The Study Of Evaluation Method Of The Effect Of Traditional Chinese Medicine Treatment Of Abdominal Postoperative Recovery Of Gastrointestinal Function

Objective:This topic used the method of literature study and retrospective study, to analyze the curative effect of traditional Chinese medicine treatment of abdominal postoperative recovery of gastrointestinal function, and to analyze perioperative evaluation indicators of gastrointestinal function, which to develop scientific and normative gastrointestinal function after surgery for perioperative evaluation standard.Methods:1. A literature studyWith the computer retrieval of CBM, CNKI, VIP, Pudmed, collect evaluation indicators and clinical randomized controlled trials of abdominal postoperative gastrointestinal functional recovery of traditional Chinese medicine treatment from2000to2013. According to the Cochrane Handbook5.2to evaluate the methodological quality of included in the research on bias risk assessment, and uses the RevMan5.2Meta analysis.2. A retrospective clinical studyWith the method of retrospective survey, collect the clinical data, a total of300cases between January2011and April2013of gynecology, liver and gallbladder surgery, gastrointestinal surgery of abdominal postoperative patients. Records related to gastrointestinal function in patients with abdominal postoperative evaluation indicators and postoperative syndrome elements of traditional Chinese medicine, summarizes the gastrointestinal function after surgery for abdominal common indicators of evaluation methods, analysis of abdominal postoperative gastrointestinal functional recovery of traditional Chinese medicine treatment through different evaluation indicators and postoperative syndromes distribution rule.Results:1. A literature study(1) Summarizes the evaluation indicatorsAccording to the search strategy, eliminates duplicate documents, and finally912papers have been left, which concluded the main objective indicators:bowel sound recovery time, anus exhaust time, anus bowel movement time; the main subjective indicators:abdominal distension, abdominal pain, vomiting, nausea, incidence of abdominal distension and clinical symptoms/signs integral; the main laboratory indicators:motilin, gastrin, vasoactive intestinal peptide, electrogastrogram, X-ray and substance P.(2) Included in the study of evaluation systemAccording to the search strategy,12randomized controlled trials were included finally, with Meta-analysis evaluated the efficacy of Chinese medicine treatment of gastrointestinal function recovery. Compared to the abdominal postoperative routine western medicine, Chinese medicine treatment in a shortened bowel sound recovery time, anus exhaust, defecation time, feeding time and reduce the incidence of abdominal distension has an advantage (P<0.05).2. A retrospective clinical study(1)300cases of abdominal postoperative patients with gastrointestinal function evaluation methods of frequency from high to low in turn is:the anus bowel movement time (100%), anal exhaust time (99%), bowel sounds recovery time (89.3%), abdominal distension (89%), nausea (82.3%), vomiting (82.3%), abdominal pain (73.7%); no laboratory evaluation indicators.(2) Recovery time of postoperative gastrointestinal function shows: Gynecologic surgery group in76.1%of patients within48h restore bowel sounds,86%of patients restore the anus exhaust within48h,86%of the patients restore the anus bowel movement after48h,50%of patients restore the anus bowel movement in48h~72h. Liver and gallbladder surgery group in57.6%of patients within48h restore bowel sounds,53.1%of patients restore the anus exhaust within48h,78%of the patients restore the anus bowel movement after48h,56%of the patients restore the anus bowel movement after72h; Gastrointestinal surgery group in56.3%of patients within48h restore bowel sounds,53.5%of patients restore the anus exhaust within48h,77%of the patients restore the anus bowel movement after48h,43%of the patients restore the anus bowel movement after72h.(3) Analysis of different treatment methods on the gastrointestinal functional recovery:after gynecological surgery foundation treatment+traditional Chinese medicine internal treatment compares with the foundation treatment, foundation treatment+traditional Chinese medicine external treatment and foundation treatment+traditional Chinese medicine internal and external treatment, the result of the bowel sounds recovery time difference was statistically significant(P<0.05), while there was no statistically significant difference on the anus exhaust, defecation time(P>0.05). After liver and gallbladder surgery foundation treatment+traditional Chinese medicine internal treatment compares with the foundation treatment, foundation treatment+traditional Chinese medicine external treatment and foundation treatment+traditional Chinese medicine internal and external treatment, the results of the bowel sounds recovery time and the anus bowel movement time differences were statistically significant(P<0.05); the foundation treatment and foundation treatment+traditional Chinese medicine internal treatment compares with foundation treatment+traditional Chinese medicine external treatment and foundation treatment+traditional Chinese medicine internal and external treatment, the result of the anus exhaust time difference was statistically significant(P<0.05). After gastrointestinal surgery the foundation treatment and foundation treatment+traditional Chinese medicine internal treatment compares with foundation treatment+traditional Chinese medicine external treatment and foundation treatment+traditional Chinese medicine internal and external treatment, the result of the anus bowel movement time difference was statistically significant (P<0.05), and bowel sounds recovery time and the anus exhaust time results showed that there was no statistically significant difference(P>0.05).(4) Postoperative TCM syndrome classification shows:The percentage of excessive syndrome of abdominal postoperative patients is55.4%. The percentage of intermingled deficiency and excess syndrome is32.6%The percentage of deficiency syndrome is12.0%. In excessive syndrome, the scale of FU OI being robstructed syndrome is76.9%. In the type of intermingled deficiency and excess syndrome, the scale of Spleen deficiency and dampness syndrome is53.6%. The scale of stagnation of liver-QI with deficiency of the spleen syndrome is39.3%; In deficiency syndrome, the scale of spleen deficiency is74.2%.Conclusion:1. A literature study(1) Clinically used for recovery of gastrointestinal function evaluation indicators are scattered, there are no uniform and normative evaluation indicators. The study of the summary of evaluation indicators shows: evaluation indicators include objective indicators, subjective indicators and laboratory indicators. Objective indicators mainly include bowel sound recovery time, anus exhaust time and anus bowel movement time; subjective indicators mainly include abdominal distension, abdominal pain, vomiting, nausea, incidence of abdominal distension and clinical symptoms/signs integral; laboratory indicators mainly include motilin, gastrin, vasoactive intestinal peptide, electrogastrogram, X-ray and substance P.(2) System evaluation research shows:traditional Chinese medicine for abdominal postoperative gastrointestinal function recovery is effective, but the quality of literature methodology is low which has potential publication bias. For the further objective evaluation of efficacy and safety traditional Chinese medicine to treat gastrointestinal function after abdominal surgery, high quality clinical research in the future is needed, and the standard and normalization of evaluation indicators is an important link of high quality research.2. A retrospective clinical study(1) Evaluation indicators of abdominal postoperative gastrointestinal function include subjective indicators (nausea, vomiting, abdominal distension, abdominal pain) and objective indicators (bowel sound recovery time, anus exhaust time and defecation anus), and the main indicators are the anus bowel sounds, anal exhaust time, defecation time recovery time and abdominal distension.(2) After abdominal surgery on the first day and the next day mainly observe the patient’s bowel sounds and anal exhaust, and on the third day or more than three days mainly observe the patient’s anus bowel movements.(3) Analysis of different treatment methods on the gastrointestinal functional recovery shows:traditional Chinese medicine internal treatment has a promoting effect to gastric bowel function. For the further objective evaluation of efficacy traditional Chinese medicine to treat gastrointestinal function, need to make a evaluation standard of gastrointestinal function for clinical use, and take the objective indicators and subjective indicators combined with laboratory indicators.(4) Abdominal postoperative patients with TCM syndrome classification is given priority to FU QI being robstructed syndrome in the excessive syndrome, and deficiency syndrome is given priority to spleen deficiency. And postoperative easily leads to liver depression, phlegm dampness, blood stasis. According to its characteristics, formulate evaluation indicators with TCM characteristic in the future.