【作者】 范丽丽；

【导师】 黄彬；

【作者基本信息】 广州中医药大学 ， 中医内科学， 2009， 硕士

【摘要】 一、目的:观察推按运经仪治疗对微创保胆取石术后患者胆囊壁厚度、胆囊收缩率及结石复发情况的影响;对家兔行推按运经仪治疗,观察对其胆囊大小、胆囊平滑肌胆囊收缩素A(CCK-A)受体基因表达的影响,探讨推按运经仪的作用机理,为临床应用该仪器防治胆囊结石提供更合理的方法和科学依据。二、方法:本研究分为临床研究及动物实验两部分。临床研究中全部73例研究对象均为深圳市中医院从2006年10月至2008年5月,行微创保胆内镜取石手术治疗的患者,采用随机单盲法,在随机数字表上连续选73个随机数,按照患者入院先后顺序,每个患者对应一个随机数,奇数纳入治疗组,共38例;偶数纳入对照组,共35例。治疗方法:患者取石术后1个月开始进行推按运经仪治疗,空腹12h后于当天上午8:30进食脂肪餐(2个油煎鸡蛋),15min后上机,取头低足高(约15°)左侧卧位,采用极板治疗方式,1个电极安放于右侧胆俞,另1个电极安放于右侧胆囊点,选用Ⅰ频输出。每次治疗30min,每月1次,总疗程为1年。观察治疗组与对照组在胆囊壁厚度、胆囊收缩率及结石复发情况的差异,然后采用SPSS 10.0统计软件进行结果分析。动物实验选取新西兰大耳白兔28只(广州中医药大学实验动物中心提供,Ⅰ级),体重2.0-2.5kg,雌雄兼用,随机分为3组,喂养方式相同。空白组不行推按运经仪治疗;实验1组禁食12小时后行推按运经仪治疗1次,取胆囊壁组织;实验2组每日每只空腹时行推按运经仪治疗1次,连续7日,后取胆囊壁组织。治疗方法:固定动物,取仰卧位,选取右侧胆俞、期门两穴,选取Ⅱ频,采用极板治疗,每次治疗20min,刺激强度控制在5-15之间。测量各组家兔胆囊体积及胆囊平滑肌CCK-A受体基因表达的差异,并采用SPSS 10.0统计软件进行结果分析。三、结果:1、临床两组资料经过t检验,P＞0.05,没有显著性差异,具有可比性。2、临床疗效评定:胆囊壁厚度比较结果为对照组＞治疗组;胆囊收缩率比较结果为对照组＜治疗组;临床疗效上有统计学意义(P＜0.05)。胆囊结石复发情况对照组1例,治疗组无复发。说明治疗组疗效优于对照组。3、动物实验结果:胆囊体积比较实验1组、实验2组均＜对照组,胆囊壁CCK-A受体基因表达实验1组、实验2组均＞对照组,疗效上有统计学意义<P＜0.05);实验1组、实验2组在以上两指标比较中无显著性差异(P＞0.05)。说明治疗组在这两项指标的调节作用方面强于对照组,且连续治疗较单次治疗对该指标影响无显著影响。四、结论:对微创保胆取石术后患者行推按运经仪治疗可有望降低胆囊结石复发率。该仪器通过增强胆囊平滑肌CCK-A受体基因表达,来加强胆囊收缩功能、增加胆汁排泄,并减轻胆囊壁炎症达到预防胆囊结石复发的目的。说明了临床应用推按运经仪的科学性与可行性,值得在临床上进一步推广应用。更多还原

【Abstract】 Objective:Observe the influence of the pushing-palpating channel-moving apparatus on the index of gallbladder volume and shrinkage of patients after the mini-invasive endoscopic stone extraction.By the treatment of pushing-palpating channel-moving apparatus on rabbit,we observe the influence of its Gallbladder size and the expression of CCK-AR mRNA in the gallbladder smooth muscle.From the kinetic point of view we investigate the mechanism of the pushing-palpating channel-moving apparatus,provide a more rational approach and scientific basis for clinical application of this apparatus.Methods:This research is divided into clinical research and animal experiments. The total 73 research objects of the clinical research are the patients of the mini-invasive endoscopic stone extraction treatment in TCM Hospital of Shenzhen City from 2006.10 to 2008.5,use randomized single-blind method, select 73 random number continuously in random number table.In accordance with the order of patients admitted to hospital,each corresponding to a random number,odd-numbered into the treatment group,that is,38 cases of treatment group;Even included in the control group,that is,35 cases of conventional treatment.We treat the treatment group with the pushing-palpating channel-moving apparatus one month after stone extraction,they eat the fat meals at 8:30am that day 12 hours after an empty stomach,and do treatment after 15 minutes,Take the head low-foot high(about 15°) left lying,use the electrode plate treatment,an electrode placed on the right side of DanShu, another Placed in the Gallbladder point,select the I Output frequency.Each treatment last for 30 minutes,one times a month,the total course of treatment is one year.Observe the differences of the Gallbladder wall thickness and shrinkage function between treatment group and control group,then use SPSS10.0 to analyze the result.We select 28 New Zealand rabbits for animal experiment(provided by Guangzhou University of Traditional Chinese Medicine Laboratory Animal Center,I-class),the weight is 2.0-2.5kg of either sex, randomly divided into 3 groups,use the same feeding patterns.The blank group do not use the pushing-palpating channel-moving apparatus treatment. Experiment group 1 use the pushing-palpating channel-moving apparatus treatment once 12 hours after Fasting,extract the gallbladder wall. Experiment group 2 use the pushing-palpating channel-moving apparatus treatment once a day only during Fasting,lasting 7 days,then extract the gallbladder wall.The treatment method is fixing animals in supine position, select the right DanShu and QiMen,use I Output frequency.We use pushing handle and Plate treatment,20min for each treatment,Control the stimulus intensity between 5—15.measure the difference of its Gallbladder size and the expression of CCK-AR mRNA in the gallbladder smooth muscle of Rabbits in each group,then use SPSS10.0 to analyze the result.Results:1.After two sets of clinical data t-test,P>0.05.There were no significant differences,they are comparable.2.Evaluation of clinical efficacy:the compare result of Gallbladder wall thickness is the control group > the treatment group;the compare result of gallbladder shrinkage function is the control group < the treatment group. Gallstone recurrence of the situation is:1 cases of the control group, treatment group,no recurrence.Description is that the treatment group is better than the control group.3.The results of animal experiments:the compare result of gallbladder volume and the expression of CCK-AR mRNA in the gallbladder smooth muscle is that experiment group 1 and experimental group 2 both < control group.It has statistics Significance(P<0.05).Experiment group 1 and experimental group 2 have no significant difference(P>0.05).This illustrate that treatment group in these two aspects of the regulating role of indicators is better than the control group,and compared with single treatment,continuous treatment has no significant influence.Conclusion:The treatment for patients after the mini-invasive endoscopic stone extraction has the potential to reduce the recurrence of gallstone.By enhance the expression of CCK-AR mRNA in the gallbladder smooth muscle,this apparatus can strengthen gallbladder shrinkage function and increase Bile excretion to prevent gallstone recurrence.It illustrate the Scientific and feasibility of the pushing-palpating channel-moving apparatus Clinical Application. Worthy of further promotion in the clinical application. KEYWORDS pushing-palpating channeI-moving apparatus;Gallstone;Recurrence Prevention;the expression of CCK-AR mRNA in the Gallbladder wall更多还原