Clinical Significance Of ’Qi Going Into Large Intestine Meridian At Maoshi’ In Postoperative Recovery Of Gastric Cancer Based On Artificial Intelligence Monitoring Technology Of Bowel Sounds

Objective:In this study,a patch-type artificial intelligence bowel sounds auscultation equipment was used to wirelessly monitor perioperative bowel sounds in gastric cancer patients undergoing the enhanced recovery after surgery concept,so as to observe the physiological phenomenon of "Qi Going into Large Intestine Meridian at Maoshi",and the changes of bowel movement of the 12-shichen rhythm during the perioperative period.And,in order to explore the clinical guiding significance of "Qi Going into Large Intestine Meridian at Maoshi" in postoperative rehabilitation of patients with gastric cancer.Methods:(1)We recruited 30 healthy volunteers as the control group.And we randomly selected 43 patients who underwent laparoscopic/robotic radical gastrectomy in the department of general surgery of the affiliated hospital of Nanjing University of Chinese medicine from December 1,2018 to December 31,2021.Three of these patients dropped out,so 40 patients were eventually included in the gastric cancer group.(2)According to whether the postoperative ventilation/defecation time in the gastric cancer group was more than 3 days,the patients were divided into group I(≤3 days)and group Ⅱ(>3 days)to observe the effect of the speed of postoperative gastrointestinal function recovery on the circadian rhythm of postoperative bowel sounds and Maoshi bowel sounds.The correlation between intestinal sounds at Maoshi on the postoperative day 3 and postoperative gastrointestinal function rehabilitation was analyzed.(3)The correlations between bowel sounds characteristics(average bowel rates,average duration and average frequency)and postoperative gastrointestinal function recovery on the 1st,2nd,and 3rd day after operation was analyzed.(4)According to whether the average bowel rates of the patient on the 3rd day after the operation is≥3 times/min,as the judgment standard of whether the qi and blood flow in the large intestine meridian.Those with≥3 times/min were divided into group A(‘Qi Going into Large Intestine Meridian at Maoshi’),and those less than 3 times/min were divided into group B(‘Qi not Going into Large Intestine Meridian at Maoshi’).We also analyzed whether‘Qi Going into Large Intestine Meridian at Maoshi’ or not had effects on systemic inflammatory response indicators(including C-reactive protein,lymphocyte-to-monocyte ratio,neutrophil-to-lymphocyte ratio,and platelet-to-lymphocyte ratio),and prognostic nutrition index on the postoperative 1st and 3rd day,the postoperative ventilation/laxation days,and the postoperative hospital stay.Results:(1)Under the physiological state,the average bowel rates increased from Maoshi to Xushi,and decreased from Haishi to Yinshi.The average duration of bowel sounds was longer from Maoshi to Youshi,and shorter from Zishi to Haishi.The average frequency of bowel sounds was relatively higher in Yinshi and Maoshi,and relatively lower in the remaining ten shichen.The average bowel rates,average duration and frequency of bowel sounds at Maoshi showed a significant upward trend compared with Yinshi.(2)Surgical traumatic stress severely interfered with the twelve shichen rhythm of bowel sounds.Compared with group I patients,the average bowel rate,average duration and average frequency of circadian rhythm of postoperative bowel sounds disappeared in group Ⅱ patients.There was no significant increase in the average intestinal rate,average duration and average frequency of intestinal sounds in group Ⅱ at Maoshi on the 1st,2nd and 3rd day after operation than those at Yinshi.The average bowel rates(3.61±1.73 vs 0.80±0.43times/min,p=0.018),average duration(2.17±1.41 vs 0.28±0.26s,p<0.001)and average frequency(842.66 ± 232.70 vs 305.13 ± 200.26Hz,p<0.001)on postoperative day 2;and the average bowel rates(3.45±0.60 vs 0.91 ±0.79times/min,p<0.001),average duration(2.24 ± 1.31 vs 0.89 ± 1.92s,p=0.023)and average frequency(878.41±214.59 vs 409.63 ± 420.91 Hz,p=0.016)on postoperative day 3 of patients in group Ⅱ was significantly lower than those of group I.(3)The results of correlation analysis showed that the average bowel rates on the 3rd day after operation was negatively correlated with the postoperative ventilation/defecation days(r2=0.887,p<0.001).(4)Compared with patients in group B,the C-reactive protein(33.77 ± 21.54 vs 82.28±75.94 mg/L,p=0.04)of patients in group A was decreased on the 3rd postoperative day,and the prognostic nutrition index(45.57 ± 3.69 vs 41.54±4.76,p=0.01)was raised,and postoperative ventilation/defecation days(2.22±0.80 vs 5.00±2.52d,p<0.01)was advanced.Although there was no significant difference in postoperative hospital stay between the two groups,the postoperative hospital stay of group A was shorter than that of group B(6.11 ± 2.06 vs 9.54 ± 5.67d,p=0.05).Conclusions:Under physiological conditions,intestinal motility exhibits a significant twelve shichen rhythmic oscillation.Intestinal movement was relatively active in the seven shichen from Maoshi to Youshi,and slowed down in the five shichen from Xushi to Yinshi.The average bowel rate,average duration and average frequency of bowel sounds in Maoshi were significantly higher than those in Yinshi.The higher the average intestinal rate on the 3rd day after operation,the earlier the postoperative ventilation/defecation time,and the faster the postoperative gastrointestinal function recovered.The average bowel rate at Maoshi on the 3rd day after operation was correlated with postoperative systemic inflammatory response and nutritional status.