国际麻醉学与复苏杂志   2019, Issue (1): 0-0
    
经天枢穴超声电导大承气汤对胃癌根治术患者 术后早期恢复质量的影响
米智华, 董大龙, 于大朋, 王存金, 葛亚丽, 高巨1()
1.扬州大学临床医学院，江苏省苏北人民医院
Effects of ultrasound?蛳mediated drug delivery of Dachengqi decoction through Tianshu(ST25) point on the early recovery quality of patients after radical gastrectomy
 全文:
摘要：

目的　观察经天枢穴超声电导透皮导入大承气汤对胃癌根治术患者术后早期恢复质量的影响。　方法　择期行胃癌根治术的患者120例，采用随机数字表法分为对照组（C组）和超声电导透皮给药组（U组），每组60例。两组均采用常规气管插管全身麻醉，麻醉诱导，术中维持用药相同。C组术后实施常规治疗和护理；U组在C组护理的基础上，选取双侧天枢穴（脐中旁开两寸），采用超声电导仪经皮导入大承气汤，30 min/次，2次/d。治疗结束后继续保留中药贴片30 min。根据患者胃肠道功能恢复情况决定总的治疗时间和次数，直至肛门排气、排便。记录术后首次肠鸣音出现时间、排气时间、排便时间。分别于术前1 d（T0）、术后24 h（T1）、术后48 h（T2）、术后72 h（T3）检测两组患者血浆胃动素（motilin, MTL）、血清胃泌素（gastrin, GAS）含量，并于T0~T3时采用40项恢复质量评分（Quality of Recovery-40, QoR-40）评价两组患者恢复质量。　结果　C组术后首次肠鸣音出现时间、排气时间、排便时间长于U组（P＜0.05）；T1、T2时两组患者血浆MTL、血清GAS含量低于T0时，且U组血浆MTL、血清GAS含量高于C组（P＜0.05）；U组在T1时，C组在T1、T2时，QoR-40的情绪状态、身体舒适度、心理支持、自理能力、疼痛评分及总评分均较T0时下降（P＜0.05），T1、T2时U组各项评分及总评分均高于C组（P＜0.05）。　结论　经天枢穴超声电导透皮导入大承气汤可促进胃癌根治术患者术后胃肠道功能恢复，提高术后早期恢复质量。 结果 C组术后肠鸣音恢复时间、肛门排气时间、排便时间分别为(32.45±5.42)h、(45.12±3.22)h、(49.34±4.71)h，U组分别为(25.32±5.37)h、(25.44±3.56)h、(32.46±3.62)h，C组时间明显长于U组(P＜0.01)；T1～T2时，两组MTL、GAS含量明显低于T0；但U组MTL、GAS明显高于C组，差异有统计学意义(P＜0.05)；U组在T1时，C组在T1、T2时，两组患者QoR-40量表情绪状态、身体舒适度、心理支持、自理能力、疼痛评分以及总评分均较T0时下降（P＜0.05）；在T1、T2时，U组各项评分以及总评分均高于C组（P＜0.05）。 结论 超声电导透皮给药可促进胃癌根治术患者术后胃肠功能的恢复，提高术后早期恢复质量。
关键词： 超声透入疗法；　透皮吸收；　胃癌根治术；　康复；　穴，天枢；　大承气汤
Abstract:

Ｏｂｊｅｃｔｉｖｅ　To observe the effects of ultrasound-mediated drug delivery of Dachengqi decoction through Tianshu (ST25) point on the early recovery quality of patients after radical gastrectomy.　Methods　A total of one hundred and twenty patients who received radical gastrectomy were randomly divided into a control group (group C) and an ultrasound transdermal delivery group (group U) (n=60). The patients in the two groups underwent conventional endotracheal intubation anesthesia, anesthesia induction and maintenance. Group C received routine treatment and nursing after operation, while group U was delivered with Dachengqi decoction through bilateral Tianshu(ST25) point (two inches apart from the umbilicus) under the mediation of ultrasound, 30 min/times and twice/day. After treatment, traditional Chinese medicine patches was retained for 30 min. According to the patients′ gastrointestinal function recovery, the total treatment duration and times were determined until anus exhaust and defecation. The time of bowel sound onset, anus exhaust time, and defecation time were recorded. The levels of plasma motilin (MTL) and serum gastrin (GAS) were measured at 1 day(T0) before operation, 24 h(T1), 48 h(T2), and 72 h(T3) after operation. The quality of recovery was assessed by Quality of Recovry?蛳40(QoR?蛳40) on T0 to T3.　Results　Group C showed remarkably longer bowel sounds appear time, anus exhaust time, and defecation time than group U(P<0.05). The contents of MTL and GAS in the two groups were significantly reduced at T1 and T2 compared with those at T0 (P<0.05), but the contents of MTL and GAS in group U were higher than those in group C(P<0.05). The emotional state, physical comfort, psychological support, self?蛳care ability, pain scores and the total scores of QoR-40 was remarkably reduced for group U at T1 and for group C at T1 and T2 in group C, compared with those at T0 (P<0.05). Group U demonstrated significantly improved emotional state, physical comfort, psychological support, self-care ability, pain scores and the total scores of QoR-40 in comparison with group C at T1 and T2(P＜0.05).　Conclusions　Ultrasound-mediated drug delivery of Dachengqi decoction through Tianshu(ST25) point can promote the recovery of gastrointestinal function in patients after radical gastrectomy and improve the quality of early recovery.
Key words: Phonophoresis therapy;　Transdermal absorption;　Radical gastrectomy;　Rehabilitation;　Point, ST25（Tianshu）;　Dachengqi decoction