减,手法为平补平泻,留针20min,1次/日,中药穴位贴敷以本院自制通腑贴外敷神阙及双涌泉,外敷4~6小时后取下,1次/日。连续使用至胃瘫缓解,最长疗程为21天。观察并统计两组患者治疗第7、14、21、30天胃瘫缓解率、胃液引流量、胃管拔出时间、症状积分、体力状况积分等指标,对比两组治疗效果,进行疗效评价,总结并优化肿瘤腹部手术后胃瘫中医外治方案。[研究结果]治疗组患者在疗效指标数据中体现出较好的疗效,并且安全性较高。1、胃瘫缓解率:在第7、14、21、30天治疗组胃瘫缓解率均明显高于对照组,分别是98.11%和 25.49%、98.11%和 60.78%、100.00%和86.27%、100.00%和 90.20%,第 7、14、21 天两组差异具有显著统计学意义(P0.01),第30天两组差异有统计学意义(P=0.026)。2、胃瘫缓解情况:第7、14、21天治疗组胃瘫缓解情况优于对照组,组间差异有显著统计学意义(P≤0.01),第30天组间差异无统计学意义(P=0.079)。3、胃液引流量:第3天后体现出组间显著差异,其中治疗组患者胃液引流量显著低于对照组患者(P0.01)。4、以胃管置入为起点的胃管拔除时间,组间差异具有显著意义(P=0.017),治疗组时间较短。以胃瘫发生为起点的胃管拔除时间组间差异无统计学意义(P=0.298)。5、症状积分:在第7、14、21天均体现出显著差异,治疗组患者症状评分显著低于对照组患者(P0.01)。6、体力状况积分:第7、14、21天均体现出显著差异,治疗组患者症状评分显著高于对照组患者(P0.01)。7、营养指标:仅有钾离子在第7天体现出组间差异(P=0.004),余指标两组差异无统计学意义(P0.05)。8、安全性:本研究中无不良事件报告,主要安全性指标临床实验室检查,包括白细胞、血红蛋白、血小板、胆红素、谷丙转氨酶、谷氨酰转肽酶、尿素氮、肌酐,组间差异均未见统计学意义(P0.05)。[研究结论]针刺("老十针")配合中药穴位贴敷(涌泉穴、神阙穴)能明显提高肿瘤腹部手术后胃瘫综合征的缓解率,减少患者术后胃液引流量,缩短胃管留置时间,减轻消化道症状,提高患者生活质量,且该治疗方法安全性较高。
[Abstract]:[background] gastroparesis syndrome after abdominal surgery (postsurgical gastroparesis, syndrome, PGS) is caused by mechanical obstruction secondary factors after abdominal surgery in gastric emptying as the core of the gastric motility disorder syndrome, PGS is troubled in patients after abdominal surgery especially tumor patients for early postoperative complications. At present western medicine therapy for PGS patients with common variety, but there are contradictions, lack of powerful, effective measures can rapidly improve the symptoms of patients. The traditional Chinese medicine in the treatment of postoperative gastroparesis syndrome on various methods, has certain advantages, unfortunately the existing research samples are less. At the same time due to gastric emptying in patients with function, traditional Chinese medicine treatment may increase the patient's gastrointestinal burden, increase nausea, vomiting abdominal symptoms, affect patient compliance, the prescription also contains the bitter cold of the goods, easy Hurt the stomach, in tumor patients with gastroparesis after abdominal operation should be cautious; acupuncture and external application of Chinese medicine, Chinese medicine enema of TCM external treatment while in the treatment of gastroparesis after abdominal operation has played a certain role, but the single therapy effect is limited. Therefore, the external treatment of TCM effective combination, treatment of abdominal tumor postoperative gastroparesis syndrome, explore and improve the existing treatment mode, give full play to the advantages and characteristics of traditional Chinese medicine treatment, has important significance to study. By a prospective, randomized controlled study design, with combined acupuncture with Acupoint Application of Chinese medicine as the intervention method of tumor after abdominal surgery complications: gastroparesis syndrome intervention, and compared with the conventional western medicine treatment, evaluation objective curative effect of medicine treatment of gastric paralysis and its characteristics, on the basis of the rule of law, to explore the external treatment of traditional Chinese Medicine Technical scheme. Research methods of gastroparesis syndrome after abdominal surgery to cure tumor in July 1, 2013 -2016 August 30th in Beijing Chinese Medicine Hospital affiliated to Capital Medical University and Chinese Academy of Medical Sciences cancer hospital with postoperative gastroparesis syndrome diagnostic criteria and research into the standard of a total of 106 patients were randomly divided into two groups randomly, of allocation concealment with an opaque envelope, the patients were divided into treatment group (acupuncture combined with external application of Chinese Medicine) and control group (conventional treatment group). Two groups were treated with the same basic treatment of Western medicine, the control group in the basic treatment combined with metoclopramide injection 10mg/, intramuscular injection, 2 times a day; treatment group on the basis of the basic treatment combined with acupuncture combined with Acupoint Application of Chinese medicine, acupuncture points to the "old ten pin" modified technique for reinforcing reducing, for 20min, 1 times / day, acupoint application of Chinese medicine in our hospital Tongfu Paste external application Shenque and double springs, with 4~6 after 24 hours, 1 times / day. The continuous use of gastroparesis to ease, the longest duration of 21 days. The observation and statistics of two groups of patients after 7,14,21,30 days of gastroparesis remission rate, gastric drainage tube pulled out of time, symptoms, physical condition of product classification the index, compared two groups of treatment effect, effect evaluation, summarize and optimize the tumor after abdominal surgery of traditional Chinese medicine external treatment of gastroparesis. Results the treatment scheme shows good effect in clinical data in patients, and high security.1, the remission rate of gastroparesis: on day 7,14,21,30 treatment group gastroparesis remission rate were significantly higher than the control group, respectively 98.11% and 25.49%, 98.11% and 60.78%, 100% and 86.27%, 100% and 90.20%, there was a statistically significant difference between the two groups in 7,14,21 days (P0.01), there was statistical significance in the thirtieth days between the two groups (P =0.026).2, reduce gastric paralysis Condition: the first day of 7,14,21 treatment of gastroparesis remission than those in the control group, there was significant difference between groups (P = 0.01), there was no significant difference between the thirtieth groups (P=0.079 days).3, gastric drainage: third days shows significant differences between the groups, the treatment group was significantly lower than that of patients with gastric drainage patients in the control group (.4, P0.01) with indwelling gastric tube as the starting point of the extubation time, significant differences between the groups (P=0.017), the treatment group for a short time. With gastroparesis was no statistically significant difference between the starting point of the gastric extubation time between groups (P= 0.298).5 symptom score: in 7,14,21 days show significant differences, patients in the treatment group symptom scores were significantly lower than the control group (P0.01.6), the physical condition of integration: the first day of 7,14,21 shows significant difference in symptom score of treatment group was significantly higher than the control group patients (P0.01.7), nutritional index: only in potassium ion The seventh day reflects the differences between the groups (P=0.004), there was no significant difference between the two groups (.8, P0.05) more than the index of safety: no adverse events reported in this study, the main safety indicators of clinical laboratory examination, including white blood cell, hemoglobin, platelet, bilirubin, alanine aminotransferase, gamma glutamyl transferase. Urea nitrogen, creatinine, the differences between groups were not statistically significant (P0.05). The conclusion of the study ("old ten] acupuncture needle combined with acupoint sticking) (Yongquan, Shenque) can significantly improve the tumor remission rate of gastroparesis after abdominal surgery syndrome, reduce postoperative gastric drainage, shorten the tube the indwelling time, reduce gastrointestinal symptoms, improve the quality of life of patients, and the treatment method of high safety.

【学位授予单位】：北京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R730.5

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