Study on the timing of intervention of gastrointestinal function recovery in patients after laparoscopic cholecystectomy with acupoint application of traditional Chinese medicine

Jian-Ru Wang,Ying Chen,Yu-Ling Wang *

1Tianjin Hospital of ITCWM Nankai Hospital,Tianjin,China.

ABSTRACT

Key words:Chinese medicine acupoint application,Gastrointestinal function,Intervention timing

1.INTRODUCTION

Cholelithiasis refers to stones that occur in the gallbladder or bile ducts of all levels and are common diseases worldwide [1].With the improvement of modern living standards and the changes in dietary habits of residents,the incidence of cholelithiasis is increasing year by year.According to the study,the total prevalence rate of cholelithiasis was 9.87%,that of males was 8.70%,and that of females was 11.88% [2].At present,surgery is still the first choice for the treatment of cholelithiasis.Laparoscopic cholecystectomy (LC) has become a common method for the treatment of gallstones due to its small incision and rapid postoperative recovery [3].However,postoperative patients still have complications such as gastrointestinal dysfunction and weakened gastrointestinal motility.Normal people usually have intestinal peristalsis disappeared within 12 - 24 h after cholecystectomy,and then gradually recover with time.After the normal bowel movement resumed 48 to 72 h after surgery,defecation and venting began [4].Traditional Chinese medicine acupoint application therapy is based on the theory of traditional Chinese medicine meridian theory.It regulates yin and yang by meridian conduction and regulates viscera.The research showed that by applying traditional Chinese medicine to postoperative patients,it can promote the patient's defecation and venting.However,most domestic studies focus on the recovery effect of point application on gastrointestinal function,and the best application effect of traditional Chinese medicine after operation is relatively lacking [5].Therefore,this study chose different time to give Chinese medicine application,and explored the best timing of its administration,the report is as follows.

2.DATA AND METHODS

2.1 Research objects

From January 2017 to December 2017,90 patients with cholelithiasis who were admitted to the Department of hepatobiliary surgery in a Grade 3A Hospital in Tianjin were randomly divided into three groups.There were no statistically significant differences in age,sex,education level,marriage,illness and pasthistory among the three groups,but were comparable (P＞ 0.05),as shown in Table1.

Table1.Three group patients general information comparison [n (%)]

2.2 Inclusion criteria

(1) The diagnosis criteria of cholelithiasis [6]; (2) those who know the condition and plan to undergo LC (3) the age was over 18 years old; (4) cultural level of primary school or above; (5)those who agree to participate in this study and sign informed consent.

2.3 Exclusion criteria

(1) Accompanied by serious diseases of heart,brain,kidney and other organs; (2) a person with a mental illness,a cognitive disorder or communication disorders; (3) habitual constipation; (4)previous history of digestive system diseases such as tumors,digestive tract ulcers,bleeding,inflammation,etc.

2.4 Elimination standard

(1) Patients who suffer from serious complications or adverse reactions such as allergies and fail to complete the study protocol as required; (2) patients who received other auxiliary measures such as enema and defecation after operation; (3) the condition worsened and could not continue this study or participate in other experimental researchers at the same time.

2.5 Intervention methods

All the patients in the three groups were given routine nursing measures in gastrointestinal surgery.Intervention group 1 and group 2 were given acupoint application of traditional Chinese medicine on the basis of routine nursing.After the doctor prescribed the application of traditional Chinese medicine,the pharmacy of Chinese herbal medicine in the hospital unified the dispensing,and took Wuzhuyu (Fructus Evodiae),Huoxiang(Herba Agastaches),Doukou (Fructus Amomi Rotundus) and Rougui (Cortex Cinnamomi),grind them and directly mix them,then mixed with 2.5 mL ginger juice,then made 2 cm × 2 cm acupoint paste.Half an hour after the operation,the first acupoint was applied and fixed with medical tape.The application time was 6 h for a total of 3 d.The intervention groups 2 were applied for the first time 6 h after the operation and fixed with medical tape for a total of 3 d.Place of application:Weiyu(BL21),Piyu (BL20),two side Zusanli (ST36).All the above operations were carried out by the nursing backbone nurses of traditional Chinese medicine after passing the unified training examination.

2.6 Research tools

The electrogastrogram (EGG) analyzer selects EGEF-2D double-conducting gastrointestinal electrogram (standard version,national patent product,patent number:ZL01217618.4).The main parameters include:waveform average frequency and waveform reaction area.The normal gastric electrical slow wave frequency is about 3 beats/min,and the variation range is 2.4 -3.73 beats/min.The waveform response area reflects the power of the EGG,which in a certain sense reflects its gastrointestinal systolic and diastolic activity index.Normal adults are 50 to 150 μV.s.

2.7 Evaluation indicators

(1)The first group of patients with the first exhaust time,defecation time,abdominal distension (level 0:abdominal circumference increased ＜ 2 cm,no bloating feeling; level 1:abdominal circumference increased ＜ 2 cm,abdominal wall tension slightly,mild abdominal distension but not affected rest and sleep; grade 2:abdominal circumference increased ≥ 2 cm,abdominal wall tension is large,moderate abdominal distension,affecting rest and sleep; grade 3:abdominal circumference increase ≥2 cm,abdominal wall tension,severe abdominal distension,cannot rest and sleep) [7]; (2) changes in EGG of the three groups before and after intervention.The normal gastric electrical rhythm is:N = 2.4 - 3.7 beats/min,N ＜ 2.4 beats/min is divided into gastric electrical rhythm.

2.8 Statistical methods

Data collation and analysis using Epidata 2.0 to build a database,using SPSS 20.0 statistical software to complete statistical analysis.Statistical descriptions of quantitative data were used to indicate that multiple groups of mean comparisons were analyzed by variance,qualitative data were statistically described as percentages,and comparisons between groups were tested.The test level was α = 0.05,and the difference was statistically significant atP＜ 0.05.

3.RESULTS

3.1 Comparison of general data among the three groups of patients

There was no significant difference in the baseline data between the three groups in terms of age,gender,education level,marriage,and condition (P＞ 0.05),which is comparable.See Table1.

3.2 Comparison of first anal exhaust and natural defecation time in three groups of patients

The analysis of the time of first anal exhaust and natural defecation in the three groups showed that:The differences of first anal exhaust time (F = 17.354,P= 0.000) and first natural defecation time (F = 49.674,P= 0.000) in the three groups were statistically significant.The first exhaust and defecation time in intervention group 1 was the shortest,followed by intervention group 2,and the control group was the longest (Table2).

Table2.Comparison of first anal exhaust time in 3 groups (h)

3.3 Comparison of abdominal distension degree among the three groups

In the three groups,the degree of abdominal distension was graded on the third day after surgery,and the degree of abdominal distension was divided into four grades according to the degree of abdominal distension and the predetermined grade.The degree of postoperative abdominal distension was statistically significant (P＜ 0.05) (Table3).

3.4 Results of physiological parameters of EGG before and after intervention in three groups of patients

The EGG waveform was detected in threegroups in half an hour before and after the first and third day of the operation,respectively.According to the inter-group analysis of the described amplitude,there were statistically significant differences in the response area (F = 41.168,P= 0.003) and waveform frequency(F = 32.157,P= 0.029) of the three groups of patients after intervention (P＜ 0.05).The EGG of intervention group 1 was better than that of intervention group 2,which was better than that of control group (Table4).

Table3.Comparison of the degree of abdominal distension among the three groups [n (%)]

Table4.Comparison of the results of three groups of patients

4.DISCUSSION

4.1 Chinese medicine acupoint application can promote the recovery of gastrointestinal function in patients after cholecystectomy

LC is currently the gold standard for the treatment of benign gallbladder disease,especially cholelithiasis [8].The advantages of small pain and rapid recovery have been widely used in clinical practice.However,due to the intraoperative artificial pneumoperitoneum affecting the blood circulation of the intestine,the inhibition of gastrointestinal smooth muscle by anesthesia,the stimulation of the intestine during the operation of the surgeon,the pain and the personal physical condition of the patient lead to gastrointestinal dysfunction in the patient [9].

Acupoint application is a traditional Chinese medicine external treatment method that combines acupuncture and herbal preparations.The drug is directly absorbed through the skin and can quickly produce strong pharmacological effects in the corresponding organs.At the same time,through the stimulation of the acupoint play a dredging meridian and resisting the function of disease and evil.For the application of drugs,it is necessary to add a product that is spicy and beneficial to the transdermal absorption of drugs to open the channels and collaterals [10].In this study,Wuzhuyu (Fructus Evodiae) has the effects of dispelling cold and relieving pain,preventing or arresting vomiting,helping Yang and stopping diarrhea [11]; As an aromatic traditional Chinese medicine,Huoxiang (Herba Agastaches) has a regulating effect on gastrointestinal motility [12].Doukou(Amomum costalum Roxb.) also belongs to the aromatic traditional Chinese medicine,which has the effects of warming the stomach and strengthening the spleen,elimination of distention and promoting the circulation of Qi,anti-vomiting and invigorating the spleen [13].Rougui (Cortex Cinnamomi) is the "interior-warming medicinal" of traditional Chinese medicine [14].Huoxiang (Herba Agastaches),Rougui (Cortex Cinnamomi) and Doukou (Amomum costalum Roxb.) are commonly used medicines for acupoint application,and Xinxiang can improve transdermal permeability of external medicine,thereby improving the curative effect [8].The above four kinds of herbal medicines have the functions of relieving pain,regulating Qi,stopping vomiting and regulating spleen and stomach.Shengjiang (Rhizoma Zingiberis Recens) juice is used as a common excipient for acupoint application,and has the effect of warming and stopping vomiting [15].The characteristics of aromatic can assist the drug effect and further promote the effect of application [16].

The results showed that the first venting and first defecation time of the patients in the Chinese medicine application group were better than the control group (P＜ 0.05),which may be related to the acupoints of Zusanli (ST36),Weiyu (BL21) and Piyu (BL20).The drug acts on the human body,regulates the viscera,increases the secretion of gastrin,and plays a role in promoting the recovery of gastrointestinal function by improving the state of the gastrointestinal tract [17 - 19].Compared with other oral administration methods,the digestive function of the gastrointestinal digestive enzyme on the effective compo-nents is avoided,the burden of the gastrointestinal tract is reduced,the influence of various barriers of the human body on the absorption of the medicine is avoided,and the bioavailability is high; and the stratum corneum of the skin has the storage function,so that the blood concentration is stable [20].

4.2 The effect of traditional Chinese medicine acupoint application is most obvious within half an hour after surgery

Different studies have shown that 0.5 h postoperatively and 6 h postoperatively are the more commonly used acupoint application time of Chinese medicine,which may be related to the physiological activities of gastrointestinal motility.The results of this study showed that the EGGs of the two groups were measured before surgery,and the difference was not statistically significant,indicating that the two groups were comparable (P＞0.05).Studies have shown that the frequency of EGGs in patients after normal LC is in a low-frequency state.In this study,the effect of acupoint application of Chinese medicine at 0.5 h after surgery was better than that of the 6 h application group and the control group.The difference was statistically significant(P＜ 0.05).The reason for the analysis may be related to the gastrointestinal tract in the postoperative patients under the influence of anesthesia,trauma and pneumoperitoneum.The application of Chinese medicine acupoint application 0.5 hours after operation can make the effective component of the drug reach the peak of blood concentration and stabilize at a certain level.Compared with 6 hours after surgery,it stimulated the recovery of gastrointestinal motility and the recovery of secretion function,which accelerated the recovery process of function and promoted the recovery of gastrointestinal function [21].However,due to the limitation of the number of cases,it cannot be confirmed that the half-hour postoperative time is the best intervention opportunity to promote the recovery of postoperative gastrointestinal function,and the lack of basic experiments to explore its mechanism of action.In the future,we can be combined with the principle of meridian flow to deepen the study and seek the best intervention time to achieve the purpose of rapid recovery.

In summary,traditional Chinese medicine acupoint application is guided by the overall concept of traditional Chinese medicine and meridian and collateral theory.It not only has the osmotic absorption effect of the drug itself,but also the stimulating effect of the drug on the acupoint and the conduction function of the meridian and collateral acupoint.They affect,interact and complement each other,and play a combined therapeutic role together [22].It can be used for the recovery of gastrointestinal function in patients after LC.It has the advantages of simple and easy operation,strong patient compliance,mild effect and less adverse reactions.Early postoperative intervention can enhance the efficacy and is worthy of clinical application.

Authors’ contributions

JRW and YLW designed this research.YC collected and analyzed the data.JRW completed the writing of this paper.

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