黄藤通腑汤联合阑尾穴中药贴敷促进腹腔镜阑尾切除术后恢复的临床研究

Clinical Study on Promotion of Recovery after Laparoscopic Appendectomy by Huangteng Tongfu Decoction(黄藤通腑汤)Combined with Chinese Medicine Application at Appendix Points

目的探讨加速康复外科联合黄藤通腑汤、阑尾穴中药贴敷促进腹腔镜阑尾切除术后恢复的临床疗效。方法选择100例急性阑尾炎诊断明确且行腹腔镜阑尾切除术的患者作为研究对象,采用随机数字法平均分为观察组与对照组两组:对照组50例术后给予抗感染、补液及加速康复外科指导,观察组50例在对照组基础上给予中药黄藤通腑汤内服及阑尾穴中药贴敷治疗。比较术后恢复及并发症发生情况,并于术前、术后6 h、12 h及24 h采用疼痛视觉模拟评分(VAS)评价患者疼痛状态;于术后24 h、术后72 h采用酶联免疫吸附法(ELISA)检测血清IL-1β、IL-6水平。结果观察组总有效率为96.0%(48/50),明显高于对照组的80.0%(40/50)(P<0.05)。观察组术后肠鸣音恢复时间、排便时间、肛门排气时间,下地活动时间,住院时间均较对照组短(P<0.05)。术后观察组并发症发生率2.0%(17/50)明显低于对照组14.0%(7/50)(P<0.05)。术后6 h、12 h及24 h观察组VAS评分均低于会对照组(P<0.05)。术后72 h两组IL-1β及IL-6水平均较术后24 h降低(P<0.05);术后72 h观察组IL-1β及IL-6水平均低于对照组(P<0.05)。结论加速康复外科联合中医内服外贴明显缩短了腹腔镜阑尾炎术后恢复时间,降低并发症发生风险,改善术后疼痛及应激反应,值得临床应用。

Objective To explore the clinical effect of accelerated rehabilitation surgery combined with Huangteng Tongfu Decoction(黄藤通腑汤) and Chinese medicine application at appendix points to promote recovery after laparoscopic appendectomy. Methods A total of 100 patients with definite diagnosis of acute appendicitis who underwent laparoscopic appendectomy were selected as the research object, and were randomly divided into observation group and control group by random number method. Fifty cases in control group were given anti-infection, fluid replacement and accelerated rehabilitation surgical guidance after operation. On the basis of the control group, 50 cases in the observation group were given Huangteng Tongfu Decoction and the traditional Chinese medicine application at appendix points. The postoperative recovery and the occurrence of complications were compared, and the pain visual analog scale(VAS) was used to evaluate the patient’s pain status before operation, 6 h, 12 h and 24 h after operation. The enzyme-linked immunosorbent assay was used at 24 h and 72 h after operation. ELISA was used to detect serum levels of IL-1β and IL-6. Results The total effective rate of the observation group was 96.0%(48/50), which was significantly higher than that of the control group(80.0%)(40/50)(P<0.05). The recovery time of bowel sounds, defecation time, anal exhaust time, time to go to the ground and hospitalization time in the observation group were shorter than those in the control group(P<0.05). The incidence of complications in the observation group after surgery was 2.0%(1/50), which was significantly lower than that in the control group(14.0%)(7/50)(P<0.05). 6 h, 12 h and 24 h after operation, the VAS scores of the observation group were lower than those of the control group(P<0.05). The levels of IL-1β and IL-6 in the two groups were lower than those 24 hours after operation(P<0.05). The levels of IL-1β and IL-6 in the observation group were lower than those in the control group 72 h after operation(P<0.05). Conclusion Accelerated rehabilitation surgery combined with TCM internal and external application significantly shortened the recovery time of laparoscopic appendicitis, reduced the risk of complications, improved postoperative pain and stress response, and was worthy of clinical application.