中药敷脐预防腹部术后胃肠功能障碍的临床研究

发布时间：2018-11-01 11:11

【摘要】：目的:随着现代医学和外科手术技术的发展,腹部手术日益增多,术后胃肠功能障碍也越来越受到人们的关注与重视。近年来,预防与治疗腹部术后胃肠功能障碍的方法研究逐渐增多,均取得一定的临床效果,但各有利弊。本研究通过观察中药敷脐对腹部术后腹胀、肠鸣音恢复、排气排便时间、恶心呕吐等指标的影响,客观评价本治疗方法对胃肠功能障碍的预防作用,旨在为本病的临床治疗探索一种便捷可行的中医治疗方案。方法:选取于2016年5月-2017年2月在广州中医药大学深圳医院普外科住院治疗,符合纳入标准的腹部术后患者,共85例。将所有患者随机分为治疗组(中药敷脐组)43例和对照组(术后常规治疗组)42例。治疗组在对照组的基础上于术后12小时后予脐部中药贴敷,每12小时贴敷一次,每次贴敷半个小时,连续贴敷3天,3天后未排气者终止治疗。对照组予腹部术后临床常规治疗(禁食禁水、吸氧、心电监测、胃肠减压、抗感染治疗、常规补液、补充水电解质、维持酸碱平衡、营养支持、抑酸护胃、止痛等,重症患者予全胃肠外营养等,鼓励患者早期下床活动)。记录两组患者术毕12小时后每6h的腹部症状及体征,包括排气时间、排便时间、肠鸣音恢复时间、恶心呕吐、腹胀情况、住院天数等,所有患者均观察5天,并对相关术后情况进行评分,采用SPSS22.0软件进行统计学分析。结果:经统计学分析,两组患者术前一般资料(性别、年龄、发病时间、麻醉方式、手术方式、手术时长、术中出血量)无明显统计学意义(P0.05)。经治疗后分析,治疗组术后肠鸣音恢复时间为(39.88±3.86)h,对照组术后肠鸣音恢复时间为(46.57±4.33)h,两组术后肠鸣音恢复时间有明显统计学意义(P0.05)。治疗组患者术后首次排气时间为(38.40±4.10)h,首次排便时间(63.49±4.53)h,对照组术后首次排气时间为(51.05±4.66)h,首次排便时间为(79.02±6.01)h,经t检验,两组患者此两项指标均有统计学意义(P0.05)。在住院时间方面,治疗组为(6.95±1.11)天,对照组为(7.43± 1.11)天,经t检验,两组无统计学意义(P0.05)。分别分析患者术后第2天,术后第3天,术后第5天腹胀评分,经t检验,两组患者在术后第2天有统计学意义(P0.05),术后第3、5天无统计学意义(P0.05)。比较两组患者术后恶心呕吐、肠鸣音评分,在术后第1、2天,两组两项指标均有统计学意义(P0.05),在术后第3、5天,两组两项指标均无统计学意义(P0.05)。结论:中药敷脐能明显缓解腹部术后患者腹胀及恶心呕吐情况,促进肠鸣音恢复及排气排便,对腹部术后胃肠功能障碍有明显的预防作用,是一种简便廉效的治疗方法,值得临床推广使用。
[Abstract]:Objective: with the development of modern medical and surgical techniques, abdominal surgery is increasing, postoperative gastrointestinal dysfunction has been paid more and more attention. In recent years, the study on the prevention and treatment of gastrointestinal dysfunction after abdominal surgery has gradually increased, and achieved certain clinical results, but each has its own advantages and disadvantages. The purpose of this study was to evaluate objectively the preventive effect of this treatment on gastrointestinal dysfunction by observing the effects of traditional Chinese medicine on abdominal distension, recovery of bowel sounds, time of exhaust and defecation, nausea and vomiting after abdominal surgery. In order to explore a convenient and feasible Chinese medicine treatment for the clinical treatment of this disease. Methods: from May 2016 to February 2017, 85 patients who were admitted to general surgery department in Shenzhen Hospital of Guangzhou University of traditional Chinese Medicine, who met the inclusive criteria, were selected. All the patients were randomly divided into two groups: treatment group (43 cases) and control group (42 cases). On the basis of the control group, the treatment group was treated with umbilical traditional Chinese medicine application 12 hours after operation, once every 12 hours, for half an hour each time, continuously for 3 days, and the treatment was terminated after 3 days without exhaust. The control group received routine clinical treatment (fasting, oxygen intake, ECG monitoring, gastrointestinal decompression, anti-infection therapy, routine fluid rehydration, water electrolyte supplement, maintenance of acid-base balance, nutritional support, acid suppression and stomach protection, pain relief, etc.) Severe patients with total parenteral nutrition, encourage patients to get out of bed early). Abdominal symptoms and signs were recorded 12 hours after operation in both groups, including exhaust time, defecation time, recovery time of bowel sound, nausea and vomiting, abdominal distension, hospital stay, etc. All patients were observed for 5 days. And the relevant postoperative situation score, SPSS22.0 software for statistical analysis. Results: there was no significant difference between the two groups in preoperative general data (sex, age, onset time, anaesthesia, operative time, intraoperative bleeding) (P0.05). After treatment, the recovery time of bowel sound was (39.88 卤3.86) h in the treatment group and (46.57 卤4.33) h in the control group. There was significant difference in the recovery time between the two groups (P0.05). The first exhaust time and first defecation time were (38.40 卤4.10) h and (63.49 卤4.53) h respectively in the treatment group and (51.05 卤4.66) h in the control group, and (79.02 卤6.01) h in the control group. By t test, the two groups of patients with these two indicators were statistically significant (P0.05). In terms of hospitalization time, the treatment group was (6.95 卤1.11) days, the control group was (7.43 卤1.11) days, after t test, there was no significant difference between the two groups (P0.05). The abdominal distension scores were analyzed on the second day, the third day and the fifth day after operation respectively. After t test, there was significant difference between the two groups on the second day after operation (P0.05), but there was no statistical significance on the 3rd day (P0.05). The scores of nausea and vomiting and bowel sounds were compared between the two groups. On the 1st and 2nd day after operation, the two indexes in both groups were statistically significant (P0.05), but on the 3rd day after operation, there was no significant difference between the two groups (P0.05). Conclusion: the application of traditional Chinese medicine can significantly relieve abdominal distension and nausea and vomiting in patients after abdominal surgery, promote the recovery of bowel sounds and exhaust, defecate and prevent gastrointestinal dysfunction after abdominal surgery, and is a simple and effective treatment method. It is worth popularizing in clinic.
【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】：R656

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