多穴位针刺治疗促进结直肠癌患者术后胃肠功能恢复的前瞻性随机对照研究

Multi-point acupuncture treatment to promote postoperative gastrointestinal function recovery in colorectal cancer patients:a prospective randomized controlled study

背景与目的:促进胃肠道功能恢复是结直肠癌(CRC)术后加速康复外科(ERAS)的关键环节之一,而许多中医古籍记载,针刺足三里、上巨虚、三阴交、内关穴四穴有助于促进胃肠道蠕动,但目前尚无多穴位针刺治疗促进CRC患者术后胃肠功能恢复系统研究。因此,本研究通过前瞻性研究评价多穴位针刺治疗促进CRC患者术后胃肠功能恢复的临床疗效,以期为临床在CRC患者中开展ERAS提供新的选择。方法:采用前瞻性随机对照设计,将2021年1月—2022年2月期间于中南大学湘雅三医院胃肠外科行腹腔镜CRC根治性手术的100例符合标准的患者随机分为观察组和对照组,每组50例。两组患者围手术期予以相同ERAS方案处理并进行根治性手术,观察组术后接受穴位针刺治疗,从手术当天至术后第3天,1次/d;对照组不施加穴位针刺。主要观察指标包括患者肠鸣音恢复时间、首次排气时间、首次排便时间;次要观察指标包括腹痛评分、腹胀发生率、恶心呕吐发生率,白细胞计数、中性粒细胞百分比、C-反应蛋白、血红蛋白、血清白蛋白、血钾浓度、术后住院时间及术后并发症发生率。结果:共有96例患者完成了研究,每组各48例。两组的年龄、性别、手术时间等基线资料差异无统计学意义(均P>0.05)。与对照组比较,观察组的肠鸣音恢复时间、首次排气时间、首次排便时间、术后住院时间明显缩短(均P<0.05),术后第2、3天腹痛评分,术后第1、2天腹胀的发生率,术后第3天恶心呕吐发生率降低(均P<0.05)。两组间剩余的比较差异均无统计学意义(均P>0.05)。结论:多穴位针刺治疗可以促进CRC微创手术患者术后胃肠道功能的恢复且不增加术后并发症,推荐纳入ERAS常规操作。

Background and aims:Promoting gastrointestinal function recovery is one of the key aspects of enhanced recovery after surgery(ERAS)for colorectal cancer(CRC).Many ancient Chinese medical texts suggest that acupuncture at four acupoints—Zusanli,Shangjuxu,Sanyinjiao,and Neiguan—helps promote gastrointestinal peristalsis.However,there is currently no systematic study on multi-point acupuncture to promote postoperative gastrointestinal function recovery in CRC patients.Therefore,this study was conducted to evaluate the clinical efficacy of multi-point acupuncture in promoting gastrointestinal function recovery in CRC patients through a prospective study to provide new options for implementing ERAS in CRC patients in clinical practice.Methods:Using a prospective,randomized,controlled design,a total of 100 eligible patients who underwent laparoscopic CRC radical surgery at the Department of Gastrointestinal Surgery,Third Xiangya Hospital of Central South University,between January 2021 and February 2022,were randomly divided into an observation group and a control group,with 50 patients in each group.Both groups underwent the same ERAS protocols and radical surgery during the perioperative period.The observation group received acupuncture treatment from the day of surgery to the third postoperative day,once per day,while the control group did not receive acupuncture.Primary outcomes included the time to bowel sound recovery,time to first flatus,and time to first defecation.Secondary outcomes included abdominal pain scores,incidence of bloating,nausea,vomiting,white blood cell count,neutrophil percentage,C-reactive protein,hemoglobin,serum albumin,blood potassium levels,postoperative hospital stay,and incidence of postoperative complications.Results:A total of 96 patients completed the study,with 48 in each group.There were no statistically significant differences in baseline characteristics such as age,gender,or surgery time between the two groups(all P>0.05).Compared with the control group,the observation group had a significantly shorter time for bowel sound recovery,first flatus,first defecation,and postoperative hospital stay(all P<0.05).Additionally,the observation group showed reduced abdominal pain scores on postoperative day(POD)2 and 3,a lower incidence of bloating on POD 1 and 2,and a reduced incidence of nausea and vomiting on POD 3(all P<0.05).There were no statistically significant differences in the remaining comparisons between the two groups(all P>0.05).Conclusion:Multi-point acupuncture treatment can promote the recovery of gastrointestinal function in patients undergoing minimally invasive CRC surgery without increasing postoperative complications,and it is recommended for integration into routine ERAS protocols.