针刺治疗腹部肿瘤外科术后胃轻瘫的随机对照试验（英文）

针刺治疗腹部肿瘤外科术后胃轻瘫的随机对照试验（英文） 针刺治疗腹部肿瘤外科术后胃轻瘫的随机 对照试验(英文) 扣西医结合学报2010年7月第8卷第7期 JournalofChineseIntegrativeMedicine,July2010.Vo1.8,No.7 OriginalClinicalResearch Acupunctureversusmetoclopramideintreatmentofpostoperative gastr0paresissyndromeinabdominalsurgicalpatients: arandomizedcontrolledtriaI Bao—maSun,MingLuo,Sheng—bingWu,Xiao—xiaChen,Meng.chaoW u DepartmentofIntegratedTraditionalChineseandWesternMedicine.EasternHepatobiliarySurgicalHospita1.SecondMilitary MedicalUniversity,Shanghai200438.China Background:Postoperativegastroparesissyndrome(PGS)isacommoncomplicationafterabdominalsurgery inpatientswithpnmaryIivercancer.However,surgeonsusuaIIYdonoihaveeffectivelreatmenlforihem. Obiective:ToexploretheeffectsofacupunctureapplledtoZusanliandotheracupointsonPGSinpatients afterabdominalsurgery. Design,setting,participantsandinterventions:Sixty—threePGSpatientsof abdominalsurgery.fromEastern HepatobiIiarySurgicalHospital,wererandomizedintoacupuncturegroup(32cases)andmetoclopramide group(31cases).rhepatientsinacupuncturegroupweretreatedwnhacupunctureappliedloZusanliand otheracupo=ntsonceaday?wh_lethepatientsinmeiocIopramjdegroupwereintramUSCUlarlyinjected20ma me{OcIODramidethreetimesaday. Mainoutcomemeasures:VolumeOfgastricdrainage.numberoftreatmentandcurerateinthetwogroups weremeasuredandevaluated. Results:Acupunctureandmetoclopramidecouldsignificantlyreducegastricdrainagevolume. Inacupuncture group,thecureratewas90.6%andthenumberoftreatmentwas6.58?4.26.whileinmetoclopramide group,thecurerateandthenumberofireatmeniwere32.3%and10.134-3.60respectively.Thereweresignifi— cantdifferencesingastricdrainagevolume,curerateandnumberoftreatmentbetweenthetwogroups(P< 0.05,P<O.01).一 Conclusion:AcupunctureisagoodtreatmentforPGS,withfewertreatments. highcurerateandrapideffect Keywords:acupuncturetherapy;abdominalneoplasms;gastroparesis;rand omizedcontrolledtria :641—644. . 2O10. ZhongXiYiJieHeXueBao. 针刺治疗腹部肿瘤外科术后胃轻瘫的随机对照试验 孙保木,罗明,昊胜兵,陈晓霞,吴孟超 第二军医大学东方肝胆外科医院中西医结合科.上海200438 背景:手术后胃轻瘫综合征是腹部手术后常见的并发症,外科医生往往无有效的治疗手段. 目的:探讨针刺治疗腹部肿瘤外科术后胃轻瘫患者的效果. 设计,场所,对象和干预 措施 《全国民用建筑工程设计技术措施》规划•建筑•景观全国民用建筑工程设计技术措施》规划•建筑•景观软件质量保证措施下载工地伤害及预防措施下载关于贯彻落实的具体措施 :选择东方肝胆外科医院63例腹部肿瘤外科手术术后呃逆的患者,随机分成针 刺组32例和胃复安组31例.针刺组采用针刺足三里等穴位治疗.1次/d;胃复安组肌肉注射胃复安20mg, 3次/d. 主要结局指标:观察治疗后胃液引流量及治疗次数和痊愈率. 结果:针剌和胃复安均可显着减少胃液引流量.针刺组痊愈率为90.69/6,平均治疗(6. 58?4.26)次;胃复安 组痊愈率为32.3,平均治疗(10.13~3.6O)次.两组胃液引流量,临床痊 愈率和治疗频次比较,差异有统 81875151 Correspondence:MingI.uo,MD,AssociateProfessor;Tel:021— ;E-mail:luoming6425@sohu.com ? 642?中西医结合学报2010年7月第8卷第7期 JournalofChineseIntegrativeMedicine,July2010,Vo1.8,No.7 计学意义(P<O.05,P<0.01). 结论:针刺可有效治疗腹部肿瘤外科术后胃轻瘫,具有治疗次数少,治 愈率高,奏效快等优点. 关键词:针刺疗法;腹部肿瘤;胃轻瘫;随机对照试验 Postsurgicalgastroparesissyndrome(PGS)is onetypeofgastricfunctionaldisordersmainly manifestedasdelayedgastricemptying.PGS oftenoccursafterresectionofstomach,pancreas, duodenumorgallbladder,whichcanbecuredby conservativetreatmentandwithoutmechanical obstructiont.Becauseitsmainsymptomisdelay ofstomachevacuation,itisalsocalledgastroplegia, delayedgastricemptyingdisease,orgastroatonia, etc.PGSasafrequentpostsurgicalcomplication hasanincreasingincidencerateinrecentyears. Nearly2%to3%ofthepatientswhohadundergone abdominaloperationsufferedfromPGS,which took19%oftheentirePGSincidence.Asthe symptomsofPGSwouldlastforarelativelylong time,ithasagreatimpactonfunctionrecovery andtreatment.Inthisstudy,weperformed acupuncturetherapyin32PGSpatientsand comparedtheresultswithmetoclopramidegroup involumeofgastricdrainage,treatmentfrequency andcurerate. 1ClinicaIdataandmethods 1.1Clinicaldata 1.1.1Studysubof63PG.iectAtotalSpatients whohadundergoneabdominalsurgeryinEastern HepatobiliarySurgicalHospitalbetween2004and 2007wereselectedintothisstudy.A11ofthem hadtherelativesymptomssuchasabdominal distension,nausea,vomitingandrefractory singultus,withdimtongue,whitetonguecoating andweakpulse. 1.1.2DiagnosticcriteriaAllpatientsinthis studywerequalifiedforPGSdiagnosticcriteriaof Chinat2J:(1)Nausea,vomiting,abdominaldistension andwithsuccussionsplashafterliquidorsemi一 1~quiddiet;(2)Drainagefluidfromstomachof over600to800mLperdaylastingfor6to10daysor evenlonger;(3)Testsdeterminenogastric mechanicalobstruction;(4)Gastrointestina1 motilitydecreasesordisappears;(5)Nosevere water,electrolyteandacid.baseimbalance;(6)No medicationwhichmayaffectstomachsmooth musclecontractionafteroperation;(7)Nocom— plicatedbasicdiseasewhichmaycausePGS,suchas diabetes.A11patientsinthisstudywereconfirmed withPGSviamegluminediatrizoate(oraladmin? istrationorbyusinggastrictube)X.rayvisualiza- tionmotionalobservatiOns. 1.1.3IncludingcriteriaPGSpatientsmeeting diagnosticcriteriareceivedconsultationfrom DepartmentofAcupunctureinEasternHepatobiliary Surgica1Hospita1.Cliniciansconsideredthat damageofspleenandstomach,weekspiritand poorbloodsupplywereresponsibleforPGS, whichrepresentedasupperabdominaldiscom. fort,nausea,vomiting,intractablehiccups,dark orgreasytonguecoatingandthinpulse. 1.1.4ExcludingcriteriaPatientswhocouldnot tolerateacupuncturetherapyororaltreatment,or wereallergictometoclopramideorsufferedfrom activebleedingwereexcludedfromthisstudy. 1.2Studymethods 1.2.1StudydesignThe63PGSpatientswere randomlydividedintoacupuncturegroupand metoclopramidegroup. 1.2.2TreatmentmethodsAcupuncturegroup: mainacupointsZhongwan(RN12),Zusanli(ST36), Neiguan(PC6)andSanyinjiao(SP6).Opera— tions:sticking0.30mm×40mmor0.30mm× 50mmstainlesssteelacupunctureneedlesinto acupointsafterregulardisinfection:liftingand thrusting,twirlingandrotatingtheneedleat Nei~uanwithmoderatetostrongstimulationof reducingmethod;liftingandthrusting,twirling androtatingtheneedleatSanyiniiaowithreinforcing method;usemildsupplementingandreducing manipulationofneedlesattheotheracupoints. Retaintheneedlesfor30min.Theabovetherapy wasperformedonceaday.Metoclopramidegroup: intramuscularin{ectionof20mgmetoclopramide threetimesaday(ShanghaiHefengPharmaceutical Co.Ltd..lotNo.H30121522).Gastricdrainage volume(mL/d),therapeuticfrequencyandcure ratewererecordedbeforeandaftertreatment. 1.2.3ObservedindexesTheefficacywas evaluatedaccordingtoreference【副.Recovery:no gastricjuiceoutflow,nonauseaorvomitingafter pullingoutthestomachtube,andthepatientcan takesemi—liquiddiet.Effective:obviousdecrease ingastricdrainagevolume,withoutvomitingbut stillhavenausea.andstillwithstomachtube. Ineffective:nodecreaseingastricdrainage volume,stillhavenauseaandvomiting,andstill withthestomachtube. 1.3StatisticalanalysisDatawereshowninthe formatof?s.thedifferenceswithinorbetween groupswereanalysedbyvarianceanalysisand chi-squaretest. 2Results 2.1BaselinedataTherewere32patients (22malesand10females)intheacupuncture group,withaverageageof(52.23?9.35)years, diseasecourseof(10.45?7.56)days,andgastric drainagevolumeof(1320.3?593.2)mL/d. Therewere31patients(24malesand7females) inthemetoclopramidegroup,withaverageageof (50.34?10.88)years,diseasecourseof(9.56? 6.48)days,andgastricdrainagevolumeof 中西医结合学报2010年7月第8卷第7期 JournalofChineseIntegrativeMedicine,July2010,Vo1.8,No.7?643? (1218.54-498.7)mL/d.Therewasnosignifi— cantdifferencebetweenthetwogroupsinbase— linedata,andnoneofthepatientswithdrewfrom thisstudy.TheflowdiagramisshowninFigure1. }船esseaforeli川脚.,{ HExcluded(n:o)I IRandomized(s)I . /\. Acupuncturegroup(n=32)Metoclopramidegroup(n=31) JJ Finalanalysis(n=32)Finalanalysis(n=31) Figure1Flowdiagramofthisrandomizedtrial 2.2VolumeofgastricdrainageInhomogeneitytest ofvariance.therewasnosignificantdifferencein gastricdrainagevolumebetweenthetwogroups beforetreatment(F===0.563,P>O.O5).There wassignificantdifferencebetweenbeforeand aftertreatmentinthetwogroups(F一1.938, P<0.01).Meanwhile,aftertreatmenttherewas significantdifferenceingastricdrainagevolume betweenthetwogroups(F===2.132,P<0.05). 2.3TherapeuticfrequencyandefficacyA11 patientsintheacupuncturegroupcouldtakesemi. 1iquiddietwithoutvomitingandnauseaafter pullingoutthestomachtube,andtheaverage therapeuticfrequencywas(6.58?4.26)times;in comparison,4patientsinthemetoclopramide groupstillhadstomachtubebutvomiting.freeand withobviousreductioningastricdrainage volume,andthetherapeuticfrequencywas (10.13?3.60)times(F一13.01,P<0.05). Twenty.nineoutof32(90.6%)patientsinthe acupuncturegroupwerecured,theother3of themwerewellimproved.whereasonly10outof 31(32.3%)patientsinthemetoclopramidegroup werecured,another12ofthemwereimprovedand theother9ofthemdidnotgetbetter.Therewas significantdifferenceincureratebetweenthetwo groups(一6.23,P<O.01). 3Discussion PGSoftenoccursafterupperabdominalopera— tion,especiallyafterstomachandpancreas surgery,andisalsoseenafterliverresection.The treatmentistroublesomeasexactmechanismis stillunclear;however,nervoussystemand gastrointestina1motilitydisordersareoftenregarded asthemaincauses.Manyfactorscancausepost- 1iversurgeryPGS.(1)Menta1andnervefactor: mentaltensionwillcausestressreactionwhich evokesthevegetativenervefunctionaldisturbance, especiallyactivatessympatheticfibers,andcannot onlyreducethegastrointestinalmotilitythrough inhibitinggastrointestina1nerveplexus,butalso inhibitthesmoothmusclecontractionanddelay theevacuationascatecholaminedeliveredbysympa. theticnerveendingsmaybindreceptorsonmembrane ofsmoothmusclecellsl41.(2)Surgicaltraumaand stomachvagusnerve1esion:surgerywillcausethe increaseofgastrOintestinalsympatheticnerve excitation,whileliverresectionsurgerymaydamage vagusnerveandaffectthestomachperistalsisand evacuation.(3)Stomachoverexpansionand muscularparalysisduetomuchairandoxygenduring anesthesiabutwithoutgastrointestinaldecompression treatment[ .(4)Inhibitoryeffectofanesthetic andimproperpostoperativefoodtaking,especially high.fatdietwillcausegastrointestinalhormone disturbanceandPGS[.(5)Gastrointestinalpeptide hormonessuchasgastrin,secretin,somatostatin, neurotensin,calcitonin,calcitoningene—related peptide,cholecvstokinin,naladorE1willcause gastricemptyingdelay.(6)Otherfactors: anemia,malnutrition,hypoproteinemia,anaphy— laxis,severeperitonealcavityinfectionand diabetes.Diabetesmaycausetheautonomic neuropathywhichwillresultingastrichypotonus. (7)Liueta1consideredadvancedage,long surgeryduration,postoperat1Veanodyneapplica. tionwerethehighriskfactorsofPGS.Intradi. tionalChinesemedicine bypostsurgeryspleen theory,PGSwascaused andstomachfunction damage,includingdyssplenism,stomachdown— wardpropellingdisorders,arteriesandveinshurt, energystagnancyandbloodstasis. Theacupointswereselectedinthistrialaccording tothetraditionalChinesemedicinerationale. Zhongwanistheacupointoffu—convergence. front—muacupointofstomach,andcrossingpoint ofconceptionvessel,andHand.Taiyang,Shaoyang andFoot.Yangmingmeridians.Neiguanisthe connectingpointofHand.Jueyinmeridian,and crossingpointofyinlinkvesselaswel1.Hand. Jueyinmeridianhastheeffectofsmoothing. ZusanliistheseapointofFoot—Yangming meridian,whileSanyinjiaoisthecrossingpointof Foot.Taiyin,ShaoyinandJueyinmeridians.Modern medicineresearchesfoundthatacupuncturing Zusanlihadtwo.wayaccommodationeffectto stomachperistalsis:acupuncturingZusanliin healthyvolunteersenlargedtheupperandlower innerdiametersandanteroposteriordiameterof gastricantrumandincreasedthefrequencyand extentofgastricperistalticwaveaswell[.Yang e口ZflOlreportedthatelectrostimulationon Zusanliincreasedthegastricelectricalpowerof emptystomachandaftermealwhichindicatedthe enhancementofgastriccontraction.Puncturing Zusanlihastheeffectsofadjustingenergyactivity, increasinggastrictonus,encouraginggastric peristalsis,thusshorteningthegastricemptying time,reinforcingthegastricretentionevacua- tion.Earacupointsofsanjiao,stomach,spleen andsmallintestinecouldinvigoratespleento ?644?中西医结合学报2010年7月第8卷第7期 JournalofChineseIntegrativeMedicine,July2010,Vo1.8.No.7 eliminatedampness,anddredgetripleenergizer, andShenmenandJiaogancouldregulatenerve functions,benefitspleenandregulatestomach,and encouragethegastrointestinalmotilityandfunc— tionalrehabilitationOfPGSpatients. 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