针刺治疗溃疡病穿孔的临床研究

【作者】 敖雪仁；

【导师】 郑泽棠；

【作者基本信息】 广州中医药大学 ， 中西医结合临床， 2002， 硕士

【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 g 针刺治疗渍疡病穿孔的临床研究 Qr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。更多还原

【Abstract】 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, twogroups 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 levelThis 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.更多还原