本文選題：針刺 + 腹部術(shù)后��； 參考：《廣州中醫(yī)藥大學(xué)》2016年碩士論文

【摘要】：背景胃腸動(dòng)力功能紊亂是外科腹腔手術(shù)后常見(jiàn)的并發(fā)癥,隨著病情進(jìn)展,可能會(huì)引起腸麻痹、腸梗阻、腸粘連等并發(fā)癥,嚴(yán)重者可引起全身性多器官功能障礙(multiple organdisfunction syndrome, MODS),甚至多器官功能衰竭(multiple organ failure,MOF)。髓過(guò)氧化物酶(MPO),MPO不僅能特異性地標(biāo)記中性粒細(xì)胞,而且能夠較好的反應(yīng)中性粒細(xì)胞活性。在腸道急性炎癥發(fā)生時(shí),MPO作為炎癥介質(zhì)參與MPO能直接參與炎癥反應(yīng)。國(guó)內(nèi)已有學(xué)者研究表明,MPO活性的表達(dá)與腸道炎癥的嚴(yán)重程度呈正相關(guān)。已有研究證實(shí)針刺治療能改善患者術(shù)后的結(jié)腸轉(zhuǎn)運(yùn)時(shí)間(colonic transit time,CTT),調(diào)節(jié)胃動(dòng)素、胃泌素等多種胃腸激素和細(xì)胞因子水平,從而改善胃腸動(dòng)力障礙,減少炎癥因子的產(chǎn)生,減輕術(shù)后腸道的炎癥反應(yīng)。但針刺在調(diào)控外科術(shù)后胃腸動(dòng)力功能紊亂-減輕并發(fā)癥發(fā)病率方面的機(jī)制仍不十分明確。基于祖國(guó)醫(yī)學(xué)“肚腹三里留”、“合治內(nèi)腑”的理論,本研究通過(guò)制造腹腔結(jié)腸吻合術(shù)大鼠模型,觀察針刺對(duì)大鼠腸道cajal細(xì)胞修復(fù)的影響,探究針刺改善胃腸功能障礙,防治術(shù)后胃腸動(dòng)力功能紊亂,是本實(shí)驗(yàn)研究目的。目的采用靳三針組穴中的“足三針”遠(yuǎn)部取穴治療腹腔結(jié)腸吻合術(shù)大鼠模型術(shù)后胃腸運(yùn)動(dòng)功能紊亂的實(shí)驗(yàn)研究,觀察針刺對(duì)術(shù)后結(jié)腸ICCs修復(fù)微環(huán)境中MPO表達(dá)的影響,旨在從胃腸Cajal細(xì)胞微環(huán)境MPO表達(dá)著手研究針刺足三針調(diào)整外科術(shù)后胃腸功能紊亂的的相關(guān)機(jī)制。方法將由廣州中醫(yī)藥大學(xué)實(shí)驗(yàn)動(dòng)物中心提供的雌雄各半,健康的SPF級(jí)成年SD大鼠30只按隨機(jī)數(shù)字表法平均分成3組。除正常組10只以外,其余大鼠均需造模,行腹腔結(jié)腸吻合術(shù),造模成功后,隨機(jī)將造模成功的大鼠分為針刺組和模型組,針刺組大鼠每日給予針刺足三針穴組,每日針刺1次,每次15min。模型組和正常組每天同一時(shí)間行空抓15min,降低人為固定的影響因素。從造模成功第二天開(kāi)始每天對(duì)各大鼠的排便粒數(shù)進(jìn)行記錄并收集大便,待實(shí)驗(yàn)日期到期后,統(tǒng)一稱(chēng)重并作記錄。術(shù)后3d灌墨汁后處死大鼠,觀察并計(jì)算小腸推進(jìn)率,取結(jié)腸組織按南京建成公司生產(chǎn)的酶聯(lián)免疫分析(ELISA)試劑盒說(shuō)明檢測(cè)結(jié)腸組織的MPO表達(dá),記錄數(shù)據(jù)。結(jié)果1.①首次排便時(shí)間：通過(guò)對(duì)比模型組與針刺組的首次排便時(shí)間得出,針刺組術(shù)后首次排便時(shí)間明顯優(yōu)于模型組。②術(shù)后大鼠排便粒數(shù)變化：術(shù)后第一至三天排便粒數(shù)模型組與正常組、針刺組與正常組均有顯著性差異(P＜0.01)。針刺組與模型組比較,術(shù)后第一天即出現(xiàn)顯著性差異(P＜0.05)。2.針刺組大鼠的小腸推進(jìn)率較模型組大鼠明顯提高。3.針刺組大鼠的結(jié)腸組織中的MPO表達(dá)水平較模型組大鼠明顯降低(P＜0.05)。結(jié)論1.針刺足三針能有效提高結(jié)腸吻合術(shù)模型大鼠的小腸推進(jìn)率,改善其小腸運(yùn)動(dòng)功能。2.針刺足三針可有效減輕結(jié)腸吻合術(shù)模型大鼠腸道炎癥反應(yīng),從而降低其結(jié)腸組織中MPO的活性。
[Abstract]:Background Gastrointestinal motility disorder is a common complication after abdominal surgery. As the disease progresses, it may lead to intestinal paralysis, intestinal obstruction, intestinal adhesion and other complications.Severe multiple organ dysfunction may cause multiple organdisfunction syndromes, mods, and even multiple organ failure.Myeloperoxidase (MPO) MPO can not only specifically label neutrophils, but also react to neutrophil activity.MPO, as an inflammatory mediator, is involved in the inflammatory response of MPO directly during the occurrence of acute inflammation in the intestine.There is a positive correlation between the expression of MPO and the severity of intestinal inflammation.It has been proved that acupuncture can improve the colonic transit time after operation, regulate the levels of motilin, gastrin and other gastrointestinal hormones and cytokines, thus improve gastrointestinal motility disorder and reduce the production of inflammatory factors.Reduce postoperative intestinal inflammation.However, the mechanism of acupuncture in regulating gastrointestinal motility disorder-reducing the incidence of complications after surgery is still unclear.Based on the theory of "three li of abdominal cavity" and "treatment of internal organs" in traditional Chinese medicine, this study observed the effect of acupuncture on the repair of intestinal cajal cells in rats by making a rat model of celiac colonic anastomosis, and explored the improvement of gastrointestinal dysfunction by acupuncture.Prevention and treatment of postoperative gastrointestinal motility disorder is the purpose of this experiment.Objective to observe the effect of acupuncture on the expression of MPO in the microenvironment of colon ICCs repair after abdominal colon anastomosis in rats with abdominal colonic anastomosis by using "foot three acupuncture" in the distal part of Jin's three-needle group to treat the gastrointestinal motility disorder after abdominal colon anastomosis, and to observe the effect of acupuncture on the expression of MPO in the microenvironment of colon ICCs repair after operation.The aim of this study was to investigate the mechanism of gastrointestinal dysfunction after three-needle acupuncture in gastrointestinal Cajal microenvironment.Methods 30 healthy adult SD rats of SPF grade were divided into 3 groups according to the random digital table method, which were provided by the Experimental Animal Center of Guangzhou University of traditional Chinese Medicine.15 minutes at a time.The model group and the normal group were subjected to 15 minutes of air capture at the same time every day to reduce the influence factors of artificial fixation.The defecation grains of each rat were recorded and collected every day from the second day after the successful establishment of the model. After the experimental date expired, the rats were weighed and recorded uniformly.After 3 days of operation, the rats were sacrificed and the intestinal propelling rate was observed and calculated. The colonic tissues were examined for the expression of MPO and recorded according to the Elisa kit produced by Nanjing Chengzheng Company.Results 1.1 the first defecation time was obtained by comparing the first defecation time between the model group and the acupuncture group.The first defecation time in the acupuncture group was significantly better than that in the model group (P < 0.01). The number of defecation grains in the model group was significantly different from that in the normal group and that in the acupuncture group and the normal group on the first to third day after operation (P < 0.01).There was a significant difference between the acupuncture group and the model group on the first day after operation (P < 0.05).The propelling rate of small intestine in acupuncture group was significantly higher than that in model group.The expression of MPO in colon of acupuncture group was significantly lower than that of model group (P < 0.05).Conclusion 1.Acupuncture of foot three needles can effectively improve the intestinal propulsion rate and improve the small intestinal motor function of colon anastomosis model rats.Acupuncture of foot three-needle can effectively reduce the inflammatory reaction of intestinal tract and decrease the activity of MPO in colonic tissue of colonic anastomosis rats.
【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】：2016
【分類(lèi)號(hào)】：R245

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