【摘要】：目的:隨著現(xiàn)代醫(yī)學(xué)和外科手術(shù)技術(shù)的發(fā)展,腹部手術(shù)日益增多,術(shù)后胃腸功能障礙也越來(lái)越受到人們的關(guān)注與重視。近年來(lái),預(yù)防與治療腹部術(shù)后胃腸功能障礙的方法研究逐漸增多,均取得一定的臨床效果,但各有利弊。本研究通過(guò)觀察中藥敷臍對(duì)腹部術(shù)后腹脹、腸鳴音恢復(fù)、排氣排便時(shí)間、惡心嘔吐等指標(biāo)的影響,客觀評(píng)價(jià)本治療方法對(duì)胃腸功能障礙的預(yù)防作用,旨在為本病的臨床治療探索一種便捷可行的中醫(yī)治療方案。方法:選取于2016年5月-2017年2月在廣州中醫(yī)藥大學(xué)深圳醫(yī)院普外科住院治療,符合納入標(biāo)準(zhǔn)的腹部術(shù)后患者,共85例。將所有患者隨機(jī)分為治療組(中藥敷臍組)43例和對(duì)照組(術(shù)后常規(guī)治療組)42例。治療組在對(duì)照組的基礎(chǔ)上于術(shù)后12小時(shí)后予臍部中藥貼敷,每12小時(shí)貼敷一次,每次貼敷半個(gè)小時(shí),連續(xù)貼敷3天,3天后未排氣者終止治療。對(duì)照組予腹部術(shù)后臨床常規(guī)治療(禁食禁水、吸氧、心電監(jiān)測(cè)、胃腸減壓、抗感染治療、常規(guī)補(bǔ)液、補(bǔ)充水電解質(zhì)、維持酸堿平衡、營(yíng)養(yǎng)支持、抑酸護(hù)胃、止痛等,重癥患者予全胃腸外營(yíng)養(yǎng)等,鼓勵(lì)患者早期下床活動(dòng))。記錄兩組患者術(shù)畢12小時(shí)后每6h的腹部癥狀及體征,包括排氣時(shí)間、排便時(shí)間、腸鳴音恢復(fù)時(shí)間、惡心嘔吐、腹脹情況、住院天數(shù)等,所有患者均觀察5天,并對(duì)相關(guān)術(shù)后情況進(jìn)行評(píng)分,采用SPSS22.0軟件進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果:經(jīng)統(tǒng)計(jì)學(xué)分析,兩組患者術(shù)前一般資料(性別、年齡、發(fā)病時(shí)間、麻醉方式、手術(shù)方式、手術(shù)時(shí)長(zhǎng)、術(shù)中出血量)無(wú)明顯統(tǒng)計(jì)學(xué)意義(P0.05)。經(jīng)治療后分析,治療組術(shù)后腸鳴音恢復(fù)時(shí)間為(39.88±3.86)h,對(duì)照組術(shù)后腸鳴音恢復(fù)時(shí)間為(46.57±4.33)h,兩組術(shù)后腸鳴音恢復(fù)時(shí)間有明顯統(tǒng)計(jì)學(xué)意義(P0.05)。治療組患者術(shù)后首次排氣時(shí)間為(38.40±4.10)h,首次排便時(shí)間(63.49±4.53)h,對(duì)照組術(shù)后首次排氣時(shí)間為(51.05±4.66)h,首次排便時(shí)間為(79.02±6.01)h,經(jīng)t檢驗(yàn),兩組患者此兩項(xiàng)指標(biāo)均有統(tǒng)計(jì)學(xué)意義(P0.05)。在住院時(shí)間方面,治療組為(6.95±1.11)天,對(duì)照組為(7.43± 1.11)天,經(jīng)t檢驗(yàn),兩組無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。分別分析患者術(shù)后第2天,術(shù)后第3天,術(shù)后第5天腹脹評(píng)分,經(jīng)t檢驗(yàn),兩組患者在術(shù)后第2天有統(tǒng)計(jì)學(xué)意義(P0.05),術(shù)后第3、5天無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。比較兩組患者術(shù)后惡心嘔吐、腸鳴音評(píng)分,在術(shù)后第1、2天,兩組兩項(xiàng)指標(biāo)均有統(tǒng)計(jì)學(xué)意義(P0.05),在術(shù)后第3、5天,兩組兩項(xiàng)指標(biāo)均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:中藥敷臍能明顯緩解腹部術(shù)后患者腹脹及惡心嘔吐情況,促進(jìn)腸鳴音恢復(fù)及排氣排便,對(duì)腹部術(shù)后胃腸功能障礙有明顯的預(yù)防作用,是一種簡(jiǎn)便廉效的治療方法,值得臨床推廣使用。
[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 鹵3.86) h in the treatment group and (46.57 鹵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 鹵4.10) h and (63.49 鹵4.53) h respectively in the treatment group and (51.05 鹵4.66) h in the control group, and (79.02 鹵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 鹵1.11) days, the control group was (7.43 鹵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.
【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R656

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