肝切除术后早期运用吴茱萸热熨腹部对门静脉血流动力学的影响

Impacts of Early Application of Abdominal Hot Compressing with Fructus Evodiae on Portal Vein Hematodynamics in Post-hepatectomy Patients

【目的】探讨肝切除术后患者早期运用吴茱萸热熨腹部对门静脉血流动力学的影响。【方法】将90例行肝切除术患者随机分为治疗组、阳性对照组和基础治疗组,每组各30例。基础治疗组术后仅给予西医常规基础治疗,治疗组术后在基础治疗的同时给予吴茱萸+粗盐热熨腹部治疗,阳性对照组术后在基础治疗的同时给予粗盐热熨腹部治疗,疗程为7 d。观察3组患者在肝切除术前及术后1、3、5、7 d的门静脉内径、血流速度、血流量及血清谷草转氨酶(AST)、谷丙转氨酶(ALT)水平的变化情况。【结果】与术前比较,术后1 d,3组患者的门静脉内径均明显缩小,血流速度均明显下降,血流量均明显减少,血清ALT和AST水平均明显升高,差异均有统计学意义(P<0.01),但组间比较,差异均无统计学意义(P>0.05);术后3、5、7 d,3组患者的门静脉内径、血流速度和血流量均较术后1 d增加(P<0.01),血清ALT和AST水平均较术后1 d降低(P<0.01),且随着治疗天数的增加,门静脉内径、血流速度和血流量呈增大趋势,血清ALT和AST水平呈下降趋势,至术后7 d,3组患者的门静脉内径、血流速度、血流量及血清ALT和AST水平均已恢复至术前水平,差异均无统计学意义(P>0.05)。组间比较,术后3 d,治疗组的门静脉内径、血流速度和血流量均大于阳性对照组和基础治疗组(P<0.01);术后5 d,治疗组和阳性对照组的门静脉血流速度和血流量均大于基础治疗组(P<0.01);术后7 d,3组患者的门静脉内径、血流速度和血流量比较,差异均无统计学意义(P>0.05)。而3组间各观察时点的血清ALT和AST水平比较,差异均无统计学意义(P>0.05)。【结论】肝切除术后早期运用吴茱萸热熨腹部的中医外治法治疗,可增加门静脉的血流量,加快门静脉的血流速度,从而促进肝脏功能恢复,对肝切除术后患者的快速康复具有积极的作用。

Objective To investigate the impacts of early application of abdominal hot compressing with Fructus Evodiae on portal vein hematodynamics in post-hepatectomy patients. Methods Ninety patients undergoing hepatectomy were randomly divided into treatment group,positive control group and basic treatment group,with30 cases in each group. The basic treatment group was given conventional basic western medicine treatment after surgery,the treatment group was given abdominal hot compressing with Fructus Evodiae and crude salt plus the basic treatment,and the positive control group was given abdominal hot compressing with crude salt plus the basis treatment. The treatment course for the 3 groups covered 7 days. Before the surgery and 1,3, 5,7 day(s)after hepatectomy, the levels of portal vein diameter, blood flow velocity, blood flow volume and serum aspartate transaminase(AST)and alanine transaminase(ALT)levels in the 3 groups were observed. Results Compared with pre-operation,portal vein diameter,blood flow velocity,and blood flow volume were significantly reduced,and serum ALT and AST levels were significantly increased in all of the 3 groups one day after operation,and the differences were statistically significant(P< 0.01),but there was no significant difference among the 3 groups(P > 0.05). In comparison with one day after surgery,the portal vein diameter,blood flow velocity and blood flow volume in the 3 groups on postoperative day 3,5 and 7 were increased(P< 0.01),and the serum ALT and AST levels were decreased(P< 0.01). With the increase of treatment days, the portal vein diameter, blood flow velocity and blood flow volume tended to increase,and the serum ALT and AST levels showed a downward trend.The portal vein diameter,blood flow velocity,blood flow volume,and serum ALT and AST levels of the 3 groups all recovered to the preoperative level 7 days after operation,the differences being no statistical significance(P >0.05). The results of intergroup comparison were as follows: 3 days after operation,the portal vein diameter,blood flow velocity and blood flow volume in the treatment group were all higher than those in the positive control group and the basic treatment group(P< 0.01);5 days after surgery,the portal vein blood flow velocity and blood flow volume in the treatment group and the positive control group were both higher than those in the basic treatment group(P< 0.01);7 days after operation,there were no significant differences in portal vein diameter,blood flow velocity and blood flow volume among the 3 groups(P > 0.05);there was no significant difference in serum ALT and AST levels among the 3 groups at various observation time points(P > 0.05). Conclusion Early application of abdominal hot compressing with Fructus Evodiae in the post-hepatectomy patients can increase the blood flow volume and accelerate the blood flow velocity of the portal vein so as to promote the recovery of liver function,which has a positive effect on the rapid recovery of patients after hepatectomy.