The clinical effect observation of gastrointestinal function after colorectal cancer surgery with integrated of Chinese and western medicine nursing methods

Yuan-Yuan Zhang,Li Lu,Wei Liu,Yu-Ling Wang*

1 Department of Nursing,Tianjin Hospital of ITCWM Nankai Hospital,Tianjin,China.

ABSTRACT

Key words:Nursing,Warm moxibustion,Acupoint application,Ggastrointestinal function

1.INTRODUCTION

Gastrointestinal dysfunction is the most common complication after abdominal surgery,referring to digestive system dysfunction that cannot be restored in time after thoracic and abdominal surgery [1].Affected by many factors in the perioperative period,patients often have delayed postoperative gastrointestinal function recovery,such as prolonged exhaustion and defecation time,weakened or disappeared bowel sounds,abdominal pain,abdominal distension,nausea and vomiting,etc.,which affecting their nutritional status and postoperative rehabilitation,increase the incidence of postoperative intestinal adhesions,wound infections and other complications,prolong hospital stay,increase hospitalization costs.Therefore,how to restore the gastrointestinal function of postoperative patients as soon as possible and promote the rapid recovery of patients is a topic worth exploring.

After abdominal surgery,in order to promote the recovery of gastrointestinal function,western medicine routinely treats symptomatic treatments such as fasting water,anti-inflammatory,fluid replacement,and enteral nutrition support.After the vital signs are stable,patients are encouraged to move out of bed [2].The pathogenesis of gastrointestinal dysfunction in traditional Chinese medicine (TCM) is deficiency of spleen and stomach,Qi activity block,ascending and descending abnormal.The treatment methods are mostly oral administration of TCM decoction,external use of TCM,acupoint therapy and other symptomatic treatment [3,4].Emotional discomfort will affect the liver,stagnation of liver Qi and spleen deficiency,which can also be treated with TCM treatment [5].Warm moxibustion therapy and acupoint sticking therapy have been widely used as National Training Program for Key Nursing Talents of traditional Chinese Medicine.In this study,the two methods were applied to postoperative patients with colorectal cancer,and their clinical effects on gastrointestinal function recovery were observed.The report is as follows.

2.RESEARCH DESIGN

2.1 Test grouping

There were 4 treatment groups in this study.The control group retrospectively selected 20 patients who underwent surgery for colorectal cancer in the period from October to December 2017 and did not receive the Chinese medicine nursing program.The observation group I,observation group II,observation group III was selected from 60 patients who underwent surgical treatment of colorectal cancer from January to June 2018.The patients were enrolled according to the order of admission,and were grouped by random number table,each group had 20 patients.

2.2 Nursing scheme

(1) Control group:routine treatment and nursing.

(2) Observation group I:On the basis of conventional treatment and care,warm moxibustion therapy was added.Selection points:Zusanli (ST36),Shangjuxu (ST37),Guanyuan (CV4).On the first day after surgery,daily warm moxibustion is given at 10:00 am,time 30 min,1 time/day,continuous treatment for 5 days.Tools:DAJ-10 multi-purpose moxibustion apparatus.

(3) Observation group II:On the basis of conventional treatment and nursing,acupoint application therapy was added.Selection points:Zusanli (ST36),Shangjuxu (ST37),Guanyuan (CV4).The first day after the operation began to be applied once a day at 2:00 pm,4 hours,1 time/day,continuous treatment for 5 days.Apply Chinese medicine:10g of Xiangfu (CyperusrotundusL.),10g of Chuanqiong (Ligusticum chuanxiong Hort.) to make granules of TCM,mix with warm water and appropriate amount of honey into a paste,apply an appropriate amount evenly at the center of acupoint application (inner diameter about 2 cm,thickness of TCM is about 1 mm).

(4) Observation group III:On the basis of routine treatment and care,warm moxibustion and acupoint application therapy were added.The acupoint selection and nursing methods were the same as observation group I and observation group II.

2.3 Subject investigated

2.3.1 Case source.Patients with colorectal cancer who underwent surgery for gastrointestinal surgery in Tianjin Nankai Hospital were selected from October 2017 to June 2018.

2.3.2 Inclusion criteria.① Hospitalized patients undergoing surgical treatment of colorectal cancer; ② age limit:18 years old ≤ y ≤ 75 years old; ③ blood,urine routine,liver,kidney function and other indicators are normal; ④ patients voluntarily accepted the test and signed informed consent.

2.3.3 Exclusion standard.① Patients with allergies,as well as patients with a history of allergies to the use of TCM; ② there are serious diseases such as cardiovascular and cerebrovascular diseases and metabolic diseases,and patients with mental illness;③ patients who are participating in other clinical drug trials;④ patients who did not meet the inclusion criteria for the case.

2.4 Curative observation

2.4.1 TCM symptom observation.Using the grading scale of gastrointestinal dysfunction symptoms,score according to clinical symptoms and signs,the main symptoms include bloating,eating less,staying,stool pain,abdominal pain [6]; Secondary symptoms include emotional depression / irritability,chest stuffy short breath,abdominal pain,diarrhea,and postdiarrhea pain reduction.Scoring method:0 points for asymptomatic,2 points for mildness,4 points for moderate degree,and 6 points for severeness.Recorded once on the first day,third day,and fifth day after surgery,the total scores for each symptom are the sum of the scores.

2.4.2 Efficacy evaluation criteria.The formula is:symptom improvement percentage = (pre-treatment score - post-treatment score)/pre-treatment score × 100%.Healing:clinical symptoms and signs disappeared,symptom scores decreased by ≥95%; markedly effective:clinical symptoms and signs improved significantly,symptom scores decreased by ≥ 70%; effective:clinical symptoms and signs improved,symptom scores decreased by ≥ 30%.Invalid:no significant improvement in clinical symptoms and signs,or even worse,symptom scores reduced by ＜ 30%.

2.5 Safety index.① General physical examination includes gender,age,height,weight,etc.; ② laboratory tests:blood,urine routine,liver,kidney function and other indicators are normal; ③ adverse reactions:observe the use of drugs after the discomfort,such as pain,allergic reactions.

2.6 Statistical method.The study data were analyzed by SPSS 17.0 statistical software,withP＜ 0.05 as the statistically significant difference.The measurement data is described by,the count data is described by frequency/composition ratio,and the data is compared and analyzed by means of variance analysis,t test and χ2test.

3.RESULTS

3.1 Comparison of general data before treatment between observation group and control group

As shown in Table1,the comparison between the observation group and the control group showed that the difference was not statistically significant (P＞ 0.05),indicating that the groups were comparable.

Table1.Comparison of general data before treatment between observation group and control group

3.2 The TCM syndrome scores of the observation group and the control group at different intervention time

As shown in Table2,the results of repeated measures analysis of variance showed that the TCM syndrome scores of the four groups were statistically different between time and group (P＜0.01),and there were statistical differences in interaction effects(P＜ 0.01).The TCM symptom scores of the four groups of patients showed significant differences with the intervention time.At the same time,the improvement of TCM symptoms in the four groups was affected by the grouping,which indicated that the three intervention methods had inconsistent effects on TCM symptoms.The comparison between the two groups by LSD method showed that the improvement of TCM symptoms in observation group I,observation group II and observation group III after treatment was better than that of the control group (Pvalues were 0.03,0.02,0.01 respectively),There was no statistical difference between observation group I and observation group II (P= 0.87),and the observation group III was superior to the observation group I and the observation group II (Pvalues were 0.03,0.04,respectively).

Table2.Analysis of TCM syndrome integral of observation group and control group at different intervention time

3.3 Analysis of therapeutic effect of observation group and control group

As shown in Table3,the efficacy comparison between the control group and each observation group showed that the scores of the main symptom score,the secondary syndrome score and the TCM syndrome total score of each observation group were better than the control group,and the difference was statistically significant.It showed that the effect of observation group is better than that of control group.

3.4 Comparison of exhaust,defecation and eating time between observation group and control group

As shown in Table4,the exhaust time (P＜ 0.01),defecation time (P＜ 0.05) and eating time (P＜ 0.05) of the patients in each observation group were earlier than those in the control group,and the difference was statistically significant.

3.5 Adverse reaction

No adverse reaction occurred before and after treatment in the control group and each observation group.

4.DISCUSSION

4.1 The theoretical basis and acupoint selection of integrated Chinese and western medicine nursing to prevent gastrointestinal disorders

Table3.Analysis of therapeutic effect of observation group and control group

Table4.Comparison of exhaust,defecation and eating time between observation group and control group

According to the theory of traditional Chinese medicine,after the abdominal operation,the organs of the patient are damaged,and the function of the visceral ventilator is destroyed,resulting in poor airflow,suffocation,no pain,no pain,and a gas stagnation.Treatment should be based on smoothing the Qi,and improving the function of the viscera.Studies have shown that the use of moxibustion and acupoint application therapy can help clear the Qi and coordinate the viscera,thus improving the function of the patient's viscera and phlegm,and achieving the purpose of treatment [7].The Stomach Channel of Foot-Yangming,which is characterized by more gas and more blood.It is beneficial to treat spleen and stomach diseases by taking acupoints.The Zusanli (ST36) and Shangjuxu (ST37) points belong to the The Stomach Channel of Foot-Yangming.

Conception Channel has the function of regulating blood and Qi,and treats related diseases of the running course of channel.Zhongwan (CV12) is the alarm point of the stomach,and the Guanyuan (CV4) is the alarm point of the small intestine,all of which belong to Conception Channel.Integrative Chinese and western medicine combined with western medicine routine nursing and TCM warm moxibustion,acupoint application,emotional conditioning and other methods,which through stimulation of Zusanli (ST36),Shangjuxu (ST37),Zhongwan(CV12),Guanyuan (CV4) and other points,promote the recovery of gastrointestinal function as soon as possible [8 - 10].

4.2 Warm moxibustion therapy and acupoint application therapy can improve patients' TCM symptoms

As shown in Table2,through the integrated Chinese and western medicine nursing intervention,the changes of TCM syndrome scores in the four groups were significantly different in time,and group interaction (P＜ 0.01).It is suggested that the effects of the three intervention methods on the symptoms of TCM are inconsistent.It can be seen that the inconsistency of the changes in TCM symptom scores of patients is different from the different methods of TCM nursing intervention.

The results of further comparison between the two groups showed that the improvement of TCM symptom in each observation group was better than that of the control group by adding warm moxibustion therapy and acupoint application therapy; the observation group III combined with warm moxibustion therapy and acupoint application therapy,the effect was better than that of one of the treatments alone (P＜ 0.05); there was no statistical difference in the effect of warm moxibustion or acupoint application alone (P＞ 0.05).It can be seen that on the basis of routine nursing of western medicine,the addition of warm moxibustion therapy or acupoint application therapy is beneficial to the recovery of gastrointestinal function in patients with colorectal cancer after operation,especially when combined with this two therapies,the effect is significant.It is suggested that these two kinds of TCM can be used to promote the recovery of gastrointestinal function in patients with colorectal cancer after operation.

The results in Table3 further shown that the integrated Chinese and western medicine nursing method is effective in improving the TCM symptoms of patients,which is consistent with the research of Wang LX,Wu JC,et al.[11,12].The application of TCM nursing therapy to regulate spleen and stomach is beneficial to improve gastrointestinal function.In addition,from the perspective of mental emotions,patients with colorectal cancer often have irritable emotions such as irritable anger,anxiety and depression.Chinese medicine believes that anger is liver injury,liver injury is dysfunctional.The spleen injury is poorly transported.The symptoms can be seen as less food,anorexia,indicated that mental factors are one of the important factors leading to gastrointestinal dysfunction.

In this study,through the method of soothing the liver,strengthening the stomach and invigorating the spleen,the Qi of channels and collaterals is accessible,so the syndrome of emotional discomfort is alleviated and the gastrointestinal function is recovered more quickly.Studies have shown that emotional nursing and TCM nursing therapy can reduce patients' stress level and relieve patients' negative emotions,thus promoting postoperative recovery of gastrointestinal function and improvement of life quality [13].

4.3 Warm moxibustion therapy and acupoint application therapy can promote the recovery of gastrointestinal function

Table4 showed that each observation group is better than the control group in terms of the time of first exhaust,defecation and feeding (P＜ 0.05).It consistent with Dong L,You JH,et al.reports [14,15],indicating that integrated Chinese and western medicine nursing intervention can make patients first exhaust,defecate and eating time in advance,conducive to the recovery of gastrointestinal function.At the same time,the exhaust time of observation group III patients was earlier than that of observation group I and observation group II (P＜ 0.05),further indicating that combined use of warm moxibustion therapy and acupoint application therapy can positively promote the recovery of gastrointestinal function in patients after colorectal cancer surgery.There were no significant differences in defecation and eating between the observation groups (P＞ 0.05),which may be related to the patients' drinking time,eating time and type,and may be related to the difference in the degree of gastrointestinal function recovery.More attention can be paid to future research.In summary,the combination of integrated traditional Chinese and Western medicine nursing intervention can promote the recovery of gastrointestinal function in postoperative patients with colorectal cancer,and the combined application of warm moxibustion therapy and acupoint application therapy has a significant effect,which is more conducive to rapid rehabilitation of patients.It is worthy of clinical application and extensive promotion.

Authors’ contributions

YYZ wrote the manuscript and designed the research.LL and WL edited the manuscript and helped to collect cases,data statistics and analysis.YLW contributed to the article's conceiving and checking.

Acknowledgments

None.

Financial support and sponsorship

None.

Patient consent

Not applicable.

Ethics approval

Not applicable.