耳穴压豆改善子宫肌瘤腹腔镜术后胃肠功能及胃肠激素水平的疗效研究

Curative effect of ear acupoint bean pressing in improving gastrointestinal function and gastrointestinal hormone level after laparoscopic hysteromyoma operation

摘要

目的 观察耳穴压豆对子宫肌瘤患者腹腔镜术后胃肠动力及相关激素的影响，探讨耳穴压豆的疗效机制。 方法 选取2022年5月至2023年12月于福建中医药大学附属人民医院妇科行腹腔镜子宫肌瘤剔除术的患者，采用随机数字表法分成试验组与对照组，每组57例。试验组采用术后常规护理+耳穴压豆（脾、胃、交感）治疗，对照组采用术后常规护理+假耳穴压豆（脾、胃、交感，不含王不留行籽）治疗。比较2组患者术后的首次排气排便时间、临床疗效和胃肠激素水平变化。 结果 试验组的术后首次排气时间［20.31（17.52，22.38） h vs. 21.51（18.53，28.15） h］、排便时间［35.32（31.47，39.17） h vs. 38.12（33.44，42.78） h］均低于对照组（P<0.05）；试验组的临床疗效优于对照组（P<0.05）；2组术前的胃动素（motilin，MTL）、胃泌素（gastrin，GAS）、生长抑素（somatostatin，SS）和P物质（substance P，SP）水平差异无统计学意义（P>0.05），MTL和GAS在术后呈上升趋势，SS和SP呈下降趋势。试验组术后24 h的MTL［（451.52±54.33） pg/mL vs. （476.24±56.35） pg/mL］、GAS［150.50（133.93，164.52） pg/mL vs. 173.44（154.45，184.63） pg/mL］水平均低于对照组（P<0.05），术后24 h的SS［38.34（33.24，40.23） pg/mL vs. 33.36（29.13，38.76） pg/mL］水平高于对照组（P<0.05），而SP水平的变化差异无统计学意义（P>0.05）。重复测量方差分析和广义估算方程结果显示，MTL时间效应和交互效应差异有统计学意义（P<0.05）；SP的时间效应差异有统计学意义（P<0.05）；GAS和SS的时间效应、组间效应和交互效应差异均有统计学意义（P<0.05）。 结论 耳穴压豆对子宫肌瘤患者腹腔镜术后腹胀的疗效明显，可有效调节患者的胃动力相关激素水平，促进患者胃肠功能恢复。

Abstract

Objective To investigate the effect of ear acupoint bean pressing on gastrointestinal motility and related hormones after laparoscopic surgery in patients with hysteromyoma，and to explore the therapeutic mechanism of ear acupoint bean pressing. Methods Patients undergoing laparoscopic myomectomy in the Department of Gynecology of The People’s Hospital Affiliated to Fujian University of Traditional Chinese Medicine from May 2022 to December 2023 were randomly divided into an experimental group and a control group，with 57 patients in each group. The experimental group was treated with postoperative routine nursing and ear acupoint bean pressing （targeting the spleen，stomach，and sympathetic），and the control group was treated with postoperative routine nursing and sham ear acupoint bean pressing （containing no Vaccaria seed，targeting the spleen，stomach，and sympathetic）. After the intervention，the time to first postoperative passing of flatus and defecation，clinical efficacy，and changes in gastrointestinal hormone levels were compared between the two groups. Results The time to first postoperative passing of flatus ［20.31 （17.52，22.38） h vs. 21.51（18.53，28.15） h］ and defecation ［35.32 （31.47，39.17） h vs. 38.12 （33.44，42.78） h］ in the experimental group was lower than that in the control group（P<0.05），and the clinical efficacy was better than that in the control group（P<0.05）. There were no significant differences in motilin（MTL），gastrin（GAS），somatostatin （SS），and substance P（SP） levels between the two groups before operation（P>0.05）. The MTL and GAS levels were increased and the SS and SP levels were decreased after operation. The MTL［（451.52±54.33） pg/mL vs. （476.24±56.35） pg/mL］ and GAS［150.50 （133.93，164.52） pg/mL vs. 173.44 （154.45，184.63） pg/mL］ levels at 24 h after operation in the experimental group were lower than those in the control group（P<0.05），and the SS［38.34（33.24，40.23） pg/mL vs. 33.36（29.13，38.76） pg/mL］ level at 24 h after operation was higher than that in the control group（P<0.05），with no significant change in the SP level（P>0.05）. The results of repeated measures analysis of variance and generalized estimation equation showed that there were significant differences in the time effect and interaction effect of MTL（P<0.05），a significant difference in the time effect of SP（P<0.05），and significant differences in the time effect，intergroup effect，and interaction effect of GAS and SS（P<0.05）. Conclusion Ear acupoint bean pressing has significant effect on abdominal distension after laparoscopic surgery in patients with hysteromyoma，effectively regulates the level of gastrointestinal motility related hormones，and promotes the recovery of gastrointestinal function.

关键词

腹腔镜 / 子宫肌瘤 / 腹胀 / 胃肠激素 / 耳穴压豆

Key words

laparoscopy / hysteromyoma / abdominal distension / gastrointestinal hormone / ear acupoint bean pressing

基金资助

福建省中医药科研资助项目(2021zylc40)