| BackgroundWhen patients suffered Cirrhosis with Portal hypertension, with damag ed intestinal mucosal barrier function, decreased cellular immunity, the occurrence of bacterial translocation, resulting in endotoxemia and spont aneous bacterial peritonitis, and perioperative morbidity and mortality o f abdominal surgery increase.. Cirrhosis of the liver is common in China,4 0% of patients with cirrhosis who have portal hypertension complicated.t he intestinal mucosal barrier was damaged in Patients suffered cirrhosis and portal hypertension. When cirrhosis with portal hypertension patients accept selective periesophagogastric devascularization surgery, postoper ative liver failure, gastrointestinal dysfunction, surgically induced sys temic inflammatory response syndrome caused further damage to the intesti nal mucosa barrier function. Intestinal mucosal barrier injury severely a ffect postoperative recovery, and can induce multiple organ dysfunction or failure. Therefore, strengthening the protection of the intestinal muc osa in patients with cirrhotic portal hypertension has important signific ance. Bacterial translocation and intestinal endotoxemia and systemic imm une function are closely linked between, cirrhosis systemic immune protec tion capacity of the body decreased, which can promote bacterial and endo toxin translocation, while the translocation of bacteria and endotoxin ca n increase the systemic immune dysfunction, improve intestinal barrier fu nction may improve systemic cellular immunity. With the concept of accele rated rehabilitation surgery used in Chinese medicine in perioperative in tervention in the perioperative management for the key issues, and furthe r give full play to the characteristics and advantages of Chinese medicin e, on the targeted perioperative effective measures can promote postopera tive recovery. The concept of accelerated rehabilitation surgery graduall y integrated into the various types of surgery, to provide the best for t he Integrative Medicine program, and enhance overall prognosis for surger y quickly and benign outcome. Treatment of bowel dysfunction is the world problems, the project of "the treatment of bowel dysfunction" led by Ji eshou Li of Nanjing General Hospital of Nanjing Military Academy, recentl y won the 2010 National Science and Technology Progress Award, the presen t study on intestinal function Abdominal surgery is still hot. the study of medical applications on abdominal surgery in the perioperative period have been carried out. some of these research results in promoting the ra pid rehabilitation of surgical patients has important clinical significan ce. Previous clinical studies have shown that Evodia hot iron therapy pro mote rapidly recovery after abdominal surgery, and promote recovery of ga strointestinal function after surgery. following the DME research design principles, an objective assessment of Evodia hot iron therapy to improve gastrointestinal motility, intestinal barrier function, cellular immunit y.ObjectiveScientificly Evaluate the effection of Evodia hot iron therapy of Traditional Chinese Medicine on improving the gastrointestinal motility, mucosal barrier function, cell immunity of postoperative patiens with portal hypertension;to explore effection of the Evodia hot iron therapy under the guidance of the spleen and stomach theory of traditional Chinese medicine theory, on the impact of rapid recovery after abdominal surgery, to interpretate the scientific substance of the the spleen and stomach theory of traditional Chinese medicine.MethodsSelected cirrhosis and portal hypertension case accepted splenectomy and /or selective pericardial devascularization surgery for the study were randomly divided into two groups, Evodia hot iron group and blank control group. Observe perioperational heart rate, body temperature and other vital signs; take the blood sample on lth day before surgery and the first lth,7th days after surgery of, to test biochemistry, liver function, C-reactive protein; record perioperative death, liver/kidney failure, multiple organ dysfunction, hepatic encephalopathy, pleural effusion, portal vein thrombosis, abdominal infections and other complications. record the recovery time of postoperative bowel sounds, flatus, bowel movement. take the blood sample on the lth day before surgery and the lth,7th days after surgery to test the plasma diamine oxidase (DAO), plasma endotoxin (LPS) level, D-lactic acid, urine fructose (L)/mannitol (M) ratio. taking the blood sample on the first day before surgery and the first,the 7th days after surgery to test peripheral blood CD3 +, CD4+, CD8+ evaluating cellular immune function.Results1. Treatment group and control group on admission clinical data such as age, sex, etiology, preoperative liver function Child-Pugh classification, combined with hypersplenism were no significant differences in the situation.2. two groups had no perioperative death, liver/kidney failure, multiple organ dysfunction, hepatic encephalopathy cases, no secondary surgery.7 patients in treatment group and 5 cases in control group with pleural effusion. 1 case suffered postoperative portal vein thrombosis in treatment group, to be recovered after thrombolytic therapy. the treatment group 1 patients and the control group 3 patients with positive ascites bacterial culture. Pulmonary infection,3 cases of the treatment group and 5 cases of control group.3. two groups, heart rate (bmp), body temperature (℃) compared.on the 7th day after operation, the heart rate of treatment group (88±8) beats/min, control group (80±5) beats/min, the treatment group compared with the control group were significantly different, P<0.05. No significant difference between two groups of body temperature, P> 0.05.4. two groups WBC (109/L), neutrophils (%), C-reactive protein (mg/L) compared. on the 7th day after operation, neutrophils after surgery treatment group (75.4±8.6)%, control group (80.5±5.1)%, treatment group was significantly lower than the control group, the difference was significant (P<0.05). C-reactive protein, treatment group (25.6±16.4) mg/L, control group (42.6±18.3) mg/L, the treatment group compared with the control group were significantly different (P<0.05)5. The treatment group and control group dynamic changes of liver function. Treatment group and control group were ALT, AST, TBIL, PT after surgery were in the first day after operation, the the third day after operation, the 7th day after operation tended to increase; but at the same stage of the two groups, treatment group was lower than the control group; on the 7th day after operation the treatment group ALT, AST was significantly lower than the control group ALT, AST values-between the two groups was statistically significant (P<0.01).6. The recovery of gastrointestinal function.Treatment group and control group patients recovery time of bowel sounds, the first exhaust time, the first defecation was significantly longer than the general abdominal surgery. Treatment group peristaltic sound recovery time (50.27±13.68) h,1st exhaust time (80.76±18.33) h,1st bowel movement (105.03±16.41) h, compared with the control group were significantly different, P<0.05.7. Abnormal gastrointestinal function after surgery.Treatment group, abnormal gastrointestinal function than the control group were significantly different, P<0.05.8. Preoperative and postoperative L/M values (L/M:lactulose/mannitol) to compare.Preoperative treatment group and control group urine L/M were higher than the normal reference range (0.019-0.036), between the two groups L/M were not significantly different (P> 0.05).7d after the first treatment group and control group urine L/M were higher than before the surgery, the treatment group L/M is less than the control group, significant difference, P<0.05.9. Two groups of patients changes in diamine oxidase DAO.Preoperative treatment group and control group, the plasma levels of diamine oxidase DAO was no significant difference (P> 0.05). the first day after operation in plasma diamine oxidase DAO lever of two groups were higher than the preoperative level。on the 7th day after operation, plasma diamine oxidase DAO of treatment group is lower than the control group, significant difference, (P<0.05).10. before and after Surgery the change of plasma endotoxin LPS (Ea/ ml). Between the two groups LPS endotoxin levels before surgery were not significantly different (P> 0.05). on the first day after operation, plasma endotoxin LPS group were higher than preoperative; on the 7th day after operation LPS endotoxin of treatment group is lower than the control group, statistically significant (P<0.05).11. before and after the operation the change of plasma D-lactate. Between the two groups before surgery, plasma D-lactate levels were not significantly different (P> 0.05). on the first day after operation, plasma D-lactate levels of two groups were higher than those before; on the 7th day after operation, D-lactic acid of treatment group is lower than the control group, t statistically significant (P<0.05).12. Perioperative immune parameters in peripheral blood cells. the CD3+, CD4+, CD8+ level of Preoperative treatment group and control group were significantly lower than normal (normal range of CD3+72±7%, CD4+43±9%, CD8+30±9%), on the postoperative firt day, peripheral Blood CD3+, CD4+, CD8+ value of two groups were significantly lower than the preoperative value (P<0.05). on the 7th day, the peripheral blood CD3+valure of both treatment and control groups were higher than before surgery (P<0.05); treatment group were significantly higher than the contral group(P<0.05).Conclusionscompared to general terms of abdominal surgery, cirrhosis with portal hypertension in patients after surgery, the gastrointestinal motility di sorder, intestinal mucosal barrier dysfunction, immune dysfunction were m ore seriously.related to the patients recovery process, prognosis or out come. The study result show that Evodia hot iron treatment can significa ntly improve the gastrointestinal motility, intestinal mucosal barrier fu nction, immune function of cirrhosis with portal hypertension patients af ter surgery. The study explains the modern connotation of the External Ev odia hot iron therapy under the guidance of the spleen and stomach theory of traditional Chinese medicine. |
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