三黄承气膏穴位贴敷联合胃肠...天性心脏病术后腹胀临床研究_杨亚峰.pdf

新中医2023年2月第55卷第4期NEW CHINESE MEDICINEFebruary 2023 Vol.55 No.4收稿日期 2022-06-30修回日期 2023-01-08基金项目河南省医学科技攻关计划项目（LHGJ20200776）作者简介杨亚峰（1989-），男，医学硕士，主治医师，E-mail：。通信作者李晶（1987-），女，医学硕士，主治医师，E-mail：。三黄承气膏穴位贴敷联合胃肠减压治疗儿童先天性心脏病术后腹胀临床研究杨亚峰1，李晶1，谌启辉2，王晓燕1，赵丽3，荆晨阳3，李坤21.河南中医药大学附属郑州市中医院儿科，河南 郑州 4500072.河南省胸科医院小儿心脏外科，河南 郑州 4500033.河南中医药大学研究生学院，河南 郑州 450046摘要目的：观察三黄承气膏穴位贴敷联合胃肠减压治疗儿童先天性心脏病术后腹胀的临床疗效及其对血清胃动素、胃泌素的影响。方法：将 110 例先天性心脏病术后腹胀患儿按随机数字表法分为 2 组各55 例。2 组均给予常规治疗，对照组加用胃肠减压治疗，观察组在对照组干预方案的基础上给予三黄承气膏穴位贴敷治疗。2 组均治疗 3 d。比较 2 组临床疗效、首次排气时间、首次排便时间，比较 2 组治疗前、治疗12 h、治疗 24 h、治疗 48 h、治疗 72 h 腹胀程度综合评分，以及术前、术后 1 d、术后 3 d 血清胃动素、胃泌素水平。结果：2 组总有效率均为 100%，差异无统计学意义（P0.05），但显愈率对照组 70.91%，观察组90.74%，差异有统计学意义（P0.05）。2 组首次排气时间及首次排便时间比较，差异均有统计学意义（P0.05），观察组均优于对照组。2 组治疗后各时间段腹胀程度综合评分分别与组内治疗前比较，差异均有统计学意义（P0.05）；2 组间治疗 12 h 腹胀程度综合评分比较，差异无统计学意义（P0.05），但 2 组间治疗24 h、治疗 48 h、治疗 72 h 分别比较，差异均有统计学意义（P0.05）。2 组术后 1 d、术后 3 d 血清胃动素、胃泌素分别与组内治疗前比较，差异均有统计学意义（P0.05）；2 组间术后 1 d、术后 3 d 血清胃动素、胃泌素分别比较，差异均有统计学意义（P0.05）。结论：三黄承气膏穴位贴敷联合胃肠减压治疗儿童先天性心脏病术后腹胀临床疗效确切，可以缩短首次排气时间、首次排便时间，减轻腹胀程度综合评分并且可以促进血清胃动素、胃泌素的恢复。关键词儿童先天性心脏病；术后腹胀；三黄承气膏；穴位贴敷；胃肠减压；胃肠激素中图分类号R541.1；R442.2文献标志码A文章编号0256-7415（2023）04-0168-05DOI：10.13457/ki.jncm.2023.04.037Clinical Study on Point Application with Sanhuang Chengqi Adhesive Plaster Combined with Gastrointestinal Decompression for Postoperative Abdominal Distension inChildren with Congenital Heart DiseasesYANG Yafeng，LI Jing，SHEN Qihui，WANG Xiaoyan，ZHAO Li，JING Chenyang，LI KunAbstract：Objective：To observe the clinical effect of point application with Sanhuang ChengqiAdhesive Plaster combined with gastrointestinal decompression for postoperative abdominal distension inchildren with congenital heart diseases and its effect on motilin and gastrin in serum.Methods：A total of110 cases of children with abdominal distension after operation for congenital heart diseases were dividedinto two groups according to the random number table method，with 55 cases in each group.Both groups 168新中医2023年2月第55卷第4期NEW CHINESE MEDICINEFebruary 2023 Vol.55 No.4腹胀是各种大型手术中常见的并发症之一，其中心脏外科手术术后腹胀的发生率为 54%1。先天性心脏病术后出现的腹胀，属功能性腹胀范畴，目前治疗上给予胃肠动力药2、益生菌制剂3、留置胃管胃肠减压4等治疗。本病属中医痞满、胀满等病范畴，在治疗上给予中药口服5、中药灌肠6、中药穴位贴敷法7、推拿按摩法8、中药热奄包9等。目前，胸外科常用减轻术后腹胀的方法是胃肠减压，因其可以引流胃内积液及胃肠道内积气，从而减轻腹胀及缝合口张力，利于伤口的愈合。中药穴位贴敷是将中药直接贴敷于腧穴上，药效通过腧穴、肌肤渗透吸收后作用于全身的一种中医特色治疗方法10。本研究旨在观察三黄承气膏穴位贴敷联合胃肠减压治疗儿童先天性心脏病术后腹胀临床疗效，结果报道如下。1临床资料1.1诊断标准参照外科学11中术后腹胀的诊断标准。术后患者出现肠鸣音消失，腹胀，腹痛，大便不通，肛门不排气，症状严重时有发热、呃逆等其他症状。1.2纳入标准符合术后腹胀诊断标准；年龄 6 个月16 岁；受试者监护人能正确理解本研究目的，无认知、表达障碍或其他精神疾病并签署知情同意书。1.3排除标准术后患儿出现生命体征不稳定等严weregivenroutinetreatment；thecontrolgroupwasadditionallytreatedwithgastrointestinaldecompression，and the observation group was additionally treated with point application with SanhuangChengqi Adhesive Plaster based on the treatment of the control group.Both groups were treated for threedays.The clinical effects，the first exhaust time and the first defecation time were compared between thetwo groups.The comprehensive scores of abdominal distension before treatment and after 12 hours，24 hours，48 hours and 72 hours of treatment，as well as the changes in motilin and gastrin in serumbefore operation，1 day and 3 days after operation were compared between the two groups.Results：Thetotal effective rates were 100%in the two groups，there being no significant difference(P0.05)；thecured and markedly effective rate was 70.91%in the control group and 90.74%in the observation group，the difference being significant(P0.05).There were significant differences being found in the comparisonof the first exhaust time and the first defecation time between the two groups(P0.05).There weresignificant differences being found in the comparison of the comprehensive scores of abdominal distensionin each period after treatment and those before treatment in the same group(P0.05)；there was nosignificant difference being found in the comparison of the comprehensive scores of abdominal distensionafter 12 hours of treatment between the two groups(P0.05)，but there were significant differencesbetween the two groups after 24 hours of treatment，48 hours of treatment and 72 hours of treatment(P0.05).There were significant differences being found in the comparison of motilin and gastrin in serum 1 dayand 3 days after operation and those before treatment in the same group(P0.05)；there were significantdifferences being found in the comparison of motilin and gastrin in serum 1 day and 3 days after operation inthe two groups(P0.05).Conclusion：Point application with Sanhuang Chengqi Adhesive Plaster combinedwith gastrointestinal decompression has a definite curative effect in treating postoperative abdominaldistension in children with congenital heart diseases.It can shorten the first exhaust time and the firstdefecation time，reduce the comprehensive scores of abdominal distension，and promote the recovery ofmotilin and gastrin in serum.Keywords：Congenital heart diseases in children；Postoperative abdominal distension；SanhuangChengqi Adhesive Plaster；Point application；Gastrointestinal decompressi