The Evolution Of Syndrome Elements In Patients With Laparoscopic Cholecystectomy And Their Correlation With Clinical Characteristics

ObjectiveTaking laparoscopic cholecystectomy patients as the research object,taking each time node of admission as the horizontal axis,taking each main syndrome type as the longitudinal axis,studying the composition ratio of each TCM syndrome type,studying the evolution law of TCM syndrome type in laparoscopic cholecystectomy,and then studying the correlation between TCM syndrome and general condition,laboratory examination index and gastrointestinal function recovery index of laparoscopic cholecystectomy patients,in order to find some specific objective indexes,introduce the microscopic differentiation of TCM syndrome differentiation for laparoscopic cholecystectomy,thus providing ideas for early prevention and blocking of diseases,It also provides the basis for the early and rapid improvement of gastrointestinal function and quality of life in patients after operation,and better guide the clinical practice in perioperative period.MethodsIn this study,180 patients with laparoscopic cholecystectomy were selected to observe the clinical characteristics of clinical syndrome and western medicine.The time of observation and recording was admission,preoperative,postoperative 1 day,postoperative 3 days,postoperative 1 week.To establish a database of observation and research,compare and analyze the elements and scores of TCM syndromes in each stage horizontally and vertically.The observation indexes of western medicine are general condition of patients,blood routine,crp、biochemistry plus ion,operation time,intraoperative condition,gastrointestinal function recovery time and so on.Enter the excel table and analyze the characteristics of TCM syndrome type and its correlation with various indexes of western medicine through spss software.Results1.This study included 180 cases of laparoscopic cholecystectomy,Among them,On admission,The distribution of single syndrome type of patients were:damp-resistance syndrome(80%),damp-heat syndrome(33.3%),Qistagnation syndrome(28.3%);Before the surgery,The main types of syndrome were:damp resistance syndrome(75%),Qi deficiency syndrome(46.7%),Qi stagnation syndrome(25%);On the first day after surgery,The main types of syndrome were:damp resistance syndrome(93.3%),Qideficiency syndrome(85%),Qi stagnation syndrome(80%);On the third day after surgery,The main types of syndrome were:dampness obstruction syndrome(70%),blood stasis syndrome(60%),Qi deficiency syndrome(40%);On day 7,The main types of syndrome were:dampness obstruction syndrome(75%),phlegm turbid syndrome(23.3%)and qi deficiency syndrome(20%).Adjacent time nodes,The number of cases of each type of card,There was a statistical difference,It is suggested that the syndrome type has evolved.2.On admission,the combination syndrome was mainly damp-heat accumulation and qi stagnation and dampness obstruction;before operatio n,qi deficiency and dampness obstruction and qi stagnation and dampness obstruction were the main factors;On the first day after operation,qi stagnation and blood stasis syndrome was high;On the third day after operation,Qi deficiency and dampness obstruction and Qi deficiency and blood stasis syndrome was the main factor.On the 7th day after operation,Qi deficiency and dampness obstruction syndrome was dominant.3.Duration of operation was related to BMI、the degree of adhesion in gallbladder area,but not to the length of hospitalization.4.The factors of influencing the recovery gastrointestinal function and prognostic factorsAfter operation,the first exhaust time was correlated with the operation time,age and preoperative albumin level,but not with preoperative coagulation function and CRP.5.Correlation between clinical features and TCM syndromesIn gallbladder polyp patients,Qi stagnation,Qi de ficiency and dampness obstruction are the main,and in gallstone patients,dampness and heat,phlegm and blood stasis syndrome are the main.Patients with hypoproteinemia had significant differences in qi deficiency syndrome on the first day after operation with other patients;patients with high crp and normal crp had significant differences in damp-heat syndrome on admission and the first day after operation.The difference between phlegm and blood stasis group>qi deficiency and dampness resistance group>dampness and heat accumulation group>qi stagnation and dampness resistance group was statistically significant.Conclusions1.In the evolution of the patient’s syndrome,the syndrome elements of the patients on admission were dominated by dampness obstruction syndrome,followed by dampness and heat syndrome and qi stagnation syndrome,and the qi deficiency syndrome increased significantly before operation.On the first day after operation,the proportion of dampness obstruction syndrome,qi deficiency syndrome and qi stagnation syndrome reached a peak,accompanied by the recovery of gastrointestinal function.On the third day after operation,Qi stagnation and dampness obstruction syndrome decreased,while Qi deficiency and blood stasis syndrome became prominent.One week after surgery,the syndrome of qi deficiency,dampness obstruction,phlegm turbid syndrome is more common.2.Duration of operation was related to BMI、the degree of adhesion in gallbladder area,but not to the length of hospitalization.The greater degree of adhesion in gallbladder area and the bigger BMI relatively lead to the longer duration of the operation.3.The rate of recovery of gastrointestinal function after operation was related to the length of operation,age and albumin level before operation,but not to the coagulation function and CRP before operation.The shorter duration of the operation,the younger age and the higher pre-operative albumin level mean to the faster recovery of gastrointestinal function.4.The main syndromes of gallbladder polyp patients were Qi stagnation,Qi de ficiency and dampness obstruction.The main syndromes of gallstone patients were damp heat,phlegm and blood stasis.Patients with hypoproteinemia were more prone to Qi deficiency on the first day after operation than patients with normal albumin level.Patients with high CRP are more likely to develop damp-heat syndrome at admission and on the first day after operation than those with normal CRP.At the rate of recovery of postoperative gastrointestinal function,from fast to slow,they were Qi stagnation and dampness resistance group,dampness and heat accumulation group,Qi deficiency and dampness resistance group and phlegm and blood stasis mutual knot group.