摘要
目的:通过观察穴位低频电刺激对胃癌根治术患者胃肠蠕动功能的影响及其对炎性反应的调节作用,评价该疗法对胃癌根治术患者围手术期胃肠蠕动功能恢复的临床价值。方法:胃癌根治术患者177例随机分为常规组43例、低频组45例、快速康复外科(FTS)组46例和FTS+低频组43例。常规组予术前机械性肠道准备、术后常规禁食、术后常规留置腹腔引流管等干预措施;低频组在常规干预措施基础上予穴位低频电刺激治疗,取双侧足三里、上巨虚、下巨虚、三阴交,从术后第1天开始至患者排气,每天1次,每次30min,频率2.5Hz,脉宽0.4ms;FTS组予快速康复外科治疗;FTS+低频组在快速康复外科治疗的基础上给予穴位低频电刺激治疗。观察比较各组患者术后首次排气、排便时间,检测各组患者术后第1、3、6天血浆中的白细胞(WBC)、中性粒细胞(N)、C-反应蛋白(CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)水平的变化情况.结果:与常规组比较,低频组、FTS组、FTS+低频组患者术后首次排气、排便时间均明显缩短(P<0.05)。FTS+低频组术后首次排气时间明显短于FTS组(P<0.05);FTS+低频组术后首次排便时间最短,但与低频组、FTS组差异无统计学意义(P>0.05)。各组患者术后第3天和术后第6天CRP水平均高于术后第1天,且术后第3天最高。与同时间点常规组比较,低频组、FTS+低频组术后第3天的CRP水平和术后第6天的CRP、IL-6水平均明显降低(P<0.05);与同时间点低频组比较,FTS组术后第3天的N、CRP和术后第6天的N、CRP、IL-6水平明显升高(P<0.05);与同时间点FTS组比较,FTS+低频组术后第3天CRP和术后第6天N、CRP、IL-6水平明显降低(P<0.05)。结论:穴位低频电刺激和FTS均能缩短胃癌根治术后患者首次排气、排便时间,促进胃癌根治术后患者的胃肠蠕动功能恢复,且FTS联合穴位低频电刺激治疗效果更佳,其作用机制可能与减轻患者术后炎性反应有关。
Objective To observe the effect of low-frequency electrical acupoint stimulation on gastrointestinal motility in patients undergoing radical gastrectomy,and its impact on regulation of inflammatory response,so as to evaluate its clinical value.Methods A total of 177 patients undergoing radical gastrectomy were randomly divided into conventional group(n=43),lowfrequency electrical acupoint stimulation(LEAS)group(n=45),fast track surgery(FTS)group(n=46)and FTS+LEAS group(n=43).Patients of the conventional group received conventional treatment(pre-surgical mechanical bowel preparation,postsurgical fasting,and indwelling abdominal drainage tube,etc.).Patients in the LEAS group were treated by low-frequency electrical stimulation at bilateral Zusanli(ST36),Shangjuxu(ST37),Xiajuxu(ST39)and Sanyinjiao(SP6)for 30 min,once daily from 1 day after the operation to first postoperative flatus.FTS group was given fast track surgery treatment,such as preoperative education,preoperative nutritional support,early oral feeding,early removal of abdominal drainage tube,etc.The FTS+LEAS group was given low-frequency electrical acupoint stimulation on the basis of the FTS treatment.Levels of white blood cells(WBC),neutrophils(N),C-reactive protein(CRP),interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)at 1,3,and 6 d after the operation in the 4 groups were assayed.The first postoperative flatus and defecation time were recorded.Results After the treatment,the first postoperative flatus and defecation time in the LEAS,FTS and FTS+LEAS groups were significantly shorter than those of the conventional group(P<0.05),and the first flatus time of the FTS+LEAS group was even earlier than that of the FTS group(P<0.05).No significant differences were found among the 3 groups in the postoperative defecation time(P>0.05).The CRP levels in the 4 groups on 3 and 6 d after operation were higher than those on the 1 st postoperative day,and the highest level was on 3 d after the operation.Compared with the conventional group,CRP level on 3 d and CRP and IL-6 levels on 3 and 6 d in the LEAS and FTS+LEAS groups were significantly lower(P<0.05).Compared with the LEAS group,the levels of N,CRP on 3 d and the levels of N,CRP,IL-6 on 6 d in the FTS group were significantly increased(P<0.05).Compared with the FTS group,the level of CRP on 3 d and the levels of N,CRP,IL-6 on 6 d in the FTS+LEAS group were significantly decreased(P<0.05).Conclusion FTS combined with LEAS is superior to simple FTS or LEAS treatment in shortening the first flatus and defecation time and promoting the recovery of gastrointestinal motility function in patients undergoing radical gastrectomy,which may be associated with its effect in alleviating postoperative inflammatory responses.
作者
何丹
王傅喆
张展
黄枫
陈娇娇
李柏
HE Dan;WANG Fu-zhe;ZHANG Zhan;HUANG Feng;CHEN Jiao-jiao;LI Bai(Department of Rehabilitation,Shanghai Changhai Hospital,,Shanghai 200433,China)
出处
《针刺研究》
CAS
CSCD
北大核心
2020年第1期51-56,共6页
Acupuncture Research
基金
上海市进一步加快中医药事业发展三年行动计划[No.ZY(2018-2020)-FWTX-8007]
关键词
穴位低频电刺激治疗
快速康复外科
胃癌根治术
胃肠蠕动功能
术后炎性反应
Low-frequency electrical acupoint stimulation
Fast track surgery
Radical gastrectomy
Gastrointestinal motility function
Postoperative inflammatory response
作者简介
第一作者:何丹,硕士研究生,研究方向:恶性肿瘤的中西医结合防治。E-mail:787824865@qq.com;通信作者:李柏,教授,研究方向:恶性肿瘤的中西医结合防治。E-mail:libai9@126.com。
