针药并用外治法治疗消化道肿瘤术后胃瘫的疗效观察

Efficacy of acupuncture combined with Chinese medicine for postoperative gastroparesis in patients with gastrointestinal cancer

目的探讨针药并用外治法治疗消化道肿瘤术后胃瘫患者的临床疗效。方法选取2013年8月至2016年8月间首都医科大学附属北京中医医院及中国医学科学院肿瘤医院收治的106例消化道肿瘤术后胃瘫患者,采用前瞻性和随机对照的研究设计,采用随机数表法进行随机分组,用不透光的信封进行分配隐藏,将患者分为治疗组和对照组。治疗组患者在基本治疗的基础上加用针刺联合中药穴位贴敷。对照组患者在基本治疗的基础上加用甲氧氯普胺注射液肌内注射。连续使用至胃瘫缓解,最长疗程为21天。观察胃瘫缓解率、症状积分、胃液引流量、胃管拔出时间及体力状态得分。结果在干预第1周、第2周和第3周治疗组患者胃瘫缓解痊愈率和有效率均高于对照组,组间比较差异均有统计学意义(均P<0.01)。第2周、第3周和第4周时,治疗组患者胃瘫症状积分总分低于对照组患者,组间比较差异均有统计学意义(均P<0.01)。治疗后第3、5、7、9、14及21天时,治疗组患者的胃液引流量均低于对照组患者,两组比较差异均有统计学意义(均P<0.01)。治疗组患者的胃管拔除时间低于对照组患者,组间比较差异有统计学意义(P<0.05)。治疗第2周、第3周和第4周,治疗组患者体力状况评分高于对照组患者,差异有统计学意义(P<0.01)。结论针药并用外治法可改善消化道肿瘤术后胃瘫患者术后消化道症状,减少胃液引流量。

Objective To observe the clinical efficacy of acupuncture combined with Chinese med- icine for postoperative gastroparesis in patients with gastrointestinal cancer. Methods With prospective and random control research design, 106 patients with gastroparesis after operation for gastrointestinal cancer were enrolled at Beijing＇s Traditional Chinese Medicine Hospital Affiliated to Capital Medical University and Cancer Hospital, Chinese Academy of Medical Sciences from August 2013 to August 2016. Using a random number table, patients were divided into a treatment group and a control group. Patients in the treatment group were given acupuncture combined with acupoint herbal application based on the routine treatment and patients in the control group received metoelopramide injection based on the routine treatment. The treat- ment was continued until the remission was achieved. Remission rate, symptom accumulated scores, gastricfluid drainage volume, time to extubation and physical condition score were observed. Results Remission rates and efficacy rates at 1-week, 2-week and 3-week were significantly higher in the treatment group than in the control group （ all P 〈 0. 01 ）. The overall symptom accumulated scores at 2-week, 3-week and 4- week were significantly lower in the treatment group than in the control group （ all P 〈 0. 01 ）. Gastric fluid drainage volume was significantly lower in the treatment group than in the control group at 3, 5, 7, 9, 14 and 21 d （P 〈 0.01 ）. Time to extubation was significantly lower in the treatment group than in the control group （ P 〈 0. 05）. At 2-week, 3-week and 4-week after the treatment, physical condition score was signifi- cantly higher in the treatment group than in the control group （ P 〈 0. 01 ）. Conclusion Acupuncture com- bined with Chinese medicine can improve gastrointestinal symptoms and reduce gastric drainage volume in patients with gastroparesis after operation for gastrointestinal cancer.