针刺联合芒硝脐敷治疗术后早期炎性肠梗阻

Acupuncture Combined with Glauber's Salt Navel Application in the Treatment of EPISBO

目的:探讨针刺联合芒硝脐敷治疗腹部手术术后早期炎性肠梗阻的临床疗效。方法:60例腹部术后出现早期炎性肠梗阻的患者随机分为观察组和对照组各30例。对照组予以常规西医治疗,包括:禁食水,胃肠减压;维持水、电解质与酸碱平衡;全肠外营养支持;给予肾上腺皮质激素;肥皂水灌肠,应用生长抑素;使用质子泵抑制剂;酌情使用广谱抗生素(包括抗厌氧菌药物)。观察组在对照组治疗基础上采用针刺下合穴联合芒硝脐敷。两组患者均治疗7 d。比较两组患者症状缓解时间,肠功能恢复时间,治疗第1天、第7天患者血清胃泌素(gastrin,GAS)水平,24小时动态心电图分析心率变异(heart rate variability,HRV)指标。结果:观察组有效率为93.3%,对照组有效率为76.7%,观察组有效率优于对照组(P<0.05)。治疗后,两组患者症状积分均显著下降(P<0.05);观察组治疗后低于对照组(P<0.05)。治疗后,观察组肠功能恢复时间均显著短于对照组,差异均有统计学意义(P<0.05)。治疗后,两组患者GAS均显著升高(P<0.05);观察组治疗后低于对照组(P<0.05)。治疗后,两组患者心率变异性的低频功率(low frequency,LF)、高频功率(high frquency,HF)、24 h相邻R-R间期差值的均方根(root mean square of successive differences,rMSSD)均高于治疗前;治疗后观察组的HF、rMSSD均高于对照组(P<0.05)。结论:针刺联合芒硝脐敷能明显改善术后早期炎性肠梗阻患者的临床症状,可有效调节自主神经功能,抑制肠道炎性渗出,减轻肠道水肿,促进胃肠功能恢复。

Objective:To explore the clinical effect of acupuncture combined with Glauber's salt navel application in the treatment of early postoperative inflammatory small bowel obstruction(EPISBO)after abdominal operation.Methods:60 patients with EPISBO after abdominal operation were randomly divided into observation group and control group,30 cases in each group.The control group received routine western medicine treatment,including:forbidding food and water,gastrointestinal decompression;maintenance of water,electrolyte and acid-base balance;total parenteral nutrition support;administration of adrenocortical hormone;enema with soap water,application of somatostatin;use of proton pump inhibitors;use of broad-spectrum antibiotics(including anti anaerobic drugs)as appropriate.The observation group used acupuncture at Xihe acupoint combined with Glauber's navel application on the basis of treatment in the control group.Both groups were treated for 7 days.The symptom relief time,intestinal function recovery time,serum gastrin(GAS)levels of patients on the first and seventh days of treatment were compared between the two groups,and heart rate variability(HRV)indicators were analyzed by 24-hour dynamic electrocardiogram.Results:The effective rate of the observation group was 93.3%,and the effective rate of the control group was 76.7%.The clinical effective rate of the observation group was better than that of the control group(P<0.05).After treatment,the symptom scores of the two groups of patients decreased significantly(P<0.05);the observation group was lower than the control group after treatment(P<0.05).After treatment,the recovery time of intestinal function in the observation group was significantly shorter than that in the control group,and the differences were statistically significant(P<0.05).After treatment,GAS in both groups increased significantly(P<0.05);the observation group was lower than the control group after treatment(P<0.05).After treatment,the low-frequency power(LF),high-frequency power(HF),and 24 h root mean square of successive differences(rMSSD)of heart rate variability between the two groups of patients were higher than before treatment;after treatment,the HF and SSD of the observation group are higher than the control group(P<0.05).Conclusion:Acupuncture combined with Glauber's salt navel application can significantly improve the clinical symptoms of patients with EPISBO,can effectively regulate autonomic nerve function,inhibit intestinal inflammatory exudation,reduce intestinal edema,and promote recovery of gastrointestinal function.