發(fā)布時間：2018-12-16 21:47

【摘要】：目的：在香檳方動物實驗的基礎上,研究臨床腰椎術后患者內服香檳方后腹脹痛、腸鳴音、肛門排氣排便以及惡心嘔吐的變化情況,闡明香檳方對腰椎術后胃腸功能恢復的影響,為發(fā)揮中藥在腰椎圍手術期的特色與優(yōu)勢,為脊柱術后患者快速康復研究奠定基礎。方法：收集廣東省中醫(yī)院住院部單、雙節(jié)段腰椎融合術患者60例,按隨機數字表,隨機分為兩組,分別為實驗組、對照組,每組各30例,術前1天記錄所有患者腹痛腹脹、排氣排便及腸鳴音等情況,術后第1天兩組開始給藥,在術后常規(guī)治療基礎上,實驗組服用中藥香檳方(檳榔10g、人參9g、烏藥10g、砂仁6g、桃仁l0g)治療；對照組服用安慰劑,直至術后第7天。每日1劑,分別在早上9：00、下午16：00服用。分別在術后6h(17：00-1：00)、術后第1天(1：00-9：00)、術后第1天(9：00-17：00)、術后第1天(17：00-1：00)、術后第2天(1：00-9：00)、術后第2天(9：00-17：00)、術后第2天(17：00-1：00)、術后第3天、術后第4天、術后第5天、術后第6天、術后第7天記錄腸鳴音活動情況,記錄術后肛門首次排氣及術后首次排便時間；記錄術后腹脹、惡心嘔吐等胃腸道變化情況,并通過圍手術期術后胃腸功能評價標準量表評價,建立數據,用統(tǒng)計SPSS13.0數據軟件對數據進行處理。結果：1.術后腸鳴音恢復時間兩組平均值分別為17.99h和25.12h,差異具有統(tǒng)計學意義。(p=0.000,p0.01)；2.術后首次排氣時間兩組平均值分別為16.87h和20.42h,差異具有統(tǒng)計學意義。(p=0.049,p0.05)；3.術后首次排便時間兩組平均值分別為60.26h和75.7h,差異具有統(tǒng)計學意義。(p=0.002,p0.01)；4.根據圍手術期術后胃腸功能評價標準量表,實驗組在術后第一天(9：00～17：00)至術后第7天在各個時間段的平均得分均高于對照組,兩者差異具有統(tǒng)計學意義,即p0.01,其中實驗組在術后第1天(9：00～17：00)、(17：00～1：00)以及術后第2天(1：00-9：00)三個時間段里,實驗組平均得分都介于60～79分之間,對照組平均得分都低于60分,實驗組平均得分比對照組高,且兩組差異有統(tǒng)計學意義(P0.01)；在術后第2天(9：00～17：00),實驗組平均得分高于80分,對照組平均得分仍低于60分,兩組有明顯差異,具有統(tǒng)計學意義(P0.01)；在術后第2天(17：00～1：00)到術后第4天,實驗組平均得分高于對照組,對照組仍低于60分,兩組差異明顯且有統(tǒng)計學意義(P0.01)；在術后第5天,實驗組平均得分高于對照組,實驗組平均得分高于90分,對照組平均得分介于60～79之間,兩組有差異且有統(tǒng)計學意義(P0.01)；在術后第6、7天,實驗組平均得分高于對照組,實驗組平均得分高于90分,對照組平均得分高于80分,兩者有差異且有統(tǒng)計學意義(P0.01)。5.所有患者經全程治療后,均未出現頭痛、頭暈、皮疹等不良事件。結論：香檳方能促使腰椎融合術患者術后腸鳴音恢復、提早肛門排氣及排便時間,總體臨床療效良好,值得推廣。
[Abstract]:Objective: to study the changes of abdominal distension pain, bowel sound, anal exhaust and defecation, nausea and vomiting in patients after lumbar vertebrae operation on the basis of animal experiment of Champagne Fang. To clarify the effect of Champagne recipe on the recovery of gastrointestinal function after lumbar vertebra operation, to give full play to the characteristics and advantages of traditional Chinese medicine in the perioperative period of lumbar vertebrae, and to lay a foundation for the study of rapid rehabilitation of patients after spinal surgery. Methods: sixty patients with single and double segmental lumbar fusion in Guangdong traditional Chinese Medicine Hospital were randomly divided into two groups: experimental group (n = 30) and control group (n = 30). Abdominal pain and abdominal distension were recorded one day before operation. On the first day after operation, the two groups were given drugs. On the basis of routine treatment, the experimental group was treated with Champagne prescription (areca nut 10g, ginseng 9g, black medicine 10g, Amomum villosum 6g, peach kernel 10g). The control group was given placebo until 7 days after operation. Take one dose a day at 9: 00 in the morning and 16:00 in the afternoon. At 6 hours (17: 00-1: 00), on the first day (1: 00-9: 00), on the first day (9: 00-17: 00), on the first day (17: 00-1: 00), on the second day (1: 00-9: 00), The second day (9: 00-17: 00), the second day (17: 00-1: 00), the third day, the fourth day, the fifth day, the sixth day and the seventh day after the operation were recorded. The first exsufflation of anus and the time of first defecation after operation were recorded. The changes of gastrointestinal tract such as abdominal distension, nausea and vomiting were recorded, and the data were established by using the perioperative gastrointestinal function evaluation scale. The data were processed by statistical SPSS13.0 data software. Results: 1. The average recovery time of postoperative bowel sounds was 17.99 h and 25.12 h, respectively, the difference was statistically significant (p0. 000 / p0.01); 2. The mean of the first time after operation was 16.87 h and 20.42 h, respectively. The difference was statistically significant (p0.049, p0.05). The mean of the first defecation time was 60.26 h and 75.7 h, respectively, the difference was statistically significant (p0. 002 / p0.01); 4. According to the evaluation scale of postoperative gastrointestinal function in perioperative period, the average scores of the experimental group were higher than those of the control group from the first day (9: 00: 17: 00) to the 7th day after operation, and the difference was statistically significant. That is, p0.01. In the experimental group, the average score of the experimental group in the first day (9: 00: 00), (17: 00 1: 00) and the second day after operation (1: 00-9: 00) was between 6079 and 6079. The average score of the control group was lower than that of the control group, and the average score of the experimental group was higher than that of the control group, and the difference between the two groups was statistically significant (P0.01). On the second day after operation (9: 00 17: 00), the average score of the experimental group was higher than 80 points, while the average score of the control group was still lower than 60 points. There was a significant difference between the two groups (P0.01). From the second day after operation (17: 00 1: 00) to the fourth day after operation, the average score of the experimental group was higher than that of the control group, and the control group was still lower than 60 points. The difference between the two groups was significant (P0.01). On the 5th day after operation, the average score of the experimental group was higher than that of the control group, the average score of the experimental group was more than 90 points, and the average score of the control group was between 600.79. The difference between the two groups was statistically significant (P0.01). On the 6th day after operation, the average score of the experimental group was higher than that of the control group, the average score of the experimental group was more than 90 points, and the average score of the control group was higher than 80 points, the difference was statistically significant (P0.01). There were no adverse events such as headache, dizziness, rash and so on. Conclusion: Champagne prescription can promote the recovery of bowel sound and the time of anal exhaust and defecation in patients with lumbar fusion. The overall clinical effect is good and worth popularizing.
【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】：2016
【分類號】：R274.9

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