针刺足三里联合中药灌肠治疗消化道肿瘤术后胃瘫综合征临床研究

Clinical study on acupuncture at Zusanli(ST 36)acupoint combined with Traditional Chinese Medicine enema in the treatment of gastroparesis syndrome after gastrointestinal tumor operation

目的探讨针刺足三里联合中药灌肠治疗消化道肿瘤术后胃瘫综合征的疗效。方法将符合入选标准的2016年6月-2021年5月本院96例消化道肿瘤术后胃瘫综合征患者采用随机抽签法分为3组, 每组32例。对照组口服枸橼酸莫沙必利片, 中医灌肠组在对照组基础上加用中药灌肠, 联合组在中医灌肠组基础上针刺足三里。3组均连续治疗4周。分别于治疗前后对主要证候进行评分, 采用放射免疫分析法检测血清促胃液素(gastrin, GAS)、胃动素(motilin, MTL)、生长抑素(somatostatin, SS)水平, 采用智能双导胃肠电图仪检测胃电生理参数(波形反应面积、波形频率、平均幅值), 记录治疗期间的不良反应, 评价临床疗效。结果联合组总有效率为96.9%(31/32)、中医灌肠组为81.3%(26/32)、对照组为68.8%(22/32), 3组比较差异有统计学意义(χ^(2)=8.72, P=0.013)。联合组治疗后脘腹胀满、疲乏无力、嗳气反酸、口干口苦评分低于中医灌肠组与对照组(F值分别为16.39、13.21、11.28、10.23, P值均<0.001)。治疗后, 联合组GAS[(140.62±15.19)ng/L 比(128.79±14.34)ng/L、(115.98±12.40)ng/L, F=21.09]、MTL[(268.66±28.21)ng/L比(245.89±25.24)ng/L、(230.78±22.43)ng/L, F=30.29]、SS[(70.58±8.17)ng/L 比(65.50±7.76)ng/L、(59.73±7.05)ng/L, F=33.19]水平高于中医灌肠组和对照组(P<0.01);波形反应面积[(172.62±17.14)μV/s 比(158.56±15.32)μV/s、(145.48±14.13)μV/s, F=20.24]、波形频率[(3.86±0.61)cpm比(3.29±0.50)cpm、(3.01±0.63)cpm, F=13.17]、平均幅值[(86.51±8.98)μV比(75.70±7.93)μV、(68.65±7.46)nμV, F=28.11]高于中医灌肠组和对照组(P<0.01)。治疗期间, 联合组不良反应发生率为18.8%(6/32)、中医灌肠组为15.6%(5/32)、对照组为12.5%(4/32), 3组比较差异无统计学意义(χ^(2)=0.47, P=0.789)。结论针刺足三里联合中药灌肠可有效改善消化道肿瘤术后胃瘫综合征患者的中医证候、胃肠激素水平、胃电生理参数, 提高疗效。

Objective To study the clinical efficacy of acupuncture at Zusanli(ST 36)combined with Traditional Chinese Medicine(TCM)enema in the treatment of gastroparesis syndrome after gastrointestinal tumor operation.Methods A total of 96 patients with gastroparesis syndrome after gastrointestinal tumor surgery in our hospital from June 2016 to May 2021,who met the inclusion criteria,were randomly divided into three groups by random drawing,with 32 in each group.The control group took mosapride citrate tablets orally,the TCM enema group added TCM enema on the basis of the control group,and the combined group added acupuncture Zusanli(ST 36)on the basis of the TCM enema group.All three groups were treated continuously for 4 weeks.The main syndromes were scored before and after treatment.The levels of serum gastrin(GAS),motilin(MTL)and somatostatin(SS)were detected by radioimmunoassay.The gastric electrophysiological parameters(waveform response area,waveform frequency and average amplitude)were detected by intelligent dual channel gastrointestinal electrograph,the adverse reactions during treatment were recorded,and the clinical efficacy was evaluated.Results The total effective rate was 96.9%(31/32)in the combined group,81.3%(26/32)in the TCM enema group and 68.8%(22/32)in the control group.There was significant difference among the three groups(χ^(2)=8.72,The scores of abdominal fullness and distention,fatigue,belching acid reflux,dry mouth and bitter mouth in the combined group were significantly lower than those in the TCM enema group and the control group(F values were 16.39,13.21,11.28 and 10.23,respectively,P<0.001).After treatment,the levels of GAS[(140.62±15.19)ng/L vs.(128.79±14.34)ng/L,(115.98±12.40)ng/L,F=21.09],MTL[(268.66±28.21)ng/L vs.(245.89±25.24)ng/L,(230.78±22.43)ng/L,F=30.29]and SS[(70.58±8.17)ng/L vs.(65.50±7.76)ng/L,(59.73±7.05)ng/L,F=33.19]in the combined group were significantly higher than those in the TCM enema group and the control group(P<0.01).The waveform response area[(172.62±17.14)nV/s vs.(158.56±15.32)|iV/s,(145.48±14.13)nV/s,F=20.24],waveform frequency[(3.86±0.61)cpm vs.(3.29±0.50)cpm,(3.01±0.63)cpm,f=13.17]and average amplitude[(86.51±8.98〕(iV vs.(75.70±7.93)[iV,(68.65±7.46〕[iV,F=28.11]were significantly higher than those in TCM enema group and control group(P<0.01).During the treatment period,the incidence of adverse reactions was 18.8%(6/32)in the combined group,15.6%(5/32)in the TCM enema group and 12.5%(4/32)in the control group.There was no significant difference between the three groupsχ^(2)=0.47,P=0.789).Conclusion Acupuncture at Zusanli(ST 36)combined with TCM enema can improve the TCM syndrome scores,gastrointestinal hormone level and gastric electrophysiological parameters of patients with gastroparesis syndrome after gastrointestinal tumor operation,improve the curative effect with safety.