| BackgroundPostoperative ileus is a brief pathophysiological process of gastrointestinal dysfunction,which is difficult to avoid after colorectal cancer surgery.It has the risk of delayed recovery of gastrointestinal function and increased postoperative complications.Deriected by the concept of Enhanced recovery after surgery,minimally invasive surgery and perioperative optimal treatment measures have been used to enhance the recovery of postoperative gastrointestinal function,and reduce incidence rate of postoperative complications.However,for patients with poor physiclal status,there is a risk of delayed recovery and increased complications after surgery.Acupoint sticking therapy was performed to shorten the recovery time of postoperative gastrointestinal function,decrease postoperative abdominal distention,postoperative nausea and vomiting,and enhance the tolerance of postoperative diet recovery.At present,there are few studies on acupoint selection for acupoint application to prevent and treat postoperative ileus.At present,more studies have suggested that acupoint application contributed to prevent and treat postoperative ileus,but there were few studies on acupoint selection.ObjectiveTo compare the therapeutic effects of different point selection in the prevention and treatment of postoperative ileus after colorectal surgery by acupoint sticking therapy with Chang Bi Fang,we observed the effect of different point selection on the recovery time of gastrointestinal function and the score of gastrointestinal symptoms during the first eating period after surgery.To provide the idea of acupoint selection for the prevention and treatment of postoperative ileus,we explored the effects of acupoint sticking therapy on postoperative ileus.Methods1.Subjects: This study is a prospective clinical randomized controlled trial of 108 patients with colorectal cancer diagnosed by pathology from June2016 to December 2017 and undergoing laparoscopic surgery in General Surgery in Guangzhou Hospital of TCM.The method of random digital table is used to divide into three groups,including Group ST36 & BL25,Group ST36 & PC6 and control group,with 36 cases in each group.2.Treatment:(1)Control group: Postoperative treatment of western medicine: Prevention of infection,routinely use of antibiotics,maintenance of water,electrolyte and acid-base balance,restricted fluid rehydration,early potassium supplementation,analgesic treatment,early extubation of urine tube,gastric tube,abdominal drainage tube,early movement out of bed,nutritional support.(2)Group ST36 & BL25:(1)The postoperative treatment of western medicine was the same as that of control group.(2)Acupoint sticking therapy: From the first day after operation,Chang Bi Fang was used to stick ST36 and BL25 on 9am and 3pm per day for 4 hours,twice a day,until the first anal defecation and 24 h after eating semi-liquid food,then end the point application treatment,the longest course of treatment is the 10 th day after operation.(3)Group ST36 & PC6:(1)The postoperative treatment of western medicine was the same as that of control group.(2)Acupoint sticking therapy:Chang Bi Fang was used to stick ST36 and PC6,and the treatment time and course of treatment were the same as that of the Group ST36 & BL25.3.Methods of observation:(1)Postoperative day 1-10,told the patients and their families in a timely manner to the staff report for the first anal exhaust time,8AM,12 N,6PM,10 PM every day to ask patients postoperative anal exhaust defecation time,8AM,12 N,6PM,10 PM every day in patients with intestinal sound auscultation until,in patients with bowel sounds more than3 beats per minute.(2)Postoperative day 1-10,7 AM,11 AM,5 PM every day record nutritional types of patients(Enteral nutrition / Parenteral nutrition)and type of diet(Full liquid diet / Semi liquid diet).(3)After the operation,the first full liquid diet for 48 h and the first semi-liquid diet for 24 h were evaluated,and the abdominal distension score and astrointestinal reaction score were evaluated every 24 h.The highest abdominal distension score and gastrointestinal reaction score were obtained during the first 72 hours after operation.(4)During the period of acupoint application after operation,the adverse reactions,safety indexes,postoperative complications and other reasons of withdrawal from treatment were recorded every day of the patients at ST36,PC6 and BL25.4.Statistical analysis: All data was treated by SPSS22.0.Quantitative data,reported as?x±s,were compared by one-way ANOVA followed by Dunnett test o r Kruskal-Wallis H test.Ordinal data,reported as x±R,were compared by Kruskal-Wallis H test and Mann-Whitney U test.Categorical data,reported as f(n),were compared by Kruskal-Wallis chi-square test.The test level wasα=0.05.Results1.Comparison of Base data: There were respectively 6 cases,4 cases and5 cases in Group ST36&BL25,Group ST36&PC6 and control group withdrewed from the study.There was no significant difference in the completion of treatment among the three groups(P>0.05).The age,sex,ASA grade,smoking history,history of COPD,history of abdominal surgery,preoperative incomplete intestinal obstruction,BMI,ALB,WBC,CRP,tumor location,tumor staging,excision,operation time,intraoperative bleeding volume,maximum VAS pain score within 3 days after operation,cumulative opioid dose,and so on were compared,it turns out that the difference is not statistically significant(P>0.05).2.Comparison of outcomes:(1)The first time to bowel movement of Group ST36 & BL25,Group ST36 & PC6 and control group were 42.90±10.16 h vs 44.41±9.85 h vs 51.68±10.26 h.The first time to flatus of those three groups were50.50±12.07 h vs 53.81±11.27 h vs 61.23±11.51 h.The first time to defecation of those three groups were 62.10±13.02 h vs 62.53±10.86 h vs 70.19±12.15 h.The first time to tolerating low residue diet without emesis for 24 hours of those three groups were 103.77±12.18 h vs 107.63±12.53 h vs 116.84±15.66 h.There was significant difference between Group ST36&BL25 or Group ST36&PC6and control group(P<0.05).(2)The abdominal distension scores of Group ST36& BL25,Group ST36 & PC6 and control group were?R =38.65 vs 49.98 vs 52.00,and the nausea and vomiting scores were?R =50.50 vs 39.36 vs 51.50.There was significant difference between Group ST36 & BL25 and Group ST36 & PC6 or control group on abdominal distension scores(P<0.05).There was significant difference between Group ST36 & PC6 and Group ST36 & BL25 or control group on abdominal distension scores(P<0.05).Conclusion1.The recovery of gastrointestinal function after surgery: The first time to bowel movement,the first time to flatus,the first time to defecation and the first time to tolerating low residue diet without emesis for 24 hours of Group ST36 & BL25,Group ST36 & PC6 were less than control group.BL25 and PC6,combined with ST36,may contribute to enhance the recovery of postoperative gastrointestinal function after laparoscopic colorectal surgery by acupoint sticking therapy with Chang Bi Fang.2.The gastrointestinal symptoms during the first diet after colorectal surgery: In the comparison of abdominal distension score,Group ST36 & BL25 was significantly lower than that of Group ST36 & PC6 and control group(P<0.05),but there was no significant difference between Group ST36 & PC6 and control group(P>0.05).In the comparison of nausea and vomiting scores during the first diet after colorectal surgery,Group ST36 & PC6 was significantly lower than that of ST36 & BL25 and control group(P<0.05),while the nausea and vomiting scores of ST36 & BL25 had no significant advantage compared with control group(P>0.05).In the prevention and treatment of postoperative ileus after laparoscopic colorectal surgery by acupoint sticking therapy with Chang Bi Fang.BL25,used in acupoint sticking therapy,may contribute to improve the abdominal distension after laparoscopic colorectal surgery.PC6,may contribute to improve the nausea and vomiting after surgery. |
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