宣肺利气法针刺联合经空肠营养管中药泵入对胰十二指肠切除术后胃肠功能恢复的影响

Effect of Xuanfei Liqi Acupuncture Combined with Traditional Chinese Medicine Pumping through Jejunal Nutrition Tube for Recovery of Gastrointestinal Function after Pancreatico-duodenectomy

目的:观察宣肺利气法针刺联合经空肠营养管中药泵入促进胰十二指肠切除术(PD)后胃肠功能恢复的疗效。方法:选择2016年1月至2019年12月于我院普外科接受PD手术患者82例,按照随机数字表法分为2组,每组41例,两组患者均由同一手术团队进行PD手术治疗,术后予以腹部外科术后常规处理,包括补液、营养支持、纠正酸碱平衡、预防性应用抗生素等,对照组经空肠营养管进行持续中药泵入;观察组在对照组治疗基础上予以宣肺利气法针刺。比较两组治疗前后中医证候评分、胃肠功能恢复指标、胃肠激素和不良反应发生情况。结果:观察组肠鸣音恢复时间、首次排气时间、呕吐次数及住院时间均少于对照组(P<0.01);治疗后观察组中医证候腹胀、腹痛、恶心、纳差评分低于对照组(P<0.05),血清胃动素、胃泌素水平均高于对照组(P<0.01),差异均有统计学意义。两组腹泻、胆瘘、胰瘘、胃排空障碍等不良发生率差异均无统计学意义(P>0.05)。结论:宣肺利气法针刺联合经空肠营养管中药泵入可调节胃肠激素,有效缩短排气、排便时间,缓解恶心、呕吐等临床症状,促进了PD术后胃肠功能的恢复。

Objective: To investigate the effect of Xuanfei Liqi Acupuncture combined with traditional Chinese medicine pumping through jejunal nutrition tube for the recovery of gastrointestinal function after pancreatico-duodenectomy(PD). Methods: 82 patients who underwent PD surgery in general surgery department of our hospital from January 2016 to December 2019 were selected and divided into 2 groups according to the random number table method, with 41 patients in each group, PD surgery was performed by the same surgical team in both groups, postoperative routine treatment of abdominal surgery was performed, including fluid replacement, nutritional support, acid-base balance correction, and prophylactic application of antibiotics, etc. The controlled group was continuously pumped of traditional Chinese medicine through the jejunal nutrition tube;the observation group received Xuanfei Liqi acupuncture on the basis of the treatment of the controlled group. TCM syndrome score, gastrointestinal function recovery index, gastrointestinal hormones and adverse reactions were compared between the two groups before and after treatment. Results: The bowel sound recovery time, first exhaust time, vomiting times and hospital stay in the observation group were all less than those in the controlled group(P<0.01). After treatment, the scores of TCM syndrome abdominal distension, abdominal pain, nausea and poor appetite in the observation group were lower than those in the controlled group(P<0.05), and the serum levels of motilin and gastrin were higher than those in the controlled group(P<0.01), with statistically significant differences. There was no statistical difference between the two groups in the incidence of diarrhea, biliary fistula, pancreatic fistula, and delayed gastric emptying(P>0.05). Conclusion: The method of Xuanfei Liqi acupuncture combined with traditional Chinese medicine pumping through jejunal nutrition tube can adjust gastrointestinal hormones and effectively shorten the exhaust and defecation time, it can also relieve nausea and vomiting and other clinical symptoms. It can promote the recovery of gastrointestinal function after PD operation.