基于快速康复理念针药联用对肝外胆道结石微创术后胃肠功能的研究

发布时间：2018-06-14 06:03

本文选题：快速康复 + 电针　；参考：《广州中医药大学》2017年硕士论文

【摘要】：目的:基于快速康复理念下,对肝外胆道结石行微创治疗的患者术后进行电针足三里、上巨虚配合吴茱萸热熨腹部治疗,观察其术后胃肠功能恢复情况及安全性指标,术后胃肠恢复情况包括术后肛门首次排气、排便时间及恢复全流饮食时间等主要指标,然后进行系统评价,探讨针药治疗在快速康复外科中的临床意义,为临床应用中医特色外治法治疗术后胃肠功能障碍加快术后康复提供依据。方法:选取2016年1月至2016年12月至广州中医药大学第一附属医院肝胆外科(三外科)收治住院治疗,诊断为肝外胆道结石(即胆囊结石或胆囊结石并胆总管结石)并行微创手术治疗的患者,运用简单随机法分为实验组(电针足三里、上巨虚联合吴茱萸热熨组)30例,对照组(常规基础治疗组)30例。围手术期均运用快速康复理念:术前均采取术前宣教、缩短禁食禁饮时间、无需肠道准备等措施;术后对照组给予常规基础治疗,主要包括:肝胆外科术后常规护理、抗生素使用,护肝,护胃,常规补液营养支持,维持水电解质平衡等。实验组在对照组治疗的基础上加电针足三里、上巨虚联合吴茱萸热熨腹部治疗。观察并记录两组患者术后胃肠功能恢复相关指标及安全性指标,结合临床观察量表收集数据,对两组所得数据进行统计、分析并总结,验证针药联合治疗对肝外胆道结石微创手术患者术后胃肠功能的疗效。结果:1.两组数据一般情况及手术相关资料比较:统计学意义上,实验组和对照组之间无差异;2.两组数据术后胃肠功能恢复比较:较之对照组患者,实验组患者术后首次排气排便时间、恢复全流饮食时间明显缩短,且差异有统计学意义(P0.05);实验组患者住院天数及术后住院天数均有所缩短,但差异不具有统计学意义(P0.05)。3.两组数据安全性评价:两组均未发生围手术期死亡或麻醉及心血管意外事件,无不良反应出现。在术前1天,术后第1、3天进行血常规、肝功能、肾功能、电解质检测,比较白细胞总数(WBC)、中性粒细胞百分比(NEUT%)等血常规主要指标;谷丙转氨酶(ALT)、谷草转氨酶(AST)、总胆红素(TB)等肝功能主要指标,肌酐(CR)等肾功能指标;钾离子(K+)等电解质主要指标,结果显示P0.05,两组间比较无明显差异。4.经t检验、方差分析及卡方检验,实验组与对照组相比较,实验组在促进腹部术后胃肠功能恢复方面优于对照组。结论:电针足三里、上巨虚联合吴茱萸热熨腹部治疗肝外胆石症微创手术治疗安全可靠,且在改善患者术后胃肠功能有积极作用,并在一定程度上可改善患者术后胃肠症状。
[Abstract]:Objective: to observe the recovery of gastrointestinal function and safety index of patients with extrahepatic cholelithiasis treated by electroacupuncture in Zusanli, Shangju Xu combined with rutaecarpa fever ironing abdomen based on the idea of rapid rehabilitation. The recovery of gastrointestinal tract after operation included the first exhaust of anus, the time of defecation and the time of recovery of whole flow diet. Then, the clinical significance of acupuncture and medicine in rapid recovery surgery was discussed. To provide the basis for clinical application of traditional Chinese medicine special external treatment for postoperative gastrointestinal dysfunction to speed up postoperative rehabilitation. Methods: from January 2016 to December 2016, the first affiliated Hospital of Guangzhou University of traditional Chinese Medicine, Department of Hepatobiliary surgery (third surgery), was selected to be hospitalized. Patients diagnosed as extrahepatic cholelithiasis (i.e. gallstone or cholecystolithiasis combined with choledocholithiasis) and minimally invasive surgical treatment were divided into experimental group (electroacupuncture Zusanli, Shangjuxu combined with rutaecarpa fever ironing group, 30 cases). Control group (routine basic treatment group, 30 cases). During the perioperative period, the idea of rapid rehabilitation was adopted: preoperatively, the duration of fasting and drinking was shortened, and no bowel preparation was required, while the control group was given routine basic treatment, including routine nursing after hepatobiliary surgery. Antibiotic use, liver protection, stomach protection, routine rehydration nutrition support, maintain water electrolyte balance, etc. The experimental group in the control group on the basis of electroacupuncture Zusanli, Shangjuxu combined with Evodia rutaecarpa abdominal ironing treatment. The related indexes and safety indexes of gastrointestinal function recovery were observed and recorded in the two groups. The data collected from the clinical observation scale were collected, and the data obtained from the two groups were analyzed and summarized. Objective: to evaluate the effect of combined acupuncture and medicine on gastrointestinal function in patients with extrahepatic cholelithiasis after minimally invasive operation. The result is 1: 1. Comparison of general data and surgical data between the two groups: statistically, there was no difference between the experimental group and the control group. Comparison of postoperative gastrointestinal function recovery between the two groups: compared with the control group, the first time of exhaust defecation and the time of recovery of whole stream diet in the experimental group were significantly shorter than those in the control group. The difference was statistically significant (P 0.05), the days of hospitalization and postoperative hospitalization of the patients in the experimental group were shortened, but the difference was not statistically significant (P 0.05). Data safety evaluation: no perioperative death, anaesthesia and cardiovascular accident occurred, and no adverse reactions occurred in both groups. Blood routine examination, liver function, renal function and electrolytes were performed 1 day before operation and 3 days after operation. The main indexes of blood routine such as WBCU, neutrophil percentage and neuter (neuter) were compared. Alanine aminotransferase (alt), alanine aminotransferase (AST), total bilirubin (TB), renal function (CRK) and potassium ion (K) were the main indexes of liver function. The results showed that there was no significant difference between the two groups. By t test, variance analysis and chi-square test, compared with the control group, the experimental group was superior to the control group in promoting the recovery of gastrointestinal function after abdominal surgery. Conclusion: electroacupuncture of Zusanli, Shangjuxu combined with rutaecarpa fever and abdominal ironing is safe and reliable in the treatment of extrahepatic cholelithiasis, and has a positive effect on improving the gastrointestinal function of the patients after operation, and to some extent can improve the postoperative gastrointestinal symptoms of the patients.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R657.4

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