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
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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。 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. 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 -
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 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 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 -
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