中频电刺激联合针刺治疗腹部术后胃肠麻痹随机平行对照研究
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摘要
[目的]观察中频电刺激联合针刺治疗腹部术后胃肠麻痹疗效。[方法]使用随机平行对照方法,将80住院患者按病志号抽签方法随机分为两组。对照组40例常规针刺,取公孙(双侧)、内关、上巨虚、下巨虚、足三里等,常规局部消毒,使用毫针(0.35mm×50mm)直刺1～1.5寸,得气后平补平泻,留针20min,每10min行针1次,1次/d,5次/周。治疗组40例中频电刺激,在手术切口双侧放置浸湿无菌纱布,将电极板置于纱布上,频率15Hz,电极启动按键并逐渐增加电流,以患者耐受度为标准,2次/d,5次/周;针刺治疗同对照组。连续治疗1周为1疗程。观测临床表现、胃潴留量、肠鸣音恢复时间、腹胀消失时间、首次肛门排气时间、排便恢复时间、不良反应。治疗1疗程(1周),判定疗效。[结果]治疗组显效28例,有效10例,无效2例,总有效率95.00%;对照组显效20例,有效11例,无效9例,总有效率77.50%;治疗组疗效优于对照组(P<0.05)。胃潴留量、肠鸣音恢复时间、腹胀消失时间、首次排气时间、排便恢复时间治疗组短于对照组(P<0.01)。[结论]中频电刺激联合针刺治疗腹部术后胃肠麻痹,疗效满意,无严重不良反应,值得推广。
[Objective] To observe the effect of medium frequency electric stimulation combined with acupuncture on gastrointestinal paralysis after abdominal operation. [Method] 80 hospitalized patients were randomly divided into two groups by drawing lots according to the disease sign by random parallel control method. In the control group, 40 cases were treated with routine needling. Gongsun(bilateral), Neiguan,Shangjuxu, Xiajuxu and Zusanli were taken for routine local disinfection. The needle was directly pricked1～1.5 inches with a filiform needle(0.35 mm×50 mm). After getting Qi, the needle was added to relieve diarrhea. The needle was retained for 20 minutes, once per 10 minutes, once a day, five times a week. 40 patients in the treatment group received medium frequency electric stimulation. The sterile gauze was wetted on both sides of the incision. The electrode plate was placed on the gauze at 15 Hz. The electrode triggered the button and gradually increased the current. The patient's tolerance was taken as the standard, twice a day, five times a week. Acupuncture treatment was the same as the control group. Continuous treatment for one week is a course of treatment. Clinical manifestations, gastric retention, recovery time of bowel sounds,disappearance time of abdominal distension, first time of anal exhaust, recovery time of defecation and adverse reactions were observed. One course of treatment(1 week) was used to determine the curative effect. [Result]In the treatment group, 28 cases were markedly effective, 10 cases were effective, 2 cases were ineffective,and the total effective rate was 95.00%. In the control group, 20 cases were markedly effective, 11 cases were effective and 9 cases were ineffective, the total effective rate was 77.50%. The curative effect of the treatment group was better than that of the control group(P<0.05). Gastric retention, recovery time of bowel sounds,disappearance time of abdominal distension, first exhaust time and defecation recovery time in the treatment group were shorter than those in the control group(P<0.01). [Conclusion] Medium frequency electric stimulation combined with acupuncture for gastrointestinal paralysis after abdominal surgery has satisfactory curative effect and no serious adverse reactions, which is worthy of promotion.
[Objective] To observe the effect of medium frequency electric stimulation combined with acupuncture on gastrointestinal paralysis after abdominal operation. [Method] 80 hospitalized patients were randomly divided into two groups by drawing lots according to the disease sign by random parallel control method. In the control group, 40 cases were treated with routine needling. Gongsun(bilateral), Neiguan,Shangjuxu, Xiajuxu and Zusanli were taken for routine local disinfection. The needle was directly pricked1～1.5 inches with a filiform needle(0.35 mm×50 mm). After getting Qi, the needle was added to relieve diarrhea. The needle was retained for 20 minutes, once per 10 minutes, once a day, five times a week. 40 patients in the treatment group received medium frequency electric stimulation. The sterile gauze was wetted on both sides of the incision. The electrode plate was placed on the gauze at 15 Hz. The electrode triggered the button and gradually increased the current. The patient's tolerance was taken as the standard, twice a day, five times a week. Acupuncture treatment was the same as the control group. Continuous treatment for one week is a course of treatment. Clinical manifestations, gastric retention, recovery time of bowel sounds,disappearance time of abdominal distension, first time of anal exhaust, recovery time of defecation and adverse reactions were observed. One course of treatment(1 week) was used to determine the curative effect. [Result]In the treatment group, 28 cases were markedly effective, 10 cases were effective, 2 cases were ineffective,and the total effective rate was 95.00%. In the control group, 20 cases were markedly effective, 11 cases were effective and 9 cases were ineffective, the total effective rate was 77.50%. The curative effect of the treatment group was better than that of the control group(P<0.05). Gastric retention, recovery time of bowel sounds,disappearance time of abdominal distension, first exhaust time and defecation recovery time in the treatment group were shorter than those in the control group(P<0.01). [Conclusion] Medium frequency electric stimulation combined with acupuncture for gastrointestinal paralysis after abdominal surgery has satisfactory curative effect and no serious adverse reactions, which is worthy of promotion.
引文
[1]江志伟,李宁,黎介寿.术后肠麻痹临床表现及病理生理机制[J].中国实用外科杂志,2007,27(9):682-683.
[2]吴东升,董胜利,李凤池,等.腹部手术后肠麻痹的治疗[J].中国微创外科杂志,1997,3(5):26-27.
[3]中华人民共和国卫生部.涉及人的生物医学研究伦理审查办法(试行)[S].(2007-03-26)[2017-05-01].http://www.moh.gov.cn/qjjys/s3581/200804/b9f1bfee4ab344ec892e68097296e2a8.shtml.
[4]吕云福.肠梗阻诊断治疗学[M].北京:人民卫生出版社,2007:55-56.
[5]莫剑忠,王承党.胃肠激素对胃运动的调节作用[J].中华消化杂志,2005,25(6):379-381.
[6]张林,蒋宁,周文霞,等.三种小鼠术后肠麻痹模型的比较研究[J].国际药学研究杂志,2016,43(2):346-350.
[7]江来,孟荣贵,王颢,等.肠梗阻的病因及诊治探讨[J].中华胃肠外科杂志,2001,4(1):34-36.
[8]齐清会.腹部手术后胃肠运动功能紊乱和治疗[J].基础医学与临床,2003,23(S1):11-12.
[9]梅懋华,陈奇,段瑞冬,等.迷走神经兴奋和胃肠激素对胃液、胰液、胆汁分泌调节的相互关系[J].大连医科大学学报,1991,13(2):51-55.
[10]何俊华,杜丽红,曾清华,等.气管插管导管连接水封瓶在肠麻痹患者中的效果观察[J].当代护士(下旬刊),2015(9):33-34.
[11]周仲瑛.中医内科学[M].北京:中国中医药出版社,2004:237.
[12]黄帝内经素问[M].北京:人民卫生出版社,2012:273.
[13]范永升.金匮要略[M].北京:中国中医药出版社,2004:148.
[14]崔延超,吴琼,周灿,等.针刺治疗腹部术后胃肠功能紊乱的疗效[J]中国老年学杂志,2013,33(8):1792-1793.
[15]徐晓月,安声潘,何新芳.《针灸大成》中公孙穴的临床应用探析[J].中医药导报,2018,24(10):70-71.
[16]陈志明.针灸足三里、曲池穴临床运用总结[J].中医外治杂志2007,16(3):28-29.
[17]何国栋,牛伟新,刘寒,等.针刺足三里调控胃肠动力机制的实验研究[J].中华消化杂志,2007,27(11):748-751.
[18]高巍,黄裕新,陈洪,等.电针足三里对大鼠垂体和外周血中脑肠肽含量的影响[J].医学争鸣,2001,22(22):2023-2025.
[19]沈献芳,倪美琴,高力琴.胃肠肿瘤术后穴位注射上巨虚、下巨虚对肠蠕动的效果观察[J].实用临床护理学电子杂志,2017,2(52)145,149.
[20]迟戈,马艳彬,李非,等.中低频电疗法的临床应用[J].中国医疗器械信息,2010,16(11):26-29.
[21]王华.电脑中频治疗仪辅助治疗术后肠麻痹48例临床观察[J].中国肛肠病杂志,2017,37(3):48.
[22]杨筱明.自拟灸疗方合中频治疗麻痹性肠梗阻40例[J].浙江中医杂志,2016,51(1):57.
[23]刘晖.针刺并音频电流治疗术后肠麻痹31例[J].福建中医药,200132(5):18-19.
[2]吴东升,董胜利,李凤池,等.腹部手术后肠麻痹的治疗[J].中国微创外科杂志,1997,3(5):26-27.
[3]中华人民共和国卫生部.涉及人的生物医学研究伦理审查办法(试行)[S].(2007-03-26)[2017-05-01].http://www.moh.gov.cn/qjjys/s3581/200804/b9f1bfee4ab344ec892e68097296e2a8.shtml.
[4]吕云福.肠梗阻诊断治疗学[M].北京:人民卫生出版社,2007:55-56.
[5]莫剑忠,王承党.胃肠激素对胃运动的调节作用[J].中华消化杂志,2005,25(6):379-381.
[6]张林,蒋宁,周文霞,等.三种小鼠术后肠麻痹模型的比较研究[J].国际药学研究杂志,2016,43(2):346-350.
[7]江来,孟荣贵,王颢,等.肠梗阻的病因及诊治探讨[J].中华胃肠外科杂志,2001,4(1):34-36.
[8]齐清会.腹部手术后胃肠运动功能紊乱和治疗[J].基础医学与临床,2003,23(S1):11-12.
[9]梅懋华,陈奇,段瑞冬,等.迷走神经兴奋和胃肠激素对胃液、胰液、胆汁分泌调节的相互关系[J].大连医科大学学报,1991,13(2):51-55.
[10]何俊华,杜丽红,曾清华,等.气管插管导管连接水封瓶在肠麻痹患者中的效果观察[J].当代护士(下旬刊),2015(9):33-34.
[11]周仲瑛.中医内科学[M].北京:中国中医药出版社,2004:237.
[12]黄帝内经素问[M].北京:人民卫生出版社,2012:273.
[13]范永升.金匮要略[M].北京:中国中医药出版社,2004:148.
[14]崔延超,吴琼,周灿,等.针刺治疗腹部术后胃肠功能紊乱的疗效[J]中国老年学杂志,2013,33(8):1792-1793.
[15]徐晓月,安声潘,何新芳.《针灸大成》中公孙穴的临床应用探析[J].中医药导报,2018,24(10):70-71.
[16]陈志明.针灸足三里、曲池穴临床运用总结[J].中医外治杂志2007,16(3):28-29.
[17]何国栋,牛伟新,刘寒,等.针刺足三里调控胃肠动力机制的实验研究[J].中华消化杂志,2007,27(11):748-751.
[18]高巍,黄裕新,陈洪,等.电针足三里对大鼠垂体和外周血中脑肠肽含量的影响[J].医学争鸣,2001,22(22):2023-2025.
[19]沈献芳,倪美琴,高力琴.胃肠肿瘤术后穴位注射上巨虚、下巨虚对肠蠕动的效果观察[J].实用临床护理学电子杂志,2017,2(52)145,149.
[20]迟戈,马艳彬,李非,等.中低频电疗法的临床应用[J].中国医疗器械信息,2010,16(11):26-29.
[21]王华.电脑中频治疗仪辅助治疗术后肠麻痹48例临床观察[J].中国肛肠病杂志,2017,37(3):48.
[22]杨筱明.自拟灸疗方合中频治疗麻痹性肠梗阻40例[J].浙江中医杂志,2016,51(1):57.
[23]刘晖.针刺并音频电流治疗术后肠麻痹31例[J].福建中医药,200132(5):18-19.