【作者】 王淑敏；

【导师】 赵东旭；

【作者基本信息】 长春中医药大学 ， 护理学， 2015， 硕士

【摘要】 目的透皮给药技术在我国具有悠久的历史,它是以皮肤、黏膜作为载体,在特定的传递速率下,将药物透过皮肤,经黏膜吸收后,渗透进入体循环发挥药效的一种方法,具有无肝脏首过效应、有效血药浓度恒定,临床应用方便等优点。中药大承气汤,作为治疗胃肠术后梗阻的常用汤剂,具有通里、清热、活血、峻下热结等功用,将含中药大承气汤的凝胶贴片(胃肠宁贴片)配合超声电导治疗仪,用于大肠系统肿瘤术后梗阻的患者,目的是观察其促进大肠肿瘤术后梗阻患者肠功能恢复的疗效,并对超声电导治疗仪的安全性进行评价。方法1.收集2014年1月至2015年2月,吉林省某三甲医院普通外科收治的大肠系统肿瘤术后发生梗阻的患者,共计110例,治疗组55例,对照组55例;男性59例,女性51例;平均年龄:对照组为55.69±4.38,治疗组为55.09±4.04;直肠癌62例,结肠癌49例,均在全麻下行结直肠癌根治术。两组病人在年龄、性别、病情等方面均无显著性差异(P>0.05),说明治疗组与对照组在性别、年龄、诊断、手术方式等因素上的均衡性较好,具有可比性。2.试验方案:根据患者入院的先后顺序,将入组病例随机分成治疗组和对照组,每组各55例,入组后即开始接受常规的外科治疗。对照组:即禁食水、胃肠减压、全胃肠外营养治疗、补充水电解质,纠正酸中毒、低钾等电解质紊乱症状,应用质子泵抑制剂等治疗,鼓励患者离床活动、按摩腹部等促进肠蠕动恢复的措施。治疗组:除常规外科治疗外,配合使用北京诺亚同舟技术有限公司提供的超声电导仪,以及含有中药大承气汤的凝胶贴片即胃肠宁贴片,每日一次,每次30分钟,治疗结束后保留胃肠宁贴片40分钟。(注意,两组患者均采用统一的静脉治疗方案);观察治疗组与对照组患者首次肛门排气的时间、首次肛门排便的时间;腹痛、腹胀消失的时间;肠鸣音恢复的时间;腹围的变化,同时记录患者的各项生化指标及各项生命体征。所有指标均采用SPSS 19.0统计学软件包进行统计学分析。统计学处理方法:使用SPSS19.0软件,计量资料以均数?标准差(sx?)表示,采用t检验;计数资料采用x2检验,以P<0.05为差异有统计学意义。结果治疗组和对照组患者术后肠鸣音恢复的时间分别为(42.83?5.301和46.5?7.50)h,首次肛门排气时间为(98.60±10.62和116.34?11.87)h,首次肛门排便的时间为(123.89?13.88和144.96?15.60)h,两组比较,差异有统计学意义。治疗组和对照组腹围的变化差异有统计学意义(P<0.05);两组患者生命体征的变化比较,差异无统计学意义(P>0.05);治疗后两组患者血、尿常规,肝肾功能,心电图检查,差异无统计学意义(P>0.05),治疗组患者在使用超声电导仪过程中有3例患者局部出现红肿等现象但未发生水泡,经统计学分析,无统计学意义(P>0.05)。结论超声电导靶位透入含有中药大承气汤的胃肠宁贴片可加快大肠系统肿瘤术后梗阻患者胃肠道功能的恢复,并可降低腹胀及腹痛的发生率,临床使用安全、有效。更多还原

【Abstract】 Research Objective:Transdermal drug delivery technology has a long history in our country,which is a method by using skin、 mucosa as the carrier to import drugs through the skin at a certain rate,and after capillary absorption,to send the drugs to the systemic circulation to play the efficacy.It has some advantages such as no liver first-pass effect、constant effective blood drug concentration、convenient clinical application and so on.The Chinese medicine Large Chengqi Decoction,as the first choice for the gastrointestinal obstruction after operation,has Tongli、clearing heat、promoting blood circulation、clearing the hot tubercle and other functions,combining the gel patch which is rich in Large Chengqi Decoction(Weichangning patch) with ultrasound for patients with postoperative obstruction of colorectal tumor,to observe the effect on promoting the bowel function recovery with postoperative obstruction of colorectal tumors,and to evaluate the safety of ultrasound conductivity treatment instrument.Subjects and Methods: The research object:Total 110 patients with postoperative obstruction of colorectal tumors in the first hospital of Jilin University、the second hospital of Jilin University、the China-Japan Union Hospital of Jilin University and the XinMin branch of the third hospital of Jilin University were collected from January 2014 to February 2015,with 55 cases in the treatment group and 55 cases in the control group; among them there were 59 male and 51 female; the average age of the control group was 55.69±4.38, and the average age of the treatment group was 55.09±4.04; there were 62 cases of rectal cancer and 49 cases of colon cancer,all of them were performed colorectal radical resection or partial resection in the general anesthesia. No significant differences were found between the two groups in age, gender, disease and other aspects(P > 0.05), which showed that the treatment group and the control group had good balance in gender,age,diagnosis, operation mode and so on, which was comparable.2.The test scheme:According to the admitted sequence,the patients were randomly divided into treatment group and control group with 55 cases in each group, and were given conventional surgical therapy immediately when accepted into group. Control group: were given fasting, gastrointestinal decompression、total parenteral nutrition、water and electron supplement, acidosis、low potassium and other electron disorder were correctted, and proton pump inhibitor treatment was applied, and the patients were encouraged ambulation、massage the abdomen to promote the bowel peristalsis. Treatment group: in addition to conventional surgical treatment,were given the ultrasound provided by Beijing Noah TongZhou Technology Limited company with the Weichangning patch containing Chinese medicine Dachengqi Decoction once a day with 30 minutes each time, and after treatment the Weichangning patch was kept 40 minutes.(note, two groups were treated with same intravenous therapy); we observed the treatment group and the control group with the first anal exhaust time、the first defecation time; abdominal pain, abdominal distention disappearance time; bowel sound recovery time; abdominal circumference changes; and simultaneously recorded the biochemical indexes and the vital signs. All the indicators were statistically analysed with SPSS 19.0 statistical software package. Statistical analysis methods: SPSS19.0 software was used, the measurement data was expressed with the mean±standard deviation( x ±s)by t test; the enumeration data was analysed by X2 test, p<0.05 as the statistical significance.Research results: The postoperative bowel sound recovery time of the treatment group and control group was 42.836±5.301and46.5 ±7.501,and the first anal exhaust time of the two groups was98.60±10.62 and 116.34±11.87, the first defecation time of the two groups was123.89±13.88 and 144.96±15.6, the two groups was statistically significant difference in. The abdominal circumference changes was statistically significant between the two groups(P<0.05); no significant differences were found between the two groups in the vital signs(P >0.05); no significant differences were found between the two groups after treatment in the blood and urine routine, hepatic and renal function, electrocardiogram examination(P >0.05), no statistically significant difference(P>0.05),three patients in the treatment group using ultrasound had local swelling phenomenon but no blisters, there was no statistical significance when analysed(P>0.05).Research conclusion: Target transdermal Weichangning patch containing Chinese medicine Large Chengqi by ultrasound can accelerate the gastrointestinal function recovery with postoperative obstruction of colorectal tumors,and reduce the incidence of abdominal distension and abdominal pain, which is safe and effective in clinic.更多还原