中医外治法治疗肿瘤术后胃瘫综合征的临床观察

【作者】 莫苑君；

【导师】 左明焕；

【作者基本信息】 北京中医药大学 ， 中西医结合临床， 2011， 硕士

【摘要】 术后胃瘫综合征(PGS)是腹部手术后常见的近期并发症,其发病率近年来有上升的趋势。其发病机制尚未十分明确,可能为多种因素综合作用导致胃和空肠的正常运动受到干扰的结果。随着社会、工业的发展,肿瘤的发病率逐年升高,肿瘤术后胃瘫的发病率也呈现出上升趋势。肿瘤术后胃瘫又有其肿瘤的特殊性,其发病率较其他手术后胃瘫高。西医治疗大多以内科保守治疗为主,但效果不理想,且均有不同程度的弊端。因此,探索一套更有效、便捷、经济、副作用小的治疗方法是当前医务工作者的重要任务。而中医治疗在治疗肿瘤术后胃瘫方面发挥了独特的优势。中医外治法历史悠久,具有药物可以直接通过皮肤、粘膜吸收,操作简单、起效快,疗效直接、耐受性好的优势。在术后胃瘫的治疗上发挥了较好的疗效,但目前文献报道肿瘤术后胃瘫与普通外科术后胃瘫治疗相似,而肿瘤术后胃瘫又具有其特殊性,治疗方法上应与普通外科术后胃瘫有所不同。导师及课题组根据临床经验,采取中药外敷、艾灸及中药灌肠相结合的以温通为主的中医外治法,取得了很好的临床疗效。目的：通过对应用以温通为主的中医外治法治疗肿瘤术后胃瘫患者的主要症状、卡氏评分、胃功能恢复时间进行观察,分析其治疗方法及用药特点,从而对现有的中医临床治疗方案做出系统评价,探索一条治疗肿瘤术后胃瘫的最佳治疗道路,丰富对该病的临床治疗手段,并对导师的学术思想、用药特点进行初步的归纳总结。方法：采用回顾性的研究方法,观察符合纳入标准的2005年1月-2011年1月共30例来自北京中医药大学东方医院肿瘤科住院病房或门诊的肿瘤术后胃瘫患者,予芳香类药物研成粉末外敷中脘穴和神阙穴配合艾灸及中药灌肠治疗,总结治疗前和治疗后第1天、第3天、第7天、第14天、第30天的腹胀、腹痛、恶心呕吐、饮食等临床症状、胃引流量的变化,对所观察收集的全部临床资料以SPSS17.0统计软件建立数据库,进行统计学分析,以观察中医外治法的临床疗效和对生活质量的影响,结果：治愈：28例(93.33%),好转：1例(3.33%),无效：1例(3.33%)。总有效率96.67%。其中从接受中医外治法治疗后至患者拔出胃管恢复进食时间最短为6天,最长为30天。平均13.21±6.27天恢复胃肠功能。经治疗1周后患者临床症状明显缓解。结论：以温通为主要治法、选择温阳健脾、行气化瘀类中药,选用中药外敷、艾灸及灌肠相结合的中医外治法改变了传统的口服给药的用药途径,避开了肿瘤术后胃瘫患者因不能进食而造成的口服药物困难的难题,是一种疗效好,显效快、操作简便、无毒副作用、无创、耐受性好的治疗方法,普遍适用于广大肿瘤术后胃瘫患者,尤其对于年纪较大、体质虚弱的患者。其疗效明确,能够明显改善患者症状,提高患者生活质量,缩短住院时间,减少住院费用,是一种值得推广的方法。更多还原

【Abstract】 Postsurgical gastroparesis syndrome (short for PCS) is a common complication of abdominal operation. The incidence rate of the PCS is on the increase for the past few years. Its pathogenesis has not been explained very clear, and comprehensive effect for a variety of factors may cause stomach and jejunal normal movements interferential.Because of the tumor, Oncolgy postsurgical gastroparesis syndrome has its particularity, and its incidence is higher. Western medicine therapy conservative treatment is given priority to, but its effect to be slow, cost expensive, and different levels of side effects. Therefore, to explore a more effective, convenient, economy and less side effects of the treatment is the medical workers important tasks. And the TCM treatment plays a certain advantages in this area, but the present literatures report that the treatment to PGS after tumor surgery is similar to ordinary surgery, with the difference between.them, they should be separate discussed. Combined with the tutor’s years clinical experience, the combination of methods of Chinese medicine enema, external therapy and moxibustion, make a very good clinical curative effect.Objectives:Through the clinical observation, to observe the improvement of major symptoms, K. P. S in different stage and gastric function recovery after application of TCM, analyze its treatment and medication characteristics, thus TCM clinical treatments make systematic evaluation, explore a best treatment, and rich clinical treatments for the disease. At the same time, make a preliminary generalization of the academic thoughts of the tutor and characteristics of the medicine used.Methods:This subject uses retrospect study research to research the 30 cases from eastern hospital Beijing university of Chinese medicine in January 2005 January 2011, summarize the clinical symptoms change before and after treatment, in order to observe the clinical efficacy and accelerate the influence of quality of life.Results: Total effectiveness rate is 96.67%.The cure:16 cases (53.3%), improve:14 cases (43.33%), invalid:lcases (3.33%). The shortest time from accepting treatment to pulling the gastric tube feeding is 6 days, and the longest is 30 days. Average day is 13.21±6.27. After a week treatment the clinical symptoms alleviate obviously.Conclusion:With warming yang and strening the spleen, acting qi and promoting blood circulat iong, The combination method of Chinese medicine enema, external therapy and moxibustion is a simple operation, non-toxic side effects, noninvasive, well tolerated and economic treatment.It can be generally used on the majority of patients and gets marked curative effect. With significantly improving patients symptoms and the quality of life, shortening the length of time and reducing the charge, it is a kind of "green therapy" method which is worth popularizing.更多还原