吴茱萸加粗盐热熨腹部对肝切除术患者胃肠功能及门静脉血流动力学的影响

Study on effect of gastrointestinal function and portal vein hemodynamics with abdominal hot compressing with evodiae fructus and crude salt after hepatectomy

目的探讨吴茱萸加粗盐热熨腹部对肝切除术后患者胃肠功能及门静脉血流动力学的影响。方法将符合入选标准的2017年4月-2019年2月广州中医药大学第一附属医院60例行肝切除术患者,采用随机数字表法分为2组,每组30例。对照组给予西医常规方法治疗,治疗组在对照组基础上给予吴茱萸加粗盐热熨腹部治疗。2组均治疗7 d。分别于治疗前后对患者腹胀、恶心呕吐进行评分,并记录肠鸣音恢复时间、首次排气与排便时间;采用全自动生物化学分析仪检测ALT、TBIL、DBIL,以彩色超声多普勒检测门静脉直径(portal vein diameter, PVD)、门静脉流速(portal venous flow velocity, PVV)。结果治疗组治疗后3 d腹胀、恶心呕吐评分低于对照组(t值分别为-3.489、-2.740 ,P值均<0.05)。治疗组肠鸣音恢复时间、首次排气时间及首次排便时间均早于对照组(t值分别为-3.622、-4.297、-4.151,P值均<0.01)。随着治疗时间的延长,2组ALT呈逐渐下降趋势(P <0.05或P<0.01);对照组DBIL治疗后3 d较同组治疗前升高(t=-2.157,P=0.039) ,TBIL治疗后7 d较同组治疗前降低(t=2.157,P=0.038)。治疗组治疗后3、5 d PVD (t值分别为3.528、2.160)、PVV (t值分别为11.096、4.264)高于对照组(P<0.01或P<0.05)。结论吴茱萸加粗盐热熨腹部可有效改善肝切除术患者门静脉血液循环,促进胃肠功能快速恢复。

Objective To study on the effects of gastrointestinal function and portal vein hemodynamics applicated with abdominal hot compressing with evodiae fructus and crude salt after hepatectomy.Methods A total of 60 patients who underwent hepatectomy were randomly divided into 2 groups by random number table method,with 30 in each group.The control group was treated with conventional basic western medicine,while the treatment group was treated with medicinal evodiae fructus and crude salt hot compress on abdomen on the basis of the control group.The portal vein diameter(PVD),portal venous flow velocity(PVV),recovery time of main clinical indexes,clinical symptom scores and liver function indexes were dynamically monitored at different observation time points.Results The scores of abdominal distension,nausea and vomiting in the treatment group were significantly lower than those in the control group 3 days after treatment(t values were-3.489 and-2.740,respectively,all Ps<0.05).The recovery time of bowel sounds,first exhaust time and first defecation time in the treatment group were significantly earlier than those in the control group(t values were-3.622,-4.297 and-4.151,respectively,all Ps<0.01).With the extension of treatment time,ALT in 2 groups showed a gradual downward trend(P<0.05 or P<0.01),DBIL in control group was significantly higher at 3 days after treatment than before(t=-2.157,P=0.039),and TBIL was significantly lower at 7 days after treatment than before(t=2.175,P=0.038).The PVD(t values were 3.528,2.160)and PVV(t values were 11.096,4.264)of the treatment group were significantly higher than those of the control group 3 and 5 days after treatment(P<0.01 or P<0.05).Conclusion Early application of abdominal hot compressing with evodiae fructus and crude salt hot compress on abdomen after hepatectomy can improve the portal vein blood circulation and promote the rehabilitation of gastrointestinal function in patients with hepatectomy.