不同针刺疗法治疗胰十二指肠切除术后C级胃排空延迟的临床疗效比较：基于倾向性评分匹配的回顾性队列研究

李天宇; 张亚敏; 米沁东; 李泽儒; 包飞; 王维斌

doi:10.12290/xhyxzz.2023-0088

不同针刺疗法治疗胰十二指肠切除术后C级胃排空延迟的临床疗效比较：基于倾向性评分匹配的回顾性队列研究

doi: 10.12290/xhyxzz.2023-0088

1.
中国医学科学院北京协和医院基本外科，北京 100730
2.
中国医学科学院北京协和医院中医科，北京 100730

基金项目:

中央高水平医院临床科研专项 2022-PUMCH-B-004

北京协和医院沉淀基金整合委托项目 ZC201903189

详细信息

通讯作者:
包飞, E-mail: bfpumch@163.com

王维斌, E-mail: wwb_xh@163.com

中图分类号: R657.5; R245
计量
- 文章访问数: 166
- HTML全文浏览量: 45
- PDF下载量: 25
- 被引次数: 0
出版历程
- 收稿日期: 2023-02-17
- 录用日期: 2023-03-28
- 刊出日期: 2023-09-30

Comparison of Clinical Efficacy of Different Acupuncture Therapies for Grade C Delayed Gastric Emptying after Pancreaticoduodenectomy: A Retrospective Cohort Study Based on Propensity Score Matching

LI Tianyu¹,
ZHANG Yamin²,
MI Qindong²,
LI Zeru¹,
BAO Fei^{2
, ,},
WANG Weibin^{1
, ,}

1.
Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
2.
Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China

Funds:

National High Level Hospital Clinical Research Funding 2022-PUMCH-B-004

Peking Union Medical College Hospital Precipitation Fund Integration Entrusted Project ZC201903189

More Information

Corresponding author: BAO Fei, E-mail: bfpumch@163.com; WANG Weibin, E-mail: wwb_xh@163.com

摘要

摘要: 目的探究不同针刺疗法治疗胰十二指肠切除术后C级胃排空延迟(delayed gastric emptying, DGE)的疗效差异。方法本研究为回顾性队列研究，研究对象为2015年1月—2021年9月北京协和医院基本外科行胰十二指肠切除术后接受中医针刺疗法治疗的C级DGE患者。根据针刺疗法的不同，将其分为体针组(单纯体针疗法)和耳体针组(耳针联合体针疗法)，并根据基线胃液引流量，采用倾向性评分法对两组患者进行1∶1匹配。比较两组主要结局指标[短期(3 d内)疗效、长期(10 d内)疗效]及次要结局指标(术后住院时间、带胃管出院患者的比例、治疗期间不良事件发生率)差异。结果共入选符合纳入与排除标准的C级DGE患者65例，其中耳体针组34例(52.3%)、体针组31例(47.7%)。(1)短期疗效：经倾向性评分法匹配后共纳入耳体针组患者23例、体针组患者23例。耳体针组短期胃液引流量下降率高于体针组[42.7%(19.6%，65.1%)比6.5%(-14.7%，50.6%)，P=0.034]。(2)长期疗效及次要结局指标：由于体针组、耳体针组分别存在4例、6例于治疗3 d内成功拔除胃管的患者，其无法计算治疗长期疗效，故将其排除。采用倾向性评分法再次对两组患者进行匹配后，共纳入耳体针组患者16例、体针组患者16例。两组治疗期间均无不良事件发生，耳体针组长期胃液引流量下降率高于体针组[49.6%(15.7%，56.9%)比8.8%(-9.3%，33.1%)，P=0.024]，术后住院时间[30.0(26.0，38.5)d比31.0(24.3，43.8)d, P=0.748]及带胃管出院患者的比例(18.8%比25.0%, P＞0.999)与体针组均无显著差异。结论相较于单纯体针疗法，耳针联合体针疗法减少胰十二指肠切除术后C级DGE患者胃液引流量的疗效更显著，可能更有利于患者术后康复。
- 胰十二指肠切除术 /
- 胃排空延迟 /
- 针刺疗法 /
- 倾向性评分
Abstract: Objective To investigate the effect of different acupuncture methods on gastric juice drainage in patients with grade C delayed gastric emptying (DGE) after pancreaticoduodenectomy. Methods This was a retrospective cohort study of patients with grade C DGE after pancreaticoduodenectomy who received acupuncture treatment from January 2015 to September 2021. According to the acupuncture methods, the patients were divided into body acupuncture group and ear-body acupuncture group. The patients in both groups were matched 1∶1, using propensity score matching based on the baseline gastric fluid drainage. The differences in the primary outcome indicators[short-term (within 3 d) outcome, long-term (within 10 d) outcome] and secondary outcome indicators (length of postoperative hospital stay, proportion of patients discharged with a gastric tube, incidence of adverse events during treatment) were compared between the two groups. Results A total of 65 patients with DGE who met the inclusion and exclusion criteria were enrolled, including 34 patients (52.3%) in the ear-body acupuncture group and 31 patients (47.7%) in the body acupuncture group. (1)Short-term efficacy: A total of 23 patients in the ear-body acupuncture group and 23 patients in the body acupuncture group were enrolled after matching by propensity score method. The short-term decrease rate of gastric fluid drainage in the ear-body acupuncture group was higher than that in the body acupuncture group[42.7%(19.6%, 65.1%) vs. 6.5%(-14.7%, 50.6%), P=0.034]. (2) Long-term efficacy and secondary outcome indicators: There were 4 and 6 patients in the body acupuncture group and the ear-body acupuncture group, respectively, who had their gastric tubes successfully removed within 3 d of treatment. Their long-term efficacy of treatment could not be calculated, so they were excluded. After matching the two groups again using the propensity score method, a total of 16 patients in the ear-body acupuncture group and 16 patients in the body acupuncture group were included. There were no adverse events during treatment in both groups, and the rate of long-term gastric drainage decline was higher in the ear-body acupuncture group [49.6% (15.7%, 56.9%) vs. 8.8%(-9.3%, 33.1%), P=0.024] than the body acupuncture group, the postoperative hospital stay[30.0(26.0, 38.5) d vs. 31.0(24.3, 43.8) d, P=0.748] and the proportion of patients discharged with a gastric tube (18.8% vs. 25.0%, P > 0.999) were not significantly different between the two groups. Conclusion Compared with body acupuncture alone, auricular acupuncture combined with body acupuncture therapy is more effective in reducing gastric drainage in patients with grade C DGE after pancreaticoduodenectomy, which may be beneficial to patients' postoperative recovery.
- pancreaticoduodenectomy /
- delayed gastric emptying /
- acupuncture therapy /
- propensity score matching
注释:

作者贡献：李天宇负责统计学分析及论文撰写；张亚敏、米沁东、李泽儒负责临床资料整理，并对论文提出修改意见；包飞、王维斌指导论文修订。

利益冲突：所有作者均声明不存在利益冲突

HTML全文

表 1 倾向性评分匹配前两组患者基线资料比较

指标	体针组(n=31)	耳体针组(n=34)	P值
男性[n(%)]	24(77.4)	20(58.8)	0.109
年龄[M(P₂₅, P₇₅), 岁]	63.0(57.0，65.0)	63.0(60.5，65.3)	0.587
体质量指数[M(P₂₅, P₇₅), kg/m²]	22.9(21.0, 25.6)	24.2(21.3, 26.6)	0.375
ASA分级[n(%)]			0.923
Ⅰ	4(12.9)	3(8.8)
Ⅱ	22(71.0)	25(73.5)
Ⅲ	5(16.1)	6(17.6)
高血压[n(%)]	12(38.7)	16(47.1)	0.497
糖尿病[n(%)]	7(22.6)	10(29.4)	0.531
冠心病[n(%)]	4(12.9)	3(8.8)	0.897
术前减黄[n(%)]	4(12.9)	9(26.5)	0.172
新辅助化疗[n(%)]	1(3.2)	1(2.9)	＞0.999
手术时间[M(P₂₅, P₇₅), h]	6.0(5.0, 7.0)	6.0(5.0, 7.8)	0.150
术中出血量[M(P₂₅, P₇₅), mL]	500(250, 700)	400(275, 800)	0.916
术中输血浆≥400 mL[n(%)]	14(45.2)	19(55.9)	0.388
术中输红细胞≥400 mL[n(%)]	12(38.7)	15(44.1)	0.659
保留幽门[n(%)]	3(9.7)	2(5.9)	0.914
术后严重并发症[n(%)]	6(19.4)	10(29.4)	0.347
术后至开始针刺治疗的时间[M(P₂₅, P₇₅), d]	17.0(12.0, 20.0)	13.0(12.0, 18.0)	0.349
基线胃液引流量[M(P₂₅, P₇₅), mL]	327(220, 587)	532(332, 882)	0.005
ASA：美国麻醉医师协会

下载: 导出CSV

表 2 倾向性评分匹配后两组患者基线资料及短期疗效比较

指标	体针组(n=23)	耳体针组(n=23)	P值
男性[n(%)]	18(78.3)	13(56.5)	0.116
年龄[M(P₂₅, P₇₅), 岁]	63.0(53.0, 65.0)	63.0(61.0, 66.0)	0.456
体质量指数[M(P₂₅, P₇₅), kg/m²]	23.2(21.8, 25.7)	24.5(21.2, 26.6)	0.621
ASA分级[n(%)]			0.839
Ⅰ	3(13.0)	2(8.7)
Ⅱ	18(78.3)	15(65.2)
Ⅲ	2(8.7)	6(26.1)
高血压[n(%)]	8(34.8)	12(52.2)	0.234
糖尿病[n(%)]	6(26.1)	6(26.1)	＞0.999
冠心病[n(%)]	3(13.0)	1(4.3)	0.601
术前减黄[n(%)]	3(13.0)	5(21.7)	0.697
新辅助化疗[n(%)]	1(4.3)	1(4.3)	＞0.999
手术时间[M(P₂₅, P₇₅), h]	6.0(5.0，7.0)	6.0(5.0，8.0)	0.465
术中出血量[M(P₂₅, P₇₅), mL]	500(250，700)	400(300，800)	0.869
术中输血浆≥400 mL[n(%)]	11(47.8)	15(65.2)	0.234
术中输红细胞≥400 mL[n(%)]	9(39.1)	12(52.2)	0.375
保留幽门[n(%)]	1(4.3)	1(4.3)	＞0.999
术后严重并发症[n(%)]	3(13.0)	9(39.1)	0.091
术后至开始针刺治疗的时间[M(P₂₅, P₇₅), d]	17.0(11.0，19.0)	13.0(12.0，18.0)	0.991
基线胃液引流量[M(P₂₅, P₇₅), mL]	480(243，633)	447(303，593)	0.860
针刺疗法治疗3 d内胃液引流量均值[M(P₂₅, P₇₅), mL]	337(210，580)	261(157，390)	0.173
短期胃液引流量下降率[M(P₂₅, P₇₅), %]	6.5(-14.7，50.6)	42.7(19.6，65.1)	0.034
ASA：同表 1

下载: 导出CSV

表 3 倾向性评分匹配后两组患者主要基线资料、长期疗效及次要结局指标比较

指标	体针组(n=16)	耳体针组(n=16)	P值
术后至开始针刺治疗的时间[M(P₂₅, P₇₅), d]	13.5(10.3，19.3)	14.5(12.0，24.8)	0.384
治疗次数[M(P₂₅, P₇₅), 次]	2.0(1.2，4.0)	2.0(1.0，2.0)	0.211
基线胃液引流量[M(P₂₅, P₇₅), mL]	529(227，659)	468(309，585)	0.792
针刺疗法治疗10 d内胃液引流量均值[M(P₂₅, P₇₅), mL]	332(211, 663)	242(150，472)	0.169
长期胃液引流量下降率[M(P₂₅, P₇₅), %]	8.8(-9.3，33.1)	49.6(15.7，56.9)	0.024
术后住院时间[M(P₂₅, P₇₅), d]	31.0(24.3，43.8)	30.0(26.0，38.5)	0.748
带胃管出院[n(%)]	4(25.0)	3(18.8)	＞0.999

下载: 导出CSV

参考文献(32)

[1]	Karim SAM, Abdulla KS, Abdulkarim QH, et al. The outcomes and complications of pancreaticoduodenectomy (Whipple procedure): Cross sectional study[J]. Int J Surg, 2018, 52: 383-387. doi: 10.1016/j.ijsu.2018.01.041
[2]	Cai X, Zhang M, Liang C, et al. Delayed gastric emptying after Pancreaticoduodenectomy: a propensity score-matched analysis and clinical Nomogram study[J]. BMC Surg, 2020, 20: 149. doi: 10.1186/s12893-020-00809-5
[3]	Qu H, Sun GR, Zhou SQ, et al. Clinical risk factors of delayed gastric emptying in patients after pancreaticoduodenectomy: a systematic review and meta-analysis[J]. Eur J Surg Oncol, 2013, 39: 213-223. doi: 10.1016/j.ejso.2012.12.010
[4]	葛佳伊, 姜跃炜, 王东煜, 等. 温针灸对糖尿病胃轻瘫患者胃肠激素的影响[J]. 中华全科医学, 2016, 14: 298-299, 316. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY201602048.htm
[5]	王蕊, 杨正飞. 针灸治疗糖尿病胃轻瘫作用机制探析[J]. 山东中医杂志, 2022, 41: 370-375. https://www.cnki.com.cn/Article/CJFDTOTAL-SDZY202204003.htm
[6]	张保良. 中药加针灸治疗食管癌、贲门癌术后胃瘫综合征临床研究[J]. 中外医学研究, 2010, 8: 59. https://www.cnki.com.cn/Article/CJFDTOTAL-XDJH201724020.htm
[7]	朱伟坚, 王茵萍, 高岑, 等. 电针预防胰十二指肠切除术后胃瘫综合征的临床观察[J]. 世界中西医结合杂志, 2021, 16: 162-166. https://www.cnki.com.cn/Article/CJFDTOTAL-SJZX202101036.htm
[8]	中华医学会外科学分会胰腺外科学组, 中国研究型医院学会胰腺病专业委员会. 胰腺术后外科常见并发症诊治及预防的专家共识(2017)[J]. 协和医学杂志, 2017, 8: 139-146. doi: 10.3969/j.issn.1674-9081.2017.03.011
[9]	None. Auricular Acupuncture Point (WFAS STANDARD-002: 2012)[J]. World J Acupunct Mox, 2013, 23: 12-21. doi: 10.1016/S1003-5257(13)60055-0
[10]	罗国德, 曹永宽, 张林, 等. 胃液引流量在腹部术后胃瘫综合征中的诊断价值及其影响因素(附19例报道)[J]. 中国现代医学杂志, 2012, 22: 69-71. https://www.cnki.com.cn/Article/CJFDTOTAL-ZXDY201235016.htm
[11]	Simon R. Complications After Pancreaticoduodenectomy[J]. Surg Clin North Am, 2021, 101: 865-874. doi: 10.1016/j.suc.2021.06.011
[12]	Camilleri M, Chedid V, Ford AC, et al. Gastroparesis[J]. Nat Rev Dis Primers, 2018, 4: 41. doi: 10.1038/s41572-018-0038-z
[13]	Hanna MM, Gadde R, Allen CJ, et al. Delayed gastric emptying after pancreaticoduodenectomy[J]. J Surg Res, 2016, 202: 380-388. doi: 10.1016/j.jss.2015.12.053
[14]	Murakami H, Li S, Foreman R, et al. Intraoperative Vagus Nerve Stimulation Accelerates Postoperative Recovery in Rats[J]. J Gastrointest Surg, 2019, 23: 320-330. doi: 10.1007/s11605-018-3969-5
[15]	李凯歌, 郭孟玮, 谭莉华, 等. 比较电针"大肠俞""天枢"穴对肠易激综合征模型大鼠内脏敏感性、Cajal间质细胞和辣椒素受体1的影响[J]. 中国针灸, 2018, 38: 625-629, 636. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGZE201806019.htm
[16]	张莘, 张选平, 杜玉茱, 等. 不同刺灸法对功能性便秘大鼠结肠组织肠神经相关蛋白表达的影响[J]. 针刺研究, 2017, 42: 407-412. https://www.cnki.com.cn/Article/CJFDTOTAL-XCYJ201705006.htm
[17]	韩娟, 荣培晶, 王宏才, 等. 基于脑肠互动学说探析针刺治疗功能性消化不良[J]. 中医杂志, 2021, 62: 845-849. https://www.cnki.com.cn/Article/CJFDTOTAL-ZZYZ202110005.htm
[18]	李怀玉, 陈云, 胡子毅, 等. 针灸治疗胃癌术后胃肠功能障碍疗效的Meta分析[J]. 中国针灸, 2022, 42: 595-602. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGZE202205028.htm
[19]	李成刚, 黄彬, 刘荣, 等. 针灸预防胰十二指肠切除术后胃排空延迟[J]. 解放军医学院学报, 2014, 35: 439-441. https://www.cnki.com.cn/Article/CJFDTOTAL-JYJX201405013.htm
[20]	刘敬萱, 孙彦辉, 张莘, 等. 耳针理论学说的研究现状与思考[J]. 针刺研究, 2021, 46: 893-900. https://www.cnki.com.cn/Article/CJFDTOTAL-XCYJ202110016.htm
[21]	Liu CH, Yang MH, Zhang GZ, et al. Neural networks and the anti-inflammatory effect of transcutaneous auricular vagus nerve stimulation in depression[J]. J Neuroinflammation, 2020, 17: 54.
[22]	Mao JJ, Liou KT, Baser RE, et al. Effectiveness of Electroacupuncture or Auricular Acupuncture vs Usual Care for Chronic Musculoskeletal Pain Among Cancer Survivors: The PEACE Randomized Clinical Trial[J]. JAMA Oncol, 2021, 7: 720-727.
[23]	葛曼, 黄晓桃, 向曦. 隐白穴艾灸合耳穴治疗对青春期异常子宫出血止血效应的影响[J]. 内蒙古中医药, 2022, 41: 99-100. https://www.cnki.com.cn/Article/CJFDTOTAL-NZYY202202057.htm
[24]	黄惠榕, 薛佳璐, 余真铃, 等. 耳穴贴压改善家兔腹部术后胃肠功能的作用机制研究[J]. 护理学杂志, 2022, 37: 43-45, 60. https://www.cnki.com.cn/Article/CJFDTOTAL-HLXZ202215012.htm
[25]	Bonaz B, Bazin T, Pellissier S. The Vagus Nerve at the Interface of the Microbiota-Gut-Brain Axis[J]. Front Neurosci, 2018, 12: 49.
[26]	He W, Wang X, Shi H, et al. Auricular acupuncture and vagal regulation[J]. Evid Based Complement Alternat Med, 2012, 2012: 786839.
[27]	Lin S, Kajimura M, Takeuchi K, et al. Expression of muscarinic receptor subtypes in rat gastric smooth muscle: effect of M3 selective antagonist on gastric motility and emptying[J]. Dig Dis Sci, 1997, 42: 907-914.
[28]	Báez-Pagán CA, Delgado-Vélez M, Lasalde-Dominicci JA. Activation of the Macrophage α7 Nicotinic Acetylcholine Receptor and Control of Inflammation[J]. J Neuroimmune Pharmacol, 2015, 10: 468-476.
[29]	侯理伟, 荣培晶, 李亮, 等. 经皮耳穴迷走神经刺激对功能性消化不良大鼠自主神经功能的影响[J]. 针刺研究, 2021, 46: 663-670. https://www.cnki.com.cn/Article/CJFDTOTAL-XCYJ202108006.htm
[30]	中华医学会麻醉学分会"穴位刺激围术期应用专家共识"工作小组. 穴位刺激围术期应用专家共识[J]. 中华麻醉学杂志, 2017, 37: 1153-1158.
[31]	季永荣, 梁仲惠. 胃及十二指肠疾病耳郭望诊与胃镜检查对比观察[J]. 中国针灸, 1995(15): 41-42. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGZE505.031.htm
[32]	全国针刺麻醉学习班选编组. 针刺麻醉原理的探讨[M]. 北京: 人民卫生出版社, 1974: 364-366.

施引文献

资源附件(0)

访问统计

点击查看大图

表(3)

计量

文章访问数: 166
HTML全文浏览量: 45
PDF下载量: 25
被引次数: 0

姓名
邮箱
手机号码
标题
留言内容
验证码

地址：	北京市东城区帅府园1号北京协和医院老楼7号楼 3层302室《协和医学杂志》编辑部
电话：	010-69154261/4262
E - mail：	medj@pumch.cn mjpumch@126.com
期刊网站版权所有：	《协和医学杂志》编辑部京ICP备 11002662

留言板

不同针刺疗法治疗胰十二指肠切除术后C级胃排空延迟的临床疗效比较：基于倾向性评分匹配的回顾性队列研究

doi: 10.12290/xhyxzz.2023-0088

通讯作者:
包飞, E-mail: bfpumch@163.com

王维斌, E-mail: wwb_xh@163.com

计量

Comparison of Clinical Efficacy of Different Acupuncture Therapies for Grade C Delayed Gastric Emptying after Pancreaticoduodenectomy: A Retrospective Cohort Study Based on Propensity Score Matching

Corresponding author: BAO Fei, E-mail: bfpumch@163.com; WANG Weibin, E-mail: wwb_xh@163.com

计量

目录

留言板

不同针刺疗法治疗胰十二指肠切除术后C级胃排空延迟的临床疗效比较：基于倾向性评分匹配的回顾性队列研究

doi: 10.12290/xhyxzz.2023-0088

通讯作者: 包飞, E-mail: bfpumch@163.com 王维斌, E-mail: wwb_xh@163.com

计量

出版历程

Comparison of Clinical Efficacy of Different Acupuncture Therapies for Grade C Delayed Gastric Emptying after Pancreaticoduodenectomy: A Retrospective Cohort Study Based on Propensity Score Matching

Corresponding author: BAO Fei, E-mail: bfpumch@163.com; WANG Weibin, E-mail: wwb_xh@163.com

计量

出版历程

目录

通讯作者:
包飞, E-mail: bfpumch@163.com

王维斌, E-mail: wwb_xh@163.com