经皮神经调控改善100例胃肠道肿瘤术后患者胃肠功能的临床价值

Clinical value of transcutaneous neuromodulation in improving gastrointestinal function of 100 patients with gastrointestinal tumor after operation

目的探讨经皮神经调控(TN)改善胃肠道肿瘤术后胃肠功能的临床价值。方法选择2019年4月至2020年6月于宁波大学附属人民医院行胃肠道肿瘤手术的100例患者。将100例患者随机分为治疗组(接受TN治疗,50例)与对照组(接受虚拟治疗,50例),比较两组接受治疗后的临床资料[首次排便、排气、下床和恢复进食时间,术后3 d内恶心呕吐的发生率,疼痛评分(0~10分)]以评估胃肠功能的恢复情况。通过比较两组的心率变异性(HRV)分析TN改善胃肠道肿瘤术后胃肠功能的可能机制。统计学方法采用独立样本t检验和卡方检验。结果100例患者中,男63例,女37例;年龄(范围)为(67.0±11.3)岁(28~92岁)。治疗组的术后首次排便、排气、下床和恢复进食时间较对照组分别缩短了31.0%、39.8%、38.0%和32.4%[(72.1±3.0)h比(104.5±2.9)h、(49.4±5.7)h比(82.1±3.1)h、(3.1±0.7)d比(5.0±0.9)d、(4.8±0.9)d比(7.1±0.8)d],术后第2天、第3天的疼痛评分和术后3 d内恶心呕吐发生率较对照组分别下降了50.0%、65.5%、26.0%[(1.5±0.6)分比(3.0±0.7)分、(1.0±0.6)分比(2.9±0.6)分、16.0%(8/50)比42.0%(21/50)],差异均有统计学意义(t=54.28、35.72、11.67、13.66、12.00、14.90,χ^(2)=8.21;P均<0.01)。HRV检测结果示治疗组术后第3天高频率波段高于同组术后第1天,术后低频率波段与高频率波段的比值较同组术前降低(0.5±0.1比0.4±0.1、1.2±0.7比1.9±1.0),差异均有统计学意义(t=-4.81、4.26,P均<0.01),提示TN可增强迷走神经活动。结论TN对于胃肠道肿瘤术后胃肠功能恢复有促进作用,可作为加快临床胃肠道肿瘤术后恢复的辅助治疗手段。

Objective To evaluate the clinical value of the transcutaneous neuromodulation(TN)in improving gastrointestinal function after gastrointestinal tumor operation.Methods From April 2019 to June 2020,at The Affiliated People′s Hospital of Ningbo University,100 patients who underwent gastrointestinal tumor surgery were included.The 100 patients were randomly divided into treatment group(receiving TN treatment,50 cases)and control group(receiving sham TN treatment,50 cases).The clinical data of the two groups was compared to evaluate the recovery of gastrointestinal function,which included the time of first defecation,time of first flatus,time of first ambulation,time of resuming diet,the incidence of nausea and vomiting within 3 d after operation and pain score(0 to 10).Heart rate variability(HRV)was compared between two groups to analyze the possible mechanism of TN improving gastrointestinal function after gastrointestinal tumor surgery.Independent sample t test and Chi-square test were used for statistical analysis.Results Among 100 patients,there were 63 male and 37 female patients,the age was(67.0±11.3)years old,ranged from 28 to 92 years old.Compared with the control group,the time of first defecation,first flatus,first ambulation and resuming diet of treatment group reduced by 31.0%,39.8%,38.0%and 32.4%((72.1±3.0)h vs.(104.5±2.9)h,(49.4±5.7)h vs.(82.1±3.1)h,(3.1±0.7)d vs.(5.0±0.9)d,(4.8±0.9)d vs.(7.1±0.8)d)),respectively;the pain scores on the day 2 and day 3 after operation and incidence of nausea and vomiting within 3 d after operation decreased by 50.0%,65.5%,26.0%(1.5±0.6 vs.3.0±0.7,1.0±0.6 vs.2.9±0.6,16.0%,8/50 vs.42.0%,21/50),respectively,and the differences were statistically significant(t=54.28,35.72,11.67,13.66,12.00 and 14.90,χ^(2)=8.21,all P<0.01).The results of HRV analysis showed that the high frequency on day 3 was higher than that on day 1 of treatment group,and the ratio of low frequency to high frequency after operation was lower than that before operation of treatment group(0.5±0.1 vs.0.4±0.1,1.2±0.7 vs.1.9±1.0),and the differences were statistically significant(t=-4.81 and 4.26,both P<0.01),which indicated TN could enhance vagal activity.Conclusions TN promote the recovery of gastrointestinal function after gastrointestinal tumor operation,and can be used as an adjuvant therapy to accelerate the recovery of gastrointestinal function after gastrointestinal tumor operation.