腹腔镜子宫肌瘤剔除术联合中药封包热熨对患者腹胀程度、血管功能及血液流变学的影响

Impact of laparoscopic myomectomy combined with Chinese medicine encapsulation hot ironing on abdominal distension,vascular function and hemorheology

目的 分析腹腔镜子宫肌瘤剔除术(LM)联合中药封包热熨对患者腹胀程度、血管功能及血液流变学指标的影响。方法 前瞻性选取2022年1月至2024年1月广州中医药大学附属清远市中医院收治的148例LM患者作为研究对象。按照随机数字表法将其分为两组,每组各74例。观察组于LM术后实施中药封包热熨+常规干预,对照组于LM术后实施常规干预。两组均连续干预7 d。统计分析两组腹胀程度、胃肠功能恢复指标(肠鸣音恢复时间、首次排气时间及首次排便时间)、血管功能[血管紧张素转化酶(ACE)、血浆肾素活性(PRA)、血管紧张素Ⅱ(AngⅡ)]及血液流变学指标(血浆黏度、高切全血黏度、低切全血黏度、红细胞压积、红细胞沉降率及红细胞聚集指数)数据。结果 干预后3 d,观察组中轻度腹胀比例为29.73%,显著低于对照组(59.46%),差异有统计学意义(P<0.05)。观察组肠鸣音恢复时间、首次排气时间及首次排便时间分别为(20.85±2.60)、(24.30±3.45)、(35.70±3.55) h,均明显短于对照组[(25.40±3.74)、(32.31±4.77)、(41.75±4.58) h],差异均有统计学意义(P<0.05)。干预后3、7 d,两组ACE、PRA及AngⅡ水平均持续下降,差异均有统计学意义(P<0.05);且两组干预后3 d的ACE、PRA及AngⅡ水平分别为(25.31±5.80)U/L、(0.72±0.10) ng·mL^(-1)·h^(-1)、(307.65±15.81) ng/dL,均显著低于对照组[(28.93±8.11)U/L、(0.94±0.11) ng·mL^(-1)·h^(-1)、(328.79±14.12) ng/dL],差异均有统计学意义(P<0.05);干预后7 d,两组ACE、PRA及AngⅡ水平比较,差异均无统计学意义(P>0.05)。干预后3、7 d,两组血浆黏度、高切全血黏度、低切全血黏度、红细胞沉降率及红细胞聚集指数均较干预前明显下降,红细胞压积较干预前明显升高,差异均有统计学意义(P<0.05);且两组干预后3 d的血浆黏度、高切全血黏度、低切全血黏度、红细胞沉降率及红细胞聚集指数分别为(1.52±0.16)mPa·s、(5.23±1.19)mPa·s、(10.55±1.53)mPa·s、(19.03±4.05)mm/h、2.87±0.36,均低于对照组[(1.67±0.20)mPa·s、(6.07±1.25)mPa·s、(12.31±1.57)mPa·s、(20.72±4.20)mm/h、3.24±0.30],红细胞压积为(35.01±1.26)%,高于对照组[(33.25±1.20)%],差异均有统计学意义(P<0.05);干预后7 d,两组各血液流变学指标比较,差异均无统计学意义(P>0.05)。结论 LM联合中药封包热熨和常规干预可有效改善患者术后腹胀、胃肠功能、血管功能及血液流变学状态,加快患者术后康复。

Objective To analyze laparoscopic myomectomy(LM)combined with Chinese medicine encapsulation hot ironing on abdominal distension,vascular function and hemorheology.Methods A total of 148 patients with LM admitted to Qingyuan Traditional Chinese Medicine Hospital Affiliated to Guangzhou University of Chinese Medicine from January 2022 to January 2024 were selected as the study objects.According to random number table method,they were divided into two groups:observation group(74 cases)and control group(74 cases).The observation group received traditional Chinese medicine encapsulation hot ironing and routine intervention after LM operation and the control group were treated with routine intervention after LM operation.Both groups were treatment continuously for 7 days.The data of abdominal distension,gastrointestinal function recovery indexes(bowel ringing recovery time,first exhaust time and first defecation time),vascular function[angiotensin converting enzyme(ACE),plasma renin activity(PRA),angiotensinⅡ(AngⅡ)]and hemorheology indexes(plasma viscosity,high whole blood viscosity,low whole blood viscosity,hematocrit,erythrocyte deposition rate and red blood cell aggregation index)were statistically analyzed in the two groups.Results At 3 days after intervention,the proportion of mild abdominal distension in the observation group was 29.73,which was significantly lower than that in the control group(59.46%),the difference was statistically significant(P<0.05).The bowel ringing recovery time,first exhaust time and first defecation time in the observation group were(20.85±2.60),(24.30±3.45),(35.70±3.55)h,which were significantly shorter than those in the control group[(25.40±3.74),(32.31±4.77),(41.75±4.58)h],the differences were statistically significant(P<0.05).At 3 days,7 days after intervention,the levels of ACE,PRA and AngⅡin the two groups continued to decrease,the levels of ACE,PRA and AngⅡin the two groups were(25.31±5.80)U/L,(0.72±0.10)ng·mL^(-1)·h^(-1) and(307.65±15.81)ng/dL,respectively,which were significantly lower than those in the control group[(28.93±8.11)U/L,(0.94±0.11)ng·mL^(-1)·h^(-1),(328.79±14.12)ng/dL],and the differences were statistically significant(P<0.05).At 7 days after intervention,there were no statistically significant differences in the levels of ACE,PRA and AngⅡbetween the two groups(P>0.05).At 3 and 7 days after intervention,the plasma viscosity,high-cut whole blood viscosity,low-cut whole blood viscosity,erythrocyte sedimentation rate and erythrocyte aggregation index of the two groups were significantly lower than those before intervention,and hematocrit was significantly higher than that before intervention,the differences were statistically significant(P<0.05);and the plasma viscosity,high shear whole blood viscosity,low shear whole blood viscosity,erythrocyte sedimentation rate and erythrocyte aggregation index of the two groups at 3 days after intervention were(1.52±0.16)mPa·s,(5.23±1.19)mPa·s,(10.55±1.53)mPa·s,(19.03±4.05)mm/h,2.87±0.36,respectively,which were lower than those of the control group[(1.67±0.20)mPa·s,(6.07±1.25)mPa·s,(12.31±1.57)mPa·s,(20.72±4.20)mm/h,3.24±0.30],and hematocrit was(35.01±1.26)%,which was higher than that of the control group[(33.25±1.20)%],the differences were statistically significant(P<0.05);at 7 days after intervention,there were no statistically significant differences in hemorheological indexes between the two groups(P>0.05).Conclusion LM combined with traditional Chinese medicine encapsulation hot ironing+routine intervention can effectively improve abdominal distension,gastrointestinal function,vascular function and hemorheology of patients with LM,and accelerate postoperative recovery.