To seek an effective method for acupuncture treatment of recalcitrant erratic reflux that occurs after abdominal surgery. METHODS:Patients with intractable eruption after abdominal surgery were randomly divided into three groups: group A, group B and group C. Results:The efficiency of group A was 98%, group B was 85%, and group C was 54%. group A was significantly better than groups B and C (P0.05, P0.005). CONCLUSION: Acupoint injection is one of the effective means of treating recalcitrant eruptions that occur after surgery.
Frequent erratic reflux (diaphragmatic spasm) often occurs in patients after abdominal gastrointestinal, biliary and hepatic organ surgery. In mild cases, it increases the pain of the surgical wound and affects the wound healing; in severe cases, it causes the surgical suture opening to break, which seriously affects the patient’s recovery. In our department, the majority of patients with post-operative erratic reflux received in the emergency consultation, the author used acupuncture point injection of vitamin B1, B6, the treatment of post-operative erratic effect is extremely satisfactory, is reported as follows
1.Clinical data
From 2002 to 2008, 117 patients, 105 males and 12 females, were received into our general surgery emergency consultation list and had persistent erratic reflux after abdominal surgery. The age ranged from 30 to 73 years old; the average was 63.5 years old. The shortest postoperative erratic reflux was 2 days, the longest was 6 days, and the average was 3.4 days.
The patients were divided into 41 cases in group A (acupoint injection group) and 39 cases in group B (simple acupuncture group); 37 cases in group C (drug intramuscular injection group) according to the randomization of the receiving physicians in the consultation sheet, and were treated by different methods. The comparison of the clinical data of the three groups before treatment is shown in Table 1, and there was no significant difference by statistical treatment (P0.05).
Comparison of clinical data of patients in the three groups before treatment Table 1
Group Number of cases Malignant tumor Possible causes of postoperative eruption
Gastrointestinal decompression tube Abdominal drainage tube Anal unvented
Group A 41 34 38 27 30
Group B 39 30 35 25 29
Group C 37 28 33 26 25
2.Treatment method
2.1 Group A (acupoint injection group)
Take acupuncture points Neiguan acupuncture point and foot Sanli acupuncture point (bilateral acupuncture points).
Drugs Vitamin B1 specification 2ml: 100mg, Tianjin Jinyao Amino Acid Co., Ltd, approval number: State Drug Quotient H12020613. Vitamin B6 specification 2ml: 0.1g, Nanjing Jinling Pharmaceutical Factory, approval number: State Drug Quotient H32021843. single-use sterile syringe, specification: 2ml 0.6×25, Henan Yu’an Medical Equipment Co. Ltd., Executive Standard: GB15810-2001.
Operation The acupuncture point is strictly disinfected with 2.5% iodine and 75% alcohol. At the Nei Guan point, the needle was inserted about 1.5 cm deep (located at the median nerve), and when the patient felt numbness in the fingers, the needle was retracted by 2 mm, and no blood was drawn back, and vitamin B 10.8 ml was injected into each point. At the Foot San Li point, the needle was inserted about 2.5 cm deep (located at the tibial nerve), and vitamin B 61 ml was injected into each point.
2.2 Group B (general acupuncture group)
The acupuncture points were taken as above, and “Hua Tuo” single-use acupuncture needles ¢0.3 mm, with milli-needles of 40-60 mm length, were used to acupuncture the Neiguan and the Sansili points, respectively, and the needles were retained for half an hour after obtaining Qi and intermittently.
2.3 Group C (drug injection group)
Drug Gastrofluan specification 1ml: 10mg, Shanghai Hefeng Pharmaceutical Co., Ltd, approval number: State Drug Quantifier H31021522. 10mg of Gastrofluan was routinely injected intramuscularly each time.
2.4 The efficacy criteria were developed with reference to the literature [1].
The patients in all three groups were observed for one day after one treatment, and those who had erratic reflux were considered effective; those who still had erratic reflux continued to be treated with the same method and observed for another day, and those who still had erratic reflux after a maximum of three days of repeated treatment were considered ineffective.
3. The treatment results are shown in Table 2
Table 2 Comparison of the number of treatments and effective [number of cases (%)] among the three groups of patients
Group Number of cases Effective once Effective twice Effective three times Ineffective
Group A 41 30 (73) 38 (93) 40 (98) 1 (2)
Group B 39 20(51)a 27(69)c 33(85)~ 6(15)
Group C 37 7(19)b 12(32)d 19(54)| 18(46)
Note: a compared with group C, (X2=7.33; P0.01) a significant difference; b compared with group A, (X2=20.83; P0.001) a highly significant difference; c compared with group A, (X2=5.96; P0.05) a significant difference; c compared with group C, (X2=8.87; P0.005) a highly significant difference, d compared with group A (X2=28.1; P0.001) had a highly significant difference; ~P0.05 and #P0.005 compared with group A; P0.01 compared with group B and C.
The results of the three treatment groups were tested by R×C table chi-square test (X2=29.97; P0.005), and the efficiency rates of the three methods for the treatment of ergotism were different. the splitting of R×C table was compared, and the difference in efficiency rate between group A and group B (X2=5.28, 0.25P0.1) was not statistically significant; there was a difference in efficiency rate between group A and group C (X2=35.14, P0.05), and the efficiency rate of group A was 98% The difference between group B and group C (X2=16.1, P0.05) was found, and the efficiency rate of group B was 85% better than that of group C (54%).
4. Discussion
In patients who underwent abdominal surgery, the emergence of erratic reflux in the postoperative period may be caused by various reasons.
①The diaphragm was stimulated by various surgical operations during the operation.
②The diaphragm is stimulated by blood (exudate) from the traumatized tissue after surgery.
③Epidural anesthesia and other anesthesia causes a weakening of gastrointestinal peristalsis and gas production in the intestinal tract, plus the irritation of the diaphragm surface caused by increased abdominal pressure due to the lap band compression bandage.
④Postoperative insertion of a gastrointestinal decompression tube from the nose through the esophagus and various other adverse stimulation of the vagus nerve and phrenic nerve (C3-5).
According to TCM, such patients are operated on in the middle jiao, which seriously injures the qi and blood and inhibits the gastrointestinal function, and if this is combined with the stimulation such as the insertion of the tube, it makes the gastrointestinal qi disorder, the intestinal qi does not work, the qi depression goes up to the chest and diaphragm, and the qi reverses and rushes upward. The diaphragm is located between the chest and abdomen, acupuncture and moxibustion “four general points song” “belly and abdomen three li stay, chest and abdomen within the plan”. Foot San Li is part of the foot Yang Ming Stomach meridian, which can invigorate the Yang Qi of the spleen and stomach, regulate the qi of the stomach and intestines, stimulate the suppressed qi, awaken the spleen and stomach, promote transportation, and guide stagnation and laxative functions.
There is experimental evidence that acupuncture treatment at the foot San Li point can enhance small intestine peristaltic waves and large intestine motor function, which can significantly increase the frequency of gastrointestinal motility and promote the recovery of gastrointestinal function in postoperative patients. Neiguan belongs to the Hand Convulsive Yin Heart Pericardium meridian, and the point is covered with Zheng Zhong Shen (C5-7) underneath, and acupuncture treatment can regulate the overexcitation of the phrenic nerve center. This point has the function of unblocking the heart qi, regulating qi, broadening the chest and stomach, and relieving diaphragmatic rebellion to stop vomiting. The combined use of the two acupuncture points, together relieving the stimulation of the phrenic nerve, is the regular acupuncture point of choice for the treatment of erratic symptoms.
When erratic flow occurs in patients after surgery, it affects the rest of the patient and increases the psychological and physiological burden in mild cases, and affects the healing of the surgical incision in severe cases. It is necessary to immediately and effectively stop the reflux. Considering that the patient’s condition is critical and complex after surgery, the safety of vitamins chosen for acupuncture point injection is high, with the aim of minimizing the side effects of the drug. The author has applied this method for many years to treat patients with eruptions arising from various other diseases without any potential dangers and contraindications, and without any adverse reactions.
Vitamin B6 forms pyridoxal phospholipids in the body, which are involved in the metabolism of amino acids and treat vomiting caused by various causes of gastrointestinal reactions. Vitamin B1 forms thiamine pyrophosphate with pyrophosphate in the body, which plays an important role in sugar metabolism and maintains the normal functions of the heart, nerves and digestive system; they do not adversely affect the function of the organism in patients undergoing surgery, and with the median nerve passing under the Neiguan point, vitamin B1 is beneficial but not harmful to the nerves.
From clinical observation, conventional gastrofacial intramuscular therapy for ergitation after abdominal surgery was not as effective as acupuncture treatment (P0.01). Acupuncture point injection is more intense than conventional acupuncture (pricking) moxibustion, the effect is longer lasting than body acupuncture, faster than body acupuncture, the treatment of postoperative erratic effect is significant (P0.05), the results show that the efficiency increases with the increase in the number of treatments, and the operation time of acupuncture point injection is shorter than conventional acupuncture treatment (generally 25 minutes), generally two or three minutes to complete, does not prevent the implementation of other treatment options for patients after surgery, the method The method is simple and easy to grasp, so it is easy to promote.
In addition to post-surgical eruptions, this method is also suitable for eruptions caused by various other reasons, and is also effective for persistent eruptions such as eruptions in tumor patients after chemotherapy.