针刺联合隔姜灸治疗胃癌根治术后腹腔热灌注化疗患者临床疗效观察

Clinical Observation on Acupuncture Combined with Ginger-partition Moxibustion for the Treatment of Patients with Hyperthermic Intraperitoneal Chemotherapy After Radical Operation of Gastric Cancer

【目的】观察针刺联合隔姜灸对脾胃虚弱型胃癌根治术后腹腔热灌注化疗(HIPEC)患者胃肠道反应(恶心、呕吐)、Karnofsky功能状态(KPS)评分、血液指标和住院时间的影响。【方法】将60例脾胃虚弱型胃癌根治术后拟行HIPEC治疗的患者随机分成对照组和治疗组,每组各30例。对照组给予胃癌根治术后常规治疗及HIPEC治疗,治疗组在对照组的基础上,于HIPEC前1 h取足三里、内关、三阴交、阴陵泉等穴位行针刺治疗,于HIPEC后2 h取足三里、内关、血海、天枢等穴位行隔姜灸治疗,疗程为3 d。观察2组患者治疗前后KPS评分和白细胞(WBC)计数、C反应蛋白(CRP)、丙氨酸氨基转移酶(ALT)、血清总胆红素(TB)、碱性磷酸酶(ALP)的变化情况,比较2组患者HIPEC后胃肠道反应及KPS评分的改善疗效、平均住院时间及不良反应情况。【结果】(1)治疗后,治疗组的止恶心、止呕吐总有效率分别为90.0%(27/30)和93.3%(28/30),而对照组均为70.0%(21/30),组间比较,治疗组的止恶心、止呕吐疗效均明显优于对照组(P<0.05)。(2)治疗后,2组患者的KPS评分均较治疗前明显升高(P<0.05),且治疗组的KPS评分明显高于对照组(P<0.05)。其中,治疗组的KPS评分总改善率为70.0%(21/30),对照组为40.0%(12/30),组间比较,治疗组的KPS评分改善疗效明显优于对照组(P<0.05)。(3)治疗后,2组患者的WBC水平较治疗前降低,而CRP水平仍较治疗前升高(P<0.05),组间比较,治疗组的WBC、CRP水平均明显低于对照组(P<0.05);而2组患者治疗前后及组间TB、ALT、ALP水平比较,差异均无统计学意义(P>0.05)。(4)治疗组的平均住院时间较对照组明显缩短(P<0.05),且除1例轻度晕针外,均未出现与针灸治疗有关的不良反应。【结论】针刺联合隔姜灸对脾胃虚弱型胃癌根治术后HIPEC患者恶心、呕吐等胃肠道反应的临床疗效确切,并能有效改善患者的KPS评分,降低患者的炎症指标,缩短患者的住院时间,同时其安全性较高,无明显不良反应。

Objective To observe the effects of acupuncture combined with ginger-partition moxibustion on gastrointestinal reactions(nausea,vomiting),Karnofsky Performance Status(KPS)scores,blood indicators,and hospitalization time in the patients treated with hyperthermic intraperitoneal chemotherapy(HIPEC)after radical operation of stomach cancer differentiated as the syndrome of spleen and stomach deficiency.Methods Sixty patients after radical operation of gastric cancer differentiated as spleen and stomach deficency syndrome and planning to receive HIPEC were randomly divided into control group and treatment group,and each group had 30 cases.The control group was given conventional treatment and HIPEC treatment after radical operation of gastric cancer.On the basis of treatment for the control group,the treatment group was given acupuncture on the acupoints of Zusanli(ST36),Neiguan(PC6),Sanyinjiao(SP6),and Yinlingquan(SP9)one hour before HIPEC,and was given ginger-partition moxibustion on the acupoints of Zusanli(ST36),Neiguan(PC6),Xuehai(SP10),Tianshu(ST25)2 hours after HIPEC.The course of the treatment lasted for 3 days.Before and after treatment,we observed the gastrointestinal reactions(nausea,vomiting),Karnofsky Performance Status(KPS)scores,white blood cell(WBC)count,and levels of C-reactive protein(CRP),alanine aminotransferase(ALT),serum total bilirubin(TB)and alkaline phosphatase(ALP)in the two groups,and compared efficacy for improving post-HIPEC gastrointestinal reactions and KPS scores,mean hospitalization time,and the adverse reaction.Results(1)After treatment,the total effective rates for relieving nausea and vomiting in the treatment group were 90.0%(27/30)and 93.3%(28/30)respectively,and those in the control group were all 70.0%(21/30).The intergroup comparison showed that the treatment group had higher total effective rates for relieving nausea and vomiting than the control group,and the differences were statistically significant(P<0.05).(2)After treatment,the KPS scores in the two groups were obviously increased as compared with those before treatment(P<0.05),and the KPS scores in the treatment group were significantly higher than those in the control group(P<0.05).The total effective rate for improving KPS scores in the treatment group was 70.0%(21/30),and that in the control group was 40.0%(12/30).The intergroup comparison showed that the efficacy for improving KPS scores in the treatment group was obviously superior to that in the control group(P<0.05).(3)After treatment,WBC count was decreased and CRP level was increased in the two groups in comparison with those before treatment(P<0.05).The intergroup comparison showed that the WBC count and CRP level in the treatment group were obviously lower than those in the control group(P<0.05).However,the differences of TB,ALT and ALP levels in the two groups before and after treatment as well as between the two groups after treatment were not significant(P>0.05).(4)The mean hospitalization time in the treatment group was shorter than that in the control group(P<0.05).In respect of the adverse reaction,there was no obvious adverse reaction associated with the acupuncture except for one case of mild fainting during acupuncture.Conclusion Acupuncture combined with ginger-partition moxibustion has a definite clinical effect on gastrointestinal nausea and vomiting in HIPEC patients after radical operation of gastric cancer differentiated as the syndrome of spleen and stomach deficiency,and can effectively improve KPS scores,reduce inflammation indicators,shorten hospitalization time,and have high safety without obvious adverse reaction.