中药大承气汤灌肠联合足三里穴位注射对胰十二指肠切除术后胃肠功能恢复的临床研究

Clinical Study on Dachengqi Decoction Enema Combined with Zusanli Acupoint Injection on Gastrointestinal Function Recovery after Pancreaticoduodenectomy

摘要: 目的：探讨大承气汤灌肠联合足三里穴位注射对胰十二指肠切除术术后患者的胃肠功能恢复情况的临床疗效。方法：选取2017年3月至2023年9月在广西中医药大学第一附属医院胃肠外科与肝胆外科行胰十二指肠切除术的120例胰头或壶腹周围恶性肿瘤患者。将120例患者随机分配为治疗组1 (大承气汤灌肠)、治疗组2 (足三里穴位注射)、治疗组3 (大承气汤灌肠联合足三里穴位注射)及对照组，每组30例。其中对照组采用常规治疗，各治疗组则在对照组的治疗基础上分别加用单纯大承气汤灌肠、单纯足三里穴位注射及大承气汤灌肠联合足三里穴位注射治疗，观察并记录各组患者术后首次出现肛门排气排便时间及肠鸣音恢复的时间，并检测每组患者术前以及术后第1天、第2天血清中胃动素(MOT)、二胺氧化酶(DAO)、胃蛋白酶原II (PG II)、肿瘤坏死因子-α (TNF-α)、胃泌素(GAS)和醛固酮(Ald)的含量。结果：对照组出现肛门排便排气及肠鸣音恢复的时间较治疗组显著延长(p < 0.05)，各组患者术前血清中胃动素含量无明显差异(p > 0.05)。治疗组1、治疗组2、治疗组3术后第1天、第2天与对照组相比，血清中各检测指标水平均有所改善，其中治疗组3改善程度较为显著(p < 0.05)。结论：相比于常规治疗，大承气汤灌肠及足三里穴位注射对于胰十二指肠切除术术后胃肠功能恢复均有促进作用。其中大承气汤灌肠与足三里穴位注射联合应用可进一步缩短胰十二指肠术后肠麻痹时间，安全系数高，临床疗效较好，值得临床上普遍推广和使用。

Abstract: Objective: To investigate the clinical efficacy of Dachengqi Decoction enema combined with Zusanli acupoint injection on the recovery of gastrointestinal function in patients after pancreaticoduodenectomy. Methods: A total of 120 patients with pancreatic head or periampullary malignant tumors who underwent pancreaticoduodenectomy in the Department of Gastrointestinal Surgery and Hepatobiliary Surgery at the First Affiliated Hospital of Guangxi University of Chinese Medicine between March 2017 and September 2023 were enrolled. They were randomly assigned into four groups (n = 30 each): Treatment Group 1 (Dachengqi Decoction enema alone), Treatment Group 2 (Zusanli (ST36) acupoint injection alone), Treatment Group 3 (Dachengqi Decoction enema combined with Zusanli acupoint injection), and a Control Group. The Control Group received standard postoperative care, while the three treatment groups received the respective interventions in addition to the standard care. The primary outcomes observed and recorded were the time to first postoperative anal exhaust/defecation and the time to bowel sound recovery. Serum levels of motilin (MOT), diamine oxidase (DAO), pepsinogen II (PG II), tumor necrosis factor-alpha (TNF-α), gastrin (GAS), and aldosterone (Ald) were measured preoperatively and on postoperative days 1 and 2 for all patients. Results: The time to first anal exhaust/defecation and recovery of bowel sounds was significantly prolonged in the Control Group compared to the treatment groups (p < 0.05). No significant difference in preoperative serum MOT levels was observed among the groups (p > 0.05). On postoperative days 1 and 2, all treatment groups showed improvements in the levels of the tested serum indicators compared to the Control Group, with Treatment Group 3 demonstrating the most significant improvement (p < 0.05). Conclusion: Compared to conventional treatment alone, both Dachengqi Decoction enema and Zusanli acupoint injection can promote the recovery of gastrointestinal function after pancreaticoduodenectomy. The combined application of Dachengqi Decoction enema and Zusanli acupoint injection can further shorten the duration of postoperative ileus, exhibits a high safety profile, and demonstrates favorable clinical efficacy, making it worthy of widespread clinical promotion and application.