本文選題：快速康復 + 電針　； 參考：《廣州中醫(yī)藥大學》2017年碩士論文

【摘要】：目的:基于快速康復理念下,對肝外膽道結(jié)石行微創(chuàng)治療的患者術后進行電針足三里、上巨虛配合吳茱萸熱熨腹部治療,觀察其術后胃腸功能恢復情況及安全性指標,術后胃腸恢復情況包括術后肛門首次排氣、排便時間及恢復全流飲食時間等主要指標,然后進行系統(tǒng)評價,探討針藥治療在快速康復外科中的臨床意義,為臨床應用中醫(yī)特色外治法治療術后胃腸功能障礙加快術后康復提供依據(jù)。方法:選取2016年1月至2016年12月至廣州中醫(yī)藥大學第一附屬醫(yī)院肝膽外科(三外科)收治住院治療,診斷為肝外膽道結(jié)石(即膽囊結(jié)石或膽囊結(jié)石并膽總管結(jié)石)并行微創(chuàng)手術治療的患者,運用簡單隨機法分為實驗組(電針足三里、上巨虛聯(lián)合吳茱萸熱熨組)30例,對照組(常規(guī)基礎治療組)30例。圍手術期均運用快速康復理念:術前均采取術前宣教、縮短禁食禁飲時間、無需腸道準備等措施;術后對照組給予常規(guī)基礎治療,主要包括:肝膽外科術后常規(guī)護理、抗生素使用,護肝,護胃,常規(guī)補液營養(yǎng)支持,維持水電解質(zhì)平衡等。實驗組在對照組治療的基礎上加電針足三里、上巨虛聯(lián)合吳茱萸熱熨腹部治療。觀察并記錄兩組患者術后胃腸功能恢復相關指標及安全性指標,結(jié)合臨床觀察量表收集數(shù)據(jù),對兩組所得數(shù)據(jù)進行統(tǒng)計、分析并總結(jié),驗證針藥聯(lián)合治療對肝外膽道結(jié)石微創(chuàng)手術患者術后胃腸功能的療效。結(jié)果:1.兩組數(shù)據(jù)一般情況及手術相關資料比較:統(tǒng)計學意義上,實驗組和對照組之間無差異;2.兩組數(shù)據(jù)術后胃腸功能恢復比較:較之對照組患者,實驗組患者術后首次排氣排便時間、恢復全流飲食時間明顯縮短,且差異有統(tǒng)計學意義(P0.05);實驗組患者住院天數(shù)及術后住院天數(shù)均有所縮短,但差異不具有統(tǒng)計學意義(P0.05)。3.兩組數(shù)據(jù)安全性評價:兩組均未發(fā)生圍手術期死亡或麻醉及心血管意外事件,無不良反應出現(xiàn)。在術前1天,術后第1、3天進行血常規(guī)、肝功能、腎功能、電解質(zhì)檢測,比較白細胞總數(shù)(WBC)、中性粒細胞百分比(NEUT%)等血常規(guī)主要指標;谷丙轉(zhuǎn)氨酶(ALT)、谷草轉(zhuǎn)氨酶(AST)、總膽紅素(TB)等肝功能主要指標,肌酐(CR)等腎功能指標;鉀離子(K+)等電解質(zhì)主要指標,結(jié)果顯示P0.05,兩組間比較無明顯差異。4.經(jīng)t檢驗、方差分析及卡方檢驗,實驗組與對照組相比較,實驗組在促進腹部術后胃腸功能恢復方面優(yōu)于對照組。結(jié)論:電針足三里、上巨虛聯(lián)合吳茱萸熱熨腹部治療肝外膽石癥微創(chuàng)手術治療安全可靠,且在改善患者術后胃腸功能有積極作用,并在一定程度上可改善患者術后胃腸癥狀。
[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.
【學位授予單位】：廣州中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R657.4

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本文編號：2016384