本文關(guān)鍵詞：針藥并用外治腫瘤腹部手術(shù)后胃癱的療效評價　出處：《北京中醫(yī)藥大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 腫瘤 術(shù)后胃癱綜合征 中醫(yī)外治 老十針 穴位貼敷

【摘要】：[研究背景]腹部手術(shù)后胃癱綜合征(postsurgical gastroparesis syndrome,PGS)是腹部手術(shù)后繼發(fā)的非機械性梗阻因素引起的以胃排空障礙為核心的胃動力紊亂綜合征,PGS是困擾腹部手術(shù)后患者尤其是腫瘤患者的一種術(shù)后早期并發(fā)癥。目前針對PGS患者常用的西醫(yī)治療方法種類繁多,卻往往存在矛盾之處,缺乏強效、可迅速改善患者癥狀的有力措施。中醫(yī)中藥在治療術(shù)后胃癱綜合征上方法多樣,具有一定的優(yōu)勢,遺憾的是現(xiàn)有研究樣本量少。同時由于患者胃排空功能減弱,中藥內(nèi)服的治療方式可能會加重患者的胃腸道負擔,加重惡心、嘔吐等腹部癥狀,影響患者依從性,處方中亦多含有苦寒之品,易傷胃氣,對腫瘤腹部手術(shù)后胃癱患者亦應(yīng)慎重;針灸、中藥外敷、中藥灌腸等中醫(yī)外治法雖然在治療腹部術(shù)后胃癱方面發(fā)揮了一定的作用,但是單一的治療方法療效有限。因此,將行之有效的中醫(yī)外治法相聯(lián)合,治療腫瘤腹部手術(shù)后胃癱綜合征,探索和完善現(xiàn)有治療模式,充分發(fā)揮中醫(yī)藥治療優(yōu)勢和特色,具有重要意義。[研究目的]采用前瞻性、隨機對照的研究設(shè)計,以針刺療法結(jié)合外用中藥穴位貼敷作為干預(yù)手段,對腫瘤腹部手術(shù)后常見并發(fā)癥——胃癱綜合征患者進行干預(yù),并與西醫(yī)常規(guī)治療方法進行比較,評價中醫(yī)外治法治療胃癱的客觀療效及其特點,在此基礎(chǔ)上,探索中醫(yī)外治法治療腫瘤腹部手術(shù)后胃癱綜合征的技術(shù)方案。[研究方法]納入2013年7月1日-2016年8月30日在首都醫(yī)科大學(xué)附屬北京中醫(yī)醫(yī)院及中國醫(yī)學(xué)科學(xué)院腫瘤醫(yī)院住院的符合術(shù)后胃癱綜合征診斷標準及研究納入標準的患者共106例,隨機數(shù)字表法進行隨機分組,用不透光的信封進行分配隱藏,將患者分為治療組(針刺+外敷中藥)和對照組(常規(guī)治療組)。兩組均采用同等的西醫(yī)基本治療,對照組在基本治療的基礎(chǔ)上加用甲氧氯普胺注射液10mg/次,肌注,每日2次;治療組在基本治療的基礎(chǔ)上加用針刺聯(lián)合中藥穴位貼敷,針刺穴以"老十針"加減,手法為平補平瀉,留針20min,1次/日,中藥穴位貼敷以本院自制通腑貼外敷神闕及雙涌泉,外敷4~6小時后取下,1次/日。連續(xù)使用至胃癱緩解,最長療程為21天。觀察并統(tǒng)計兩組患者治療第7、14、21、30天胃癱緩解率、胃液引流量、胃管拔出時間、癥狀積分、體力狀況積分等指標,對比兩組治療效果,進行療效評價,總結(jié)并優(yōu)化腫瘤腹部手術(shù)后胃癱中醫(yī)外治方案。[研究結(jié)果]治療組患者在療效指標數(shù)據(jù)中體現(xiàn)出較好的療效,并且安全性較高。1、胃癱緩解率:在第7、14、21、30天治療組胃癱緩解率均明顯高于對照組,分別是98.11%和 25.49%、98.11%和 60.78%、100.00%和86.27%、100.00%和 90.20%,第 7、14、21 天兩組差異具有顯著統(tǒng)計學(xué)意義(P0.01),第30天兩組差異有統(tǒng)計學(xué)意義(P=0.026)。2、胃癱緩解情況:第7、14、21天治療組胃癱緩解情況優(yōu)于對照組,組間差異有顯著統(tǒng)計學(xué)意義(P≤0.01),第30天組間差異無統(tǒng)計學(xué)意義(P=0.079)。3、胃液引流量:第3天后體現(xiàn)出組間顯著差異,其中治療組患者胃液引流量顯著低于對照組患者(P0.01)。4、以胃管置入為起點的胃管拔除時間,組間差異具有顯著意義(P=0.017),治療組時間較短。以胃癱發(fā)生為起點的胃管拔除時間組間差異無統(tǒng)計學(xué)意義(P=0.298)。5、癥狀積分:在第7、14、21天均體現(xiàn)出顯著差異,治療組患者癥狀評分顯著低于對照組患者(P0.01)。6、體力狀況積分:第7、14、21天均體現(xiàn)出顯著差異,治療組患者癥狀評分顯著高于對照組患者(P0.01)。7、營養(yǎng)指標:僅有鉀離子在第7天體現(xiàn)出組間差異(P=0.004),余指標兩組差異無統(tǒng)計學(xué)意義(P0.05)。8、安全性:本研究中無不良事件報告,主要安全性指標臨床實驗室檢查,包括白細胞、血紅蛋白、血小板、膽紅素、谷丙轉(zhuǎn)氨酶、谷氨酰轉(zhuǎn)肽酶、尿素氮、肌酐,組間差異均未見統(tǒng)計學(xué)意義(P0.05)。[研究結(jié)論]針刺("老十針")配合中藥穴位貼敷(涌泉穴、神闕穴)能明顯提高腫瘤腹部手術(shù)后胃癱綜合征的緩解率,減少患者術(shù)后胃液引流量,縮短胃管留置時間,減輕消化道癥狀,提高患者生活質(zhì)量,且該治療方法安全性較高。
[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.

【學(xué)位授予單位】：北京中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R730.5

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