| The gastroenteric function of the patients after abdominal operations of gynecology is more or less inhibited, that make the gastrointestinal peristalsis weaken or disappear, because of the anesthesia, peritoneal irritation, gastrointestinal tensions by operating, a little bleeding and oozing liquid in the cavity of the abdomen after operation, operative trauma, water and electrolytes imbalance, and regulating disturbances of gastrointestinal hormones. In addition, with Women' s physical and psychological traits, having low painful threshold, being more sensitive to diseases, they are afraid of pain and dare not move after operations, therefore the clinical symptoms such as abdominal distention, abdominal pain, anepithymia, nausea and vomiting, thick and greasy fur on tongue, or even abdominal adhesion and intestinal obstruction etc usually appear after abdominal operations of gynecology.Either Traditional Chinese Medicine(TCM) or Western medicine has advantage in curing the patients who have impaired digestion after abdominal operations of gynecology. However, the medical treatments of Western medicine are usually after the patients suffer from abdominal distention, abdominal pain, anepithymia, nausea and vomiting etc. Compare with Western medicine, TCM has more complex treatments and better effective to the patients after abdominal operations. Moreover, TCM can intervene actively and prevent the symptoms such as abdominal distention, abdominal pain, anepithymia, nausea and vomiting etc after abdominal operations. With more and more gynecological operations, there are greater prospects of making full use of the advantages of TCM in perioperafive period.1. Literature researchTCM believes that, compare with traditional diet or overwork damages the function of Spleen and Stomach, the trauma of abdominal surgery is a new modern factor of causing diseases, which has its own pathological characteristic. The pathogenesis mostly concern with stagnation of Qi and stasis of blood, dys-splenism, obstruction of Fu Qi, disturbance of elevation and subsidencei etc. The main principles of treatment are clearing the hollow viscera and purging away the heat, promoting circulation of Qi and dissolving lumps, promoting blood circulation by removing blood stasis, strengthening the spleen and stomach etc. The methods of treatment are taking herbal drugs orally, clystering by herbal drugs, acupuncture and moxibustion etc. However, to the patients who selective operations, we think the key pathogenesis is dysfunction of the spleen in transport, the principles of treatment is resolving Dampness by tonifying Spleen and relieving flatulence by promoting circulation of Qi.Western medicine considers that the reasons for gastrointestinal dysfunction after abdominal operations are various. The key factors are the change of dissective relation, interdiction of parts of the innervation, regulating dysfunction of gastrointestinal hormones and nerves etc. The recent studies have focused on the relationship with gastroenteric movement and gastrointestinal hormones.Motilin(MTL) is a kind of peptide hormones that plays an important role to regulate gastroenteric movement. MTL can stimulate contractions of the organs such as stomach and duodenum, form theⅢof migrating motility complex wave in interdigestive period and fast period, and speed gastric emptying. Related studies show that the level of MTL declines after operations is the key reason for gastroenteric inhibition. Glucagon(GLU) is a kind of peptide containing 29 molecules of amino acids, which can raise blood sugar. GLU is subject to the negative feedback regulation of low blood sugar, which not only inhibites the secretion of gastric acid stimulated by gastrin and histamine, but also weakens the movements of the sphincter of esophagus and stomach, stomach, intestine, and the contraction of gallbladder. Therefor, GLU has the obvious inhibitory action to the gastrointestinal peristalsis. 2. Clinical researchYunpiyin is composed of Cangzhu(12g) Zhishi(12g) Houpu(12g) Huoxiang(12g) Danshen(15g) Huangqi(15g) Chenpi(6g). It can resolve Dampness by tonifying Spleen and relieve flatulence by promoting circulation of Qi. Yunpiyin is worked over by Professor Zhang Yuzhen and other gynecologists from the No. 1 Affiliated Hosptial of Guangzhou University of Traditional Chinese Medicine. It is an experiential prescription, which was used to treat the patients after abdominal operations in our gynecology department for a long time. In fore experimental research, we have found that the improvement of the symptoms, such as abdominal distention, nausea and vomiting etc in treated group was superior to those in control group (P＜0. 01).It indicates that Yunpiyin can shorten the time of anal aerofluxus obviously, promote the disgestive ability of the stomach and intestines afther operation of abdominal gynecology, reduce the occurrence of related complications. However, it is not clear how Yunpiyin treats the patients with gastrointestinal dysfunction after abdominal operations. This research is designed in order to make it clear.All cases are in the Gynecology department of the No. 1 Affiliated Hosptial of Guangzhou University of Traditional Chinese Medicine between October, 2006 and March, 2007. All cases are filtered by enter standard and exclusion standard. 93 patients are filtered and their operation ways are abdominal operations. The anaesthesia way is outside the hard membrane anaesthetize or hard waist union anaesthetize or general anesthesia. The patients after abdominal operations have varying degree symptioms of gastrointestinal dysfunction such as abdominal distention, abdominal pain, anepithymia, nausea and vomiting, thick and greasy fur on tongue etc, the dialectical of TCM is that Spleen Dysfunction due to Dampness. By the stochastic comparison method, 93 patients were divided into the control group(n=33) and the treated group(n=60). Treated group: age ranged from 20 to 68, average (42.18±9.97),the average time of anaesthesia is (2.96±0.73) hours, the average time of operation is (1.81±0.49) hours. Control group: age ranged from 18 to 66, average (39.70±14.06) , the average time of anaesthesia is (3.01±0.94) hours, the average time of operation is (1.97±0.64) hours. Compared with the materials of two groups, such as the patients' ages, the kinds of disease, the time of anaesthesia, the ways and times of operations etc, has no statistics significance(P＞0.05). Two groups were both nursed by routine nursing method. Patients in treated group drank Yunpiyin in the first day after operations, 100ml at a time, twice a day, taking 3 days. But patients in control group drank isometric water. To observe patients' improvement of the symptoms, such as temperature, tongue picture, nausea and vomiting, abdominal distention, abdominal pain and the time of anal aerofluxus etc. We also respectively examine two-group patients' MTL and GLU before operation, the first day morning and the fourth day morning after operations by radioimmunoassay. All data is processed by SPSS 11.0, both t-test and x~2 test are used repectively.3. results(1) The effective rate of treated group is 95.0%, control group' s is 69.7%, there is obvious statistics significance(P＜0. 05).(2) Shorten time of anal aerofluxus and improve the symptoms, such as abdominal distention, nausea and vomiting etc in treated group,were superior to those in control group(P＜0. 05).(3) All patients after operations have a low-level of MTL(P＜0.05) and an increase of GLU(P＜0.05). In the fourth day, compared with the first day, the level of MTL has increased obviously (P＜0. 05),the level of GLU has decreased obviously (P＜0.05) in treated group. There is obvious difference to compared with the control group(P＜0.O5).4. Conclusion(1) Yunpiyin is good for the patients with gastrointestinal dysfunction after abdominal operations. It can shorten the time of anal aerofluxus, reducing the symptoms of abdominal distention, abdominal pain, anepithymia, nausea and vomiting etc.(2) It indicates that the patients after abdominal operations have a low-level of MTL and an increase of GLU. But Yunpiyin can raise MTL and reduce GLU.(3) It indicates that Yunpiyin can stimulate contractions of the organs such as stomach and duodenum, form theⅢof migrating motility complex wave in interdigestive period and fast period, and speed gastric emptying by raising MTL. Moreover, it can release from the inhibitory action of GLU to the gastrointestinal peristalsis by reducing GLU. rhat' s why Ynpiyin can strengthen gastrointestinal digestant, absorptive and kinetic enginery of the patients after operations. More researches are to be made to understand Yunpiyin' s active mechanism. |
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