本文選題：胃腸外科術(shù) + 肛門排氣延遲��； 參考：《四川中醫(yī)》2017年04期

【摘要】：目的:比較不同中醫(yī)方法對胃腸外科術(shù)后肛門排氣延遲患者的干預(yù)效果。方法:收集我院2014年4月2015年8月期間行胃腸外科手術(shù)的94例患者,術(shù)后均伴有肛門排氣延遲(3d)癥狀。抽簽隨機(jī)分為3組并給予不同干預(yù)手段,其中對照組30例僅給予術(shù)后病情監(jiān)護(hù)、切口清潔處理等常規(guī)護(hù)理干預(yù);中醫(yī)干預(yù)1組32例術(shù)后在對照組基礎(chǔ)上給予溫水足浴按摩法,浸泡25min/次,3次/d,浸泡時在足底穴位按摩。中藥干預(yù)2組32例術(shù)后在對照組基礎(chǔ)上給予小茴香熱敷結(jié)合針灸療法干預(yù),30min/次,2次/d;均持續(xù)干預(yù)5d后,觀察3組干預(yù)方法對肛門排氣延遲患者胃腸動力學(xué)[胃動素(MTL)、胃泌素(GAS)、五羥色胺(5—HT)]的影響,記錄兩組腹脹腹痛、惡心嘔吐、低熱等相關(guān)胃腸道癥狀發(fā)生情況,比較干預(yù)后3組肛門排氣時間、排便時間以及干預(yù)前后視覺模擬疼痛(VAS)、生活質(zhì)量(SF—36)變化。結(jié)果:(1)胃動力學(xué)方面:中醫(yī)干預(yù)1、2組干預(yù)后MTL、GAS、5—HT較干預(yù)前均有明顯改善,且MTL、5—HT優(yōu)于對照組,均差異顯著(P0.05),但二組相較無顯著差異(P0.05);(2)胃腸道癥狀:中醫(yī)干預(yù)1、2組相較對照組均能降低胃腸道不良癥狀發(fā)生率,差異顯著(P0.05),但二者相較無顯著差異(P0.05);(3)排氣、排便方面:中醫(yī)干預(yù)1、2組肛門排氣、排便時間均低于對照組,差異顯著(P0.05),但二者相較無顯著差異(P0.05);(4)VAS、SF—36方面:中醫(yī)1、2組干預(yù)后VAS較對照組低,SF—36較對照組高,均差異顯著(P0.05),但中醫(yī)2組VAS較中醫(yī)1組低,差異顯著(P0.05)。結(jié)論:1對胃腸外科術(shù)后肛門排氣延遲患者采用小茴香熱敷結(jié)合針灸療法、溫水足浴按摩干預(yù)方法均能有效改善胃腸動力、促進(jìn)胃腸蠕動,減少胃腸道癥狀,縮短肛門排氣、排便時間,對減輕患者疼痛和改善預(yù)后質(zhì)量效果較為顯著;2小茴香熱敷結(jié)合針灸療法在降低疼痛方面優(yōu)于腸內(nèi)滴注通腑排氣湯,更適用于老年或疼痛不耐受患者。
[Abstract]:Objective: to compare the effect of different TCM methods on delayed anal exhaust after gastrointestinal surgery. Methods: a total of 94 patients underwent gastrointestinal surgery in our hospital from April to August, 2014. All the patients were accompanied with anus exhaust delay for 3 days. Three groups were randomly divided into 3 groups, 30 cases in the control group were treated with routine nursing intervention such as postoperative condition monitoring, incision cleaning treatment and other routine nursing interventions, 32 cases in TCM intervention group 1 received warm water foot bath massage on the basis of the control group, 32 cases in the traditional Chinese medicine intervention group were given warm water foot bath massage on the basis of the control group. Soak 25min/ 3 times / d, immerse in foot massage. 32 cases of Chinese medicine intervention group were treated with fennel hot compress combined with acupuncture and moxibustion therapy for 30 mins / twice / d after operation on the basis of control group, all of them were treated continuously for 5 days. The effects of three intervention methods on gastrointestinal motility [motilin, gastrin GASA, serotonin 5-HT] in patients with anus exhaust delay were observed, and the incidence of gastrointestinal symptoms such as abdominal distention, nausea and vomiting, low fever and other related gastrointestinal symptoms were recorded in the two groups. The anus exhaust time, defecation time, visual analogue pain and quality of life (QOL) were compared before and after intervention. Results (1) in terms of gastric dynamics, MTL GAS-5-HT was significantly improved after TCM intervention in both groups, and MTL 5-HT was better than that in control group. There was no significant difference in gastrointestinal symptoms between the two groups. The incidence of adverse gastrointestinal symptoms was significantly decreased in group 1 and 2 compared with that in control group, but there was no significant difference between the two groups in the incidence of adverse gastrointestinal symptoms, but no significant difference between the two groups in the incidence of adverse gastrointestinal symptoms (P0. 05%) and exhaust gas (P 0. 05%) in the control group (P 0. 05), but there was no significant difference between the two groups (P 0. 05, P 0. 05). Defecation: the anal exhaust and defecation time of group 1 and 2 were significantly lower than that of control group (P 0.05), but there was no significant difference between the two groups in the aspect of VASA SF-36: the VAS of group 1 and 2 was lower than that of control group (P 0.05), and the time of defecation was higher than that of control group (P < 0.05). The VAS of TCM group 2 was lower than that of TCM group 1, and the difference was significant (P 0.05). Conclusion the combination of fennel hot compress with acupuncture and moxibustion and warm water foot bath massage can effectively improve gastrointestinal motility, promote gastrointestinal peristalsis, reduce gastrointestinal symptoms and shorten anal exhaust in patients with delayed anal exhaust after gastrointestinal surgery. The effect of defecation time on relieving pain and improving the quality of prognosis was obvious. 2 the combination of fennel hot compress and acupuncture therapy was better than enteral infusion of Tongfu and exhaust decoction in reducing pain, which was more suitable for elderly patients or patients with pain intolerance.
【作者單位】： 德陽市第二人民醫(yī)院;四川大學(xué)華西醫(yī)院;
【分類號】：R248.2

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