| Objective: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 at present.However,Western medicine congsider it naturally recover and the medical treatments of Western medicine are usually after the patients suffer from abdominal distention,abdominal pain,anepithymia,nausea and vomiting etc.For example,gastrointestinal decompression or even re-operation of laparotomy would be performed if ileus appeared.Compare with Western medicine,TCM has more complex treatments and better effective to the patients after abdominal operations.Moreover,TCM can intervene actively,prevent gastrointestinal dysfunction after abdominal operations and exert obvious advantages in perioperative period.With more and more gynecological operations,there are greater prospects of making full use of the advantages of TCM in perioperative period.The trauma of abdominal surgery is a modern factor of causing diseases,which has its own pathological characteristic.TCM believes that the pathogenesis is mostly concerned with stagnation of Qi and stasis of blood,obstruction of Fu Qi,disturbance in ascending and descending of the functional activities of qi 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 or Chinese patent medicine orally,external applications such as clystering by herbal drugs,navel administration,acupuncture and moxibustion etc.However,to the patients undergoing 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.Accordingly,we choose Yunpiyin in order to reinforce spleen and stomach,regulate qi and relieve distension. The development was presided over by Professor Zhang Yuzhen and worked over by other gynecologists from the No.1 Affiliated Hosptial of Guangzhou University of Traditional Chinese Medicine.This prescription 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.Previous research have proved that Yunpiyin can shorten the time of anal aerofluxus obviously,promote the disgestive ability of the stomach and intestines after operation of abdominal gynecology,reduce the occurrence of related complications.Besides,make MTL and GLU in plasma restore to the level before operation in a short period of time.Western medicine considers that the reasons for gastrointestinal dysfunction after abdominal operations,are the anesthesia,peritoneal irritation,gastrointestinal tensions by operating,a little bleeding and oozing liquid in the cavity of the abdomen after operation,operative trauma,anatomic change,water and electrolytes imbalance,and regulating disturbances of gastrointestinal hormones etc..The key factor is the regulating dysfunction of gastrointestinal hormones and nerves.The recent studies have focused on the relationship between gastroenteric movement and gastrointestinal hormones.GAS is a 17 mer peptide.digestive tract hormone and one of the brain-gut peptide secreted from G cell,which has a dual role as circulation hormone and neurotransmitter.It can not only stimulate the secretion of digestive enzymesgastric,such as gastric acid and pepsin,trypsin etc.,but also directly stimulate gastrointestinal smooth muscle cells to enhance gastric peristalsis,accelerate the stomach emptying and promote the growth and development and function of maturity of gastrointestinal mucosa.Relative reseaches have showed that the level of GAS reduced after an operation is the important reason leading to gastrointestinal inhibition. Vasoactive intestinal peptide(VIP),a straight-chain peptide composed of 28 amino acid,is a neurotransmitter of non-adrenergic non-cholinergic(NANC) inhibition systems.It has a significant inhibition on gastrointestinal activities which can loosen gastric body.Furthermore,VIP receptor can block stomach contraction caused by electrical stimulation and vagus nerve reflection,which has a significant inhibition on gastrointestinal peristalsis.On the basis of previous study,through studying on the impact of Yunpiyin on serum GAS and VIP after abdominal operations of gynecology,this research observed further clinical efficancy of Yunpiyin treating various symptoms after abdominal operations of gynecology,explored its mechanism,and provided new ideas for TCM to prevent and cure diseases in perioperative period as well as the development of perioperative new drugs.Methods:We chose patients who were in the Gynecology Department of the No.1 Affiliated Hosptial of Guangzhou University of Traditional Chinese Medicine between November,2007and April,2008.All cases are filtered by enter standard and exclusion standard.51 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,51 patients were divided into the control group(n=21)and the treated group(n=30).Treated group:age ranged from 31 to 49,average(41.03±5.92),the average time of anaesthesia is(3.58±0.97) hours,the average time of operation is(2.98±0.79)hours.Control group: age ranged from 25 to 62,average(38.00±8.54),the average time of anaesthesia is(3.76±0.90)hours,the average time of operation is(3.08±0.79) 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 2 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' GAS and VIP before operation,the first day morning and the Third day morning after operations by radioimmunoassay.All data is processed by SPSS 13.0,both t-test and x~2 test are used repectively.Results:(1)The effective rate of treated group is 100.0%,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 GAS(P＜0.05)and an increase of VIP(P＜0.05).In the third day,compared with the first day,the level of GAS has increased obviously(P＜0.05),the level of VIP has decreased obviously(P＜0.05)in treated group.There is obvious difference to compared with the control group(P＜0.05).Conclusions:(1)It indicates that the patients after abdominal operations have a low-level of GAS and an increase of VIP.But Yunpiyin can raise GAS and reduce VIP,consequently promote gastrointestinal functional recovery.(2)It indicates that Yunpiyin can stimulate the secretion of digestive enzymesgastric,such as gastric acid and pepsin,trypsin etc.,directly stimulate gastrointestinal smooth muscle cells to enhance gastric peristalsis,accelerate the stomach emptying and promote the growth and development and function of maturity of gastrointestinal mucosa by raising GAS.Moreover,it can release from the inhibitory action of VIP to the gastrointestinal peristalsis and the stomach contraction block of VIP receptor to electrical stimulation and vagus nerve reflection by reducing VIP.That'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.(3)It indicates again that Yunpiyin has an effct of activating spleen and eliminate dampness,promoting qi circulation and relieving distension,which 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.
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