The Clinical Study Of Qi-promoting And Blood-activating Method Combined With Enteral Nutrition In Peri-operative Patients With Anorectal Diseases

Objective:To evaluate the therapeutic efficacy of Qi-promoting and Blood-activating method combined with enteral nutrition on nutritional status, immune function and prognosis in peri-operative patients with anorectal diseases.Methods:Using prospective, randomized controlled study,40 anorectal diseases patients were randomized to two groups:study group (group A, n=20)and control group(group B, n=20).There was no significance difference between the two groups in gender, age, nutritional status of preoperation and pathological changes. Both group were threated with enteral nutrition during peri-operation period, while group A combined with Qi-promoting and Blood-activating method. Body weight (BW), BMI, triceps skinfold thickness(TSF), arm muscle circumference(AMC), albumin(ALB), prealbumin(PA) and transferrin(TF) were determined as nutritional indictors. Immune responses were investigated by IgG, IgA, IgM, CD3+, CD4+, CD8+, CD4+/CD8+. Time of recovery of bowel function and wound healing, postoperative complications were also evaluated.Results:(1) On postoperative day 5, BW,BMI,AMC,TSF in both group were higher than preoperation(P＞0.05), but had no significant difference between the two groups(P＞0.05). On postoperative day 1, ALB,PA,TF in both group were significant lower than preoperation(P＜0.05), while had no significant difference between the two groups(P＞0.05). On postoperative day 5, ALB,TF in both group were higher than postoperative day 1, but only the increase of TF had significance (P＜0.05), and had no significant difference between the two groups (P＞0.05). On postoperative day 5, PA in both group were higher than postoperative day 1 (P＜0.05), while PA in group A was significantly higher than it in group B(P＜0.05). (2)On postoperative day 1, IgG,IgA,IgM,CD3+,CD4+,CD4+/CD8+ in both group were lower than preoperation(P＜0.05), while CD8+ was higher than preoperation(P＜0.05), but had no significant difference between the two groups in all above variables(P＞0.05). On postoperative day 5, IgG,IgA,CD3+,CD4+,CD4+/CD8+ in both group were higher than postoperative day 1 (P＜0.05); CD8+ in group A was lower than it on postoperative day 1 (P＜0.05); meanwhile, IgG,IgA,CD4+,CD4+/CD8+ in group A were significantly higher than that on preoperation (P＜0.05). On postoperative day 5, IgA,CD4+,CD4+/CD8+ in group A were significantly higher than group B(P＜0.05), with CD8+ significantly lower than group B(P＜0.05), but had no significant difference in IgG,IgM,CD3+. (3)The time of recovery of bowel function and wound healing in group A, were significantly shot than group B(P＜0.05), but had no significant difference in the time of the first defecation (P＞0.05). (4) In peri-operative period, the TCM symptom scores of group A was significantly lower than group B(P＜0.05).Conclusions:(1)The using of Qi-promoting and Blood-activating method combined with enteral nutrition can do better in preventing malnutritional status, enhancing the function of immune, compared to the merely using of enteral nutrition in peri-operative patients with anorectal diseases. (2)Qi-promoting and Blood-activating method combined with enteral nutrition have the benefit of promoting bowel function recovery and wound healing, and reducing complications.(3)Qi-promoting and Blood-activating method can enhance the effect of enteral nutrition, but the mechanism is not yet clear, we speculate it may contribute to its function of promoting the absorption of nutrient, and strengthening metabolism, as well as participating in the regulation of the neuroendocrine system and cytokine release.