本文選題：快速康復(fù) + 電針��； 參考：《廣州中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的:基于快速康復(fù)理念下,對(duì)肝外膽道結(jié)石行微創(chuàng)治療的患者術(shù)后進(jìn)行電針足三里、上巨虛配合吳茱萸熱熨腹部治療,觀察其術(shù)后胃腸功能恢復(fù)情況及安全性指標(biāo),術(shù)后胃腸恢復(fù)情況包括術(shù)后肛門首次排氣、排便時(shí)間及恢復(fù)全流飲食時(shí)間等主要指標(biāo),然后進(jìn)行系統(tǒng)評(píng)價(jià),探討針?biāo)幹委熢诳焖倏祻?fù)外科中的臨床意義,為臨床應(yīng)用中醫(yī)特色外治法治療術(shù)后胃腸功能障礙加快術(shù)后康復(fù)提供依據(jù)。方法:選取2016年1月至2016年12月至廣州中醫(yī)藥大學(xué)第一附屬醫(yī)院肝膽外科(三外科)收治住院治療,診斷為肝外膽道結(jié)石(即膽囊結(jié)石或膽囊結(jié)石并膽總管結(jié)石)并行微創(chuàng)手術(shù)治療的患者,運(yùn)用簡(jiǎn)單隨機(jī)法分為實(shí)驗(yàn)組(電針足三里、上巨虛聯(lián)合吳茱萸熱熨組)30例,對(duì)照組(常規(guī)基礎(chǔ)治療組)30例。圍手術(shù)期均運(yùn)用快速康復(fù)理念:術(shù)前均采取術(shù)前宣教、縮短禁食禁飲時(shí)間、無需腸道準(zhǔn)備等措施;術(shù)后對(duì)照組給予常規(guī)基礎(chǔ)治療,主要包括:肝膽外科術(shù)后常規(guī)護(hù)理、抗生素使用,護(hù)肝,護(hù)胃,常規(guī)補(bǔ)液營養(yǎng)支持,維持水電解質(zhì)平衡等。實(shí)驗(yàn)組在對(duì)照組治療的基礎(chǔ)上加電針足三里、上巨虛聯(lián)合吳茱萸熱熨腹部治療。觀察并記錄兩組患者術(shù)后胃腸功能恢復(fù)相關(guān)指標(biāo)及安全性指標(biāo),結(jié)合臨床觀察量表收集數(shù)據(jù),對(duì)兩組所得數(shù)據(jù)進(jìn)行統(tǒng)計(jì)、分析并總結(jié),驗(yàn)證針?biāo)幝?lián)合治療對(duì)肝外膽道結(jié)石微創(chuàng)手術(shù)患者術(shù)后胃腸功能的療效。結(jié)果:1.兩組數(shù)據(jù)一般情況及手術(shù)相關(guān)資料比較:統(tǒng)計(jì)學(xué)意義上,實(shí)驗(yàn)組和對(duì)照組之間無差異;2.兩組數(shù)據(jù)術(shù)后胃腸功能恢復(fù)比較:較之對(duì)照組患者,實(shí)驗(yàn)組患者術(shù)后首次排氣排便時(shí)間、恢復(fù)全流飲食時(shí)間明顯縮短,且差異有統(tǒng)計(jì)學(xué)意義(P0.05);實(shí)驗(yàn)組患者住院天數(shù)及術(shù)后住院天數(shù)均有所縮短,但差異不具有統(tǒng)計(jì)學(xué)意義(P0.05)。3.兩組數(shù)據(jù)安全性評(píng)價(jià):兩組均未發(fā)生圍手術(shù)期死亡或麻醉及心血管意外事件,無不良反應(yīng)出現(xiàn)。在術(shù)前1天,術(shù)后第1、3天進(jìn)行血常規(guī)、肝功能、腎功能、電解質(zhì)檢測(cè),比較白細(xì)胞總數(shù)(WBC)、中性粒細(xì)胞百分比(NEUT%)等血常規(guī)主要指標(biāo);谷丙轉(zhuǎn)氨酶(ALT)、谷草轉(zhuǎn)氨酶(AST)、總膽紅素(TB)等肝功能主要指標(biāo),肌酐(CR)等腎功能指標(biāo);鉀離子(K+)等電解質(zhì)主要指標(biāo),結(jié)果顯示P0.05,兩組間比較無明顯差異。4.經(jīng)t檢驗(yàn)、方差分析及卡方檢驗(yàn),實(shí)驗(yàn)組與對(duì)照組相比較,實(shí)驗(yàn)組在促進(jìn)腹部術(shù)后胃腸功能恢復(fù)方面優(yōu)于對(duì)照組。結(jié)論:電針足三里、上巨虛聯(lián)合吳茱萸熱熨腹部治療肝外膽石癥微創(chuàng)手術(shù)治療安全可靠,且在改善患者術(shù)后胃腸功能有積極作用,并在一定程度上可改善患者術(shù)后胃腸癥狀。
[Abstract]:Objective: to observe the recovery of gastrointestinal function and safety index of patients with extrahepatic cholelithiasis treated by electroacupuncture in Zusanli, Shangju Xu combined with rutaecarpa fever ironing abdomen based on the idea of rapid rehabilitation. The recovery of gastrointestinal tract after operation included the first exhaust of anus, the time of defecation and the time of recovery of whole flow diet. Then, the clinical significance of acupuncture and medicine in rapid recovery surgery was discussed. To provide the basis for clinical application of traditional Chinese medicine special external treatment for postoperative gastrointestinal dysfunction to speed up postoperative rehabilitation. Methods: from January 2016 to December 2016, the first affiliated Hospital of Guangzhou University of traditional Chinese Medicine, Department of Hepatobiliary surgery (third surgery), was selected to be hospitalized. Patients diagnosed as extrahepatic cholelithiasis (i.e. gallstone or cholecystolithiasis combined with choledocholithiasis) and minimally invasive surgical treatment were divided into experimental group (electroacupuncture Zusanli, Shangjuxu combined with rutaecarpa fever ironing group, 30 cases). Control group (routine basic treatment group, 30 cases). During the perioperative period, the idea of rapid rehabilitation was adopted: preoperatively, the duration of fasting and drinking was shortened, and no bowel preparation was required, while the control group was given routine basic treatment, including routine nursing after hepatobiliary surgery. Antibiotic use, liver protection, stomach protection, routine rehydration nutrition support, maintain water electrolyte balance, etc. The experimental group in the control group on the basis of electroacupuncture Zusanli, Shangjuxu combined with Evodia rutaecarpa abdominal ironing treatment. The related indexes and safety indexes of gastrointestinal function recovery were observed and recorded in the two groups. The data collected from the clinical observation scale were collected, and the data obtained from the two groups were analyzed and summarized. Objective: to evaluate the effect of combined acupuncture and medicine on gastrointestinal function in patients with extrahepatic cholelithiasis after minimally invasive operation. The result is 1: 1. Comparison of general data and surgical data between the two groups: statistically, there was no difference between the experimental group and the control group. Comparison of postoperative gastrointestinal function recovery between the two groups: compared with the control group, the first time of exhaust defecation and the time of recovery of whole stream diet in the experimental group were significantly shorter than those in the control group. The difference was statistically significant (P 0.05), the days of hospitalization and postoperative hospitalization of the patients in the experimental group were shortened, but the difference was not statistically significant (P 0.05). Data safety evaluation: no perioperative death, anaesthesia and cardiovascular accident occurred, and no adverse reactions occurred in both groups. Blood routine examination, liver function, renal function and electrolytes were performed 1 day before operation and 3 days after operation. The main indexes of blood routine such as WBCU, neutrophil percentage and neuter (neuter) were compared. Alanine aminotransferase (alt), alanine aminotransferase (AST), total bilirubin (TB), renal function (CRK) and potassium ion (K) were the main indexes of liver function. The results showed that there was no significant difference between the two groups. By t test, variance analysis and chi-square test, compared with the control group, the experimental group was superior to the control group in promoting the recovery of gastrointestinal function after abdominal surgery. Conclusion: electroacupuncture of Zusanli, Shangjuxu combined with rutaecarpa fever and abdominal ironing is safe and reliable in the treatment of extrahepatic cholelithiasis, and has a positive effect on improving the gastrointestinal function of the patients after operation, and to some extent can improve the postoperative gastrointestinal symptoms of the patients.
【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R657.4

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 劉海維;呂小芹;周希環(huán);孫瑩瑩;紀(jì)棟棟;;加速康復(fù)外科措施對(duì)膽石癥手術(shù)患者的影響[J];齊魯護(hù)理雜志;2016年20期

2 周洋;董聯(lián)玲;;中醫(yī)熱熨法的研究進(jìn)展[J];實(shí)用醫(yī)技雜志;2016年09期

3 魏強(qiáng);陳強(qiáng)譜;歐琨;張興元;管清海;張帆;成雨;呂小芹;周希環(huán);盧艷敏;趙寶磊;;加速康復(fù)外科在膽道外科圍手術(shù)期應(yīng)用的臨床研究及體會(huì)[J];世界華人消化雜志;2016年25期

4 鄭凱欣;許銳銳;韓慧;吳成亮;陳耿臻;;單孔與多孔腹腔鏡膽囊切除術(shù)的安全性Meta分析[J];中華腔鏡外科雜志(電子版);2016年03期

5 余建中;胡常明;胡曉華;;快速康復(fù)外科在肝膽管結(jié)石圍術(shù)期的應(yīng)用[J];肝膽外科雜志;2016年02期

6 解龍;簡(jiǎn)闖;紀(jì)樂;鞏鵬;;單孔腹腔鏡與傳統(tǒng)多孔腹腔鏡膽囊切除術(shù)療效對(duì)比薈萃分析[J];大連醫(yī)科大學(xué)學(xué)報(bào);2016年02期

7 蔡清倫;陳翔;牟燕;樊福勝;;開腹膽囊切除術(shù)與腹腔鏡膽囊切除術(shù)治療膽囊結(jié)石的術(shù)后并發(fā)癥分析[J];現(xiàn)代醫(yī)藥衛(wèi)生;2016年07期

8 徐艷萍;鄧霄玲;;神闕穴外治法對(duì)腹部術(shù)后胃腸功能恢復(fù)的臨床觀察[J];中國中醫(yī)藥現(xiàn)代遠(yuǎn)程教育;2016年05期

9 伊鑫;魯志華;邱博;鄭立杰;張安紅;馬杰;姜遠(yuǎn)輝;;加速康復(fù)外科在膽石癥圍手術(shù)期應(yīng)用的前瞻性研究[J];中國現(xiàn)代普通外科進(jìn)展;2016年02期

10 江志偉;黎介壽;;規(guī)范化開展加速康復(fù)外科幾個(gè)關(guān)鍵問題[J];中國實(shí)用外科雜志;2016年01期

相關(guān)會(huì)議論文 前2條

1 蔡炳勤;劉明;;中醫(yī)手術(shù)觀[A];中國中西醫(yī)結(jié)合學(xué)會(huì)圍手術(shù)期專業(yè)委員會(huì)成立大會(huì)暨第二屆全國中西醫(yī)結(jié)合圍手術(shù)期醫(yī)學(xué)專題研討會(huì)論文集[C];2007年

2 馬必生;;圍手術(shù)期中西醫(yī)結(jié)合研究的內(nèi)容與進(jìn)展[A];第七屆全國中西醫(yī)結(jié)合普通外科臨床及基礎(chǔ)研究學(xué)術(shù)會(huì)議論文匯編[C];2001年

相關(guān)碩士學(xué)位論文 前2條

1 李佳美;基于快速康復(fù)外科理念的麻醉管理在結(jié)直腸外科手術(shù)患者的應(yīng)用[D];吉林大學(xué);2016年

2 郭永強(qiáng);CO_2氣腹、免氣腹技術(shù)及常規(guī)開腹對(duì)兔胃腸運(yùn)動(dòng)影響及比較[D];鄭州大學(xué);2011年

，

本文編號(hào)：2016384