摘要
随着医学的不断发展,人们对生活、生存质量的要求不断提高,在对医疗手段的选择上,将患者的生活、生存质量放在了重要的位置。对胃、十二指肠溃疡病急性穿孔的治疗,历来有不同的主张,如主张施行穿孔修补术、胃大部分切除术、以胃肠减压及针灸为主的非手术疗法等。我国六十年代初便开始运用中西医结合治疗的方法治疗本病。七十年代以来许多医院相继采用了这种方法,并且取得了可喜的进展,但是,绝大部分仅停留在临床治疗总结上,而对治疗机理的探讨较为少见。本论文通过对以针刺为主治疗溃疡病穿孔的疗效观察,探讨其疗效意义及作用机制。
本研究采用前瞻、对照、分组随机化的方法进行,将60例符合纳入标准的患者分为治疗组和对照组,两组的一般资料经统计分析具有可比性。两组患者均按各组的方案进行治疗。临床指标由专人负责观察、记录、汇总,检验指标于治疗前和治疗12小时后各抽血一次,送中心实验室进行监测。结果提示:①在腹痛缓解时间方面,治疗组(24.83±6.58),对照组(55.40±9.28),差异有统计学意义(p<0.01):②在肠鸣音恢复时间上,治疗组(51.41±10.89),对照组(70.38±15.27),差异有统计学意义(p<0.01);③治疗组患者的肛门首次排气时间为(94.67±6.23),对照组为(112.03±10.31),经统计分析,有显著性差异(p<0.01);④两组治疗后的血清胃泌素水平分别是:治
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针刺治疗渍疡病穿孔的临床研究
Q
r圭主王(64.98二士二26,31),>卜工M妄上工(sl.54 tt28.49),妄霎巨圭乡己亏一卜e〕自目至,p<0.of,
表明两者有显著性差异;⑤在血清胃动素方面,治疗前,两者无差异,。
治疗12h 后,治疗组(250。75士刀.38),对照组(313.48上a.72·),经
I
啻
分析有统计学意义…功.m人③通过对两组治疗前后表皮生长因子
水平的检测,发现:泊疗组治疗前后有显著性差异,对照组有差异,。
2
但无统计学意义,而两组治疗后比较则有显著性差异巾功刀 1人
上述研究结果表明,以针刺为主的中西医结合疗法较之一般疗。
法:①可明显缩短腹痛缓解、肠鸣音恢复及肛门首次排气时间,②针-
刺可抑制胃泌素、胃动素的分泌,可提高血清EGF水平,从而有利;
于穿孔的愈合。
Along with the development of medicine, patients put more attention to the quality of subsistence when they select medical treatment.
Generally several different treatments are used to cure Acute Perforation of Gastroduodenal Ulcer, such as gastrorrhaphy, subtotal gastrectomy, and the non-operational method represented by gastrointestinal and acupuncture. Since 1960's, TCM-WM therapy has been put into practice to cure Acute Perforation of Gastroduodenal Ulcer in China. And this method extended in 1970's. Most of non-operational therapy researches rested on summing up clinical experience, and less discussed mechanism. By observing clinical curative effect, this dissertation discuss curative effect and mechanism of the treatment that mainly depends on acupuncture to cure Acute Perforation of Gastroduodenal Ulcer.
Clinical prospective randomized controlled trail is made on 60 cases of Acute Perforation of Gastroduodenal Ulcer. 60 cases are divided into 2 groups at random. Routine is treated on one group, and we added acupuncture therapy on the other. Clinical index is observed, recorded, and stated by same observer. The test index, which is gotten by two times' phlebotomizing, one is before operation and the other is after 12-hour-operation, is inspected in centre clinical laboratory.
The results of this research suggest that:Observing the time of bellyache lenitive, there are marked different scores between acupuncture group(24.83+6.58) and control group(55.40+9.28), and the difference is significant at the 0.01 level; Comparing the time of bowel sound reablement, the difference is significant at the 0.01 level between the acupuncture group(51.41+10.89) and the control group( 70.38+15.27); (3)About the time of the fist anus exhausting, the scores of acupuncture group is 94.67+6.23, which is significantly lower than the one (112.03 + 10.31) of control group;After operation, two
groups get different level of serum gastrin. Acupuncture group is 64.98 +26.31, and control group is 81.54 + 28.49 that is marked higher than another group; There are the same level of blood gastral motilin before operation, and after 12-hour-operation, the significant difference at the 0.01 level is concluded between acupuncture group and control group; By testing the level of epidermal growth factor in fore-and-aft operation, scores show that there are variation in every group but it is out of the statistical significance. Then comparing two groups' level of after operation is found to be marked difference with each other, which is significant at the 0.01 level
This research suggest that to cure Acute Perforation of Gastroduodenal Ulcer, TCM-WM therapy which mainly depends on acupuncture is get better clinical curative effect than typical therapy in the following ways:It can decrease the time of bellyache lenitive, bowel sound reablement and the fist anus exhausting; (2)it can inhibit gastrin, gastral motilin from secretion, and increase the level of blood EOF, so perforation speed healing.
引文
[1]中国人民解放军第一军医大学第一附属医院溃疡病科研协作组.溃疡病的中医分型及其病理基础初探,中医杂志,1980,21(2):17
[2]中医研究院西苑医院,中医辨证分型治疗胃及十二指肠溃疡病40例疗效观察.新医学杂志,1974,(10):35
[3]江苏新医学院.中医学.江苏人民出版社,1972:366
[4]王建华,等,脾胃病患者的中医辨证与胃电图检查结果关系的探讨.中医杂志,1993,,24(6):64
[5]高正末,等,中西医对照分型治疗消化性溃疡.湖北中医杂志,1999,21(7):312
[6]熊槐梧,等,胃病的证治分类.张伯臾主编.中医内科学.第一版.北京:人民卫生出版社,1988:266-271
[7]刘建民,等.中医针药治疗胃、十二指肠溃疡急性穿孔.陕西中医学院学报,1984,(3):27-29
[8]张端兴,等,中西医结合治疗溃疡穿孔160例临床分析.福建中医药,1989,20(1):26
[9]谢晓华,等,通腑泻热灌肠合剂治疗溃疡病急性穿孔58例早期疗效观察.新中医,1998,30(9):37
[10]赵先明,等.溃疡病穿孔的中西医结合治疗体会——附96例临床分析,新中医,1996,(4):21
[11]李志锐,等.通腑解毒汤直肠内缓慢滴注治疗溃疡病单纯穿孔50例:中国中西医结合杂志,1994,14(10):609
[12]陶之理,等,用HRP法探讨胃各部的交感传入神经的节段性分布.针刺研究,1984,4(3):38
[13]汲会贤.从灸公孙穴对胃肠电图变化对观察胃肠功能的调整作用.辽宁中医杂志,1991,18(11):32
[14]邵雷.B超现象观察针刺足三里对胃蠕动的影响.上海针灸杂志,1991,10(1):13
[15]陈演江,等,电针对大鼠胃酸分泌的影响.南京中医学院学报,1990,6(4):47
[16]李瑜元.针刺对胃酸分泌的影响.中华消化杂志,1991,6(6):358
[17]沈德凯,等.电针预防大鼠应激性胃溃疡过程中胃泌素、肥大细胞和粘膜屏障的作用.针刺研究,1995,20(3):46
[18]黄裕新,等.针刺及试餐对健康人胃动素、内皮素分泌人血浆的影响.第四军医大学报,1993,14(6):462
[19]卢燕燕.针刺治疗胃、十二指肠急性穿24孔例.上海针灸杂志,1993,12(1):25
[20]Konturek SJ,etal. Role of epidermal growth fator in healing of chronicgastroduodenal ulers in rats. Gastroenterology 1988; 94:1300-1307