Effects Of Acupoint Application At Different Time On Postoperative Gastrointestinal Function And Autonomic Nerve Based On Enhanced Recovery After Surgery Concept

Objective:Under the guidance of the concept of enhanced recovery after surgery,bibliometrics was used to screen out the intervention acupoints for acupoint application to treat abdominal gastrointestinal dysfunction.Through clinical trials,comparison of preoperative and postoperative application for the clinical efficacy of postoperative gastrointestinal function and autonomic nervous system recovery,to find the best intervention time for acupoint application of gastrointestinal dysfunction after laparoscopic-assisted radical colorectal cancer surgeryMethods:(l)Acupoint points were established by the bibliometrics and the law of acupoints chosen in the retrieved 217 articles on acupoint application for gastrointestinal dysfunction after abdominal surgery(2)From October 2018 to December 2019,105 patients undergoing laparoscopic-assisted radical colorectal cancer surgery in the General Surgery of Jiangsu Province Hospital of Chinese Medicine were randomly divided into the preoperative acupoint application group(n=35),postoperative acupoint application group(n=35),and the control group(n=35).Patients in the control group received measures based on enhanced recovery after surgery.The preoperative acupoint application group and postoperative acupoint application group were treated with acupoint application on the basis of the control group from 3 days before operation and 6 hours after operation,respectively,until the patients had exhausted or defecated for the first time.The first time of self-exhaust,the first time of self-defecation and the first time to eat after surgery,the postoperative 1-3 days Visual analogue scale(VAS)abdominal pain scores,the admission and postoperative day 7 Gastrointestinal symptom rating scale(GSRS)scores,the admission,postoperative day 1 and 3 heart rate variability(SDNN,LF/HF)and adverse reactions during the intervention were recorded.Compared the clinical efficacy of acupoint application at different times and find the best timing for intervention.Results:(1)Based on bibliometrics,we find the most common sticking points are Shenque,Tsusanli,Tianshu,Shangjuxu,Guanyuan,Dachangshu,Qihai,Sanyinjiao,Neiguan and Xiajuxu acupoints,get 3 to 5 acupoints with the highest application frequency as intervention points.In order to avoid the surgical incision and facilitate intervention,acupuncture points of the limbs were selected in this study,they are bilateral Tsusanli,Shangjuxu,Sanyinjiao,Neiguan and Xiajuxu(2)Compared with the control group,the first time of self-exhaust,the first time of self-defecation,and the first time to eat after surgery were earlier in the preoperative acupoint application group,and the differences were statistically significant.Postoperative 1-3 days visual analogue scale abdominal pain scores were lower,and the differences were significant.GSRS scores of postoperative day 7 decreased,the differences were statistically significant.The SDNN and LF/HF of postoperative day 1 and 3 were higher than those of the control group,and the differences were statistically significant.(3)Compared with the postoperative acupoint application group,the preoperative acupoint application group had shorter first exhaust and defecation time after surgery,and the differences were statistically significant.Postoperative 1-3 days visual analogue scale abdominal pain scores were lower,and the differences were statistically significant.The SDNN of postoperative day 1 and 3 were higher than the postoperation acupoint application group,and the differences were statistically significant.The LF/HF of postoperative day 1 was higher than the postoperation acupoint application group,and the difference is statistically significant(4)Compared with the control group,the time of first exhaust and defecation after surgery in the postoperative acupoint application group were earlier,and the differences were statistically significant.Postoperative 1-3 days visual analogue scale abdominal pain scores were lower,and the differences were statistically significant.The GSRS scores of postoperative day 7 decreased,and the difference was statistically significant.Conclusions:(1)The operation of traditional Chinese medicine can be based on the theory of meridians,combined with literature retrieval,and using statistical methods such as bibliometrics to screen out the most commonly used and evidenced acupoints,which is conducive to improving the accuracy of acupuncture and thus improving the efficacy.(2)Preoperative acupoint application can effectively shorten the first time of exhaust,defecation,and the first time to eat after surgery,improve postoperative gastrointestinal symptoms,and improve postoperative gastrointestinal functional recovery(3)Acupoint application can effectively reduce postoperative abdominal pain.Preoperative acupoint application has better analgesia.(4)Preoperative acupoint application can increase heart rate variability,reduce the body's stress response,reduce the degree of impaired autonomic nerve function,increase the parasympathetic nerve activity,and thereby promote the recovery of gastrointestinal function after surgery.(5)Preoperative acupoint application can safely and effectively treat gastrointestinal dysfunction in patients undergoing laparoscopic-assisted radical colorectal cancer surgery and is worthy of clinical promotion or further study.