| 1 purpose In the clinical observation part,the effects of qi huang decoction on the recovery time of bowel sounds,anal exhaust,defecation time and the time of contrast agent reaching the colon after gastrectomy were compared to investigate whether qi huang decoction could promote the recovery of gastrointestinal motility after gastrectomy.Animal experiment part,by establishing the rat model with gastric resection,yellow stilbene decoction on gastric resection rate of rat small intestine propulsion,and by immunofluorescence labeling under confocal laser scanning microscopy detection ENS ACh,SP,VIP,NO positive neurons in the shape of the structure,distribution and quantity,discusses on the impact of stilbene huang decoction on gastrointestinal movement mechanism.2 methods 2.1 clinical trials 2.1.1 source and grouping of cases A total of 80 patients who underwent radical gastrectomy for gastric cancer in the first affiliated hospital of anhui university of traditional Chinese medicine from January 2018 to December 2019 were collected for clinical retrospective study.According to the use of qi huang decoction after the surgery,37 patients in the control group and 43 patients in the qi huang decoction group were divided into the control group and the control group.2.1.2 therapies(1)control group: routine preoperative preparation,gastric tube and jejunal nutrition tube were inserted on the day of surgery,radical gastrectomy was performed,followed by water fasting,routine fluid supplementation and parenteral nutrition support on the day of surgery.On the 1st day after the operation,enteral nutrition was administered via nasoenteral nutrition tube.According to the standard of 20ml(30kal)/kg,the nasoenteral nutrition tube was given twice in the morning and evening.The speed was controlled at 40 ～ 60 drops /min,and the temperature was controlled at about 37℃.The total course of treatment lasted 7 days.(2)qi-huang decoction group: preoperative preparation,surgical method selection and postoperative routine treatment were the same as the control group.On the first day after the operation,the enteral nutrition preparation + astragalus decoction was successively injected through the nasoenteral nutrition tube,once a day in the morning and once a day in the evening.The enteral nutrition standard was the same as that of the control group.The decoction of qi huang(decoction of the first affiliated hospital of anhui university of traditional Chinese medicine)was boiled into 300 ml water decoction,and the infusion was started 1 hour after the enteral nutrition every day.Each infusion was 150 ml,the speed was controlled at 30 ～ 40ml/min,and the temperature was controlled at about 37 ℃.The course of treatment lasted for 7 days.2.1.3 observation indicators and detection methods(1)indicators of intestinal function: recovery time of bowel sounds,time of first anal exhaust and defecation;In the stethoscope examination of bowel sounds,the recovery of bowel sounds was determined as 3 or more times per minute in the double area of the abdomen,and the earliest time(h)was recorded.Meanwhile,the patient was informed to record the specific time(h)of the earliest exhaust and defecation of the anus.(2)imaging indicators: on the 7th day after the operation,gastrointestinal imaging was conducted by a special person,who contacted the imaging department of our hospital to take X-ray pictures and read them(machine model: Brivo XR 515/575).After 30 min of activity,the first abdominal positionfilm was taken to determine the arrival of the contrast agent in the intestinal cavity.After that,2h,4h,6h,8h,10 h and 12 h of intermittent photography were conducted to determine the time of the contrast agent reaching the position of the colon.The final results were recorded in 2h,4h,6h,8h,10 h and 12 h.2.1.4 statistical methods All the data were analyzed by statistical software SPSS23.0,the measurement data were expressed as(±s),the mean value was compared by t test,and the count data was tested by 2 test.Data of the two groups were examined for normality and homogeneity of variances,and P<0.05 was considered as statistically significant.2.2 animal experiments 2.2.1 modeling and grouping methods(1)modeling method: 80 healthy and clean Wistar rats were selected to establish a model of gastrectomy rats.After partial gastric wall tissue resection and suture,the hanging ligament of the duodenum(Treitz ligament)was searched down,and a silicone tube with a diameter of about 1.0mm was placed at the distal end of 15 cm for postoperative small intestinal infusion.(2)grouping method: 80 rats were randomly divided into sham operation group,standard nutrition group,immunonutrition group and qi huang decoction group by software random code,with 20 rats in each group.2.2.2 grouping intervention methods In the sham operation group,only abdominal midline incision and suture were performed without gastrectomy.After the operation,free drinking and eating were given without enteral nutrition and traditional Chinese medicine.The model of gastrectomy was established in the other three groups.The standard nutrition group was given enteral nutrition preparation(ruisin)+6ml normal saline.In the immunonutrition group,enteral immunonutrition preparation(ruineng)+6ml normal saline was given.The group of qi huang decoction was given enteral nutrition preparation(ruisin)+6ml water decoction of qi huang decoction.Each group was treated for 7 days.After the treatment,the rats were killed and samples were collected.2.2.3 observation indicators and detection methods(1)detection of small intestine propulsion rate: 0.04% phenol red solution 0.25 m L/g was injected into the small intestine by silica gel tube,and the rats were sacrificed 30 min later.The whole small intestine was immediately opened and removed.Formula: small intestine propulsion rate = phenol red propulsion length/total length of small intestine ×100%.(2)detection of morphology,structure,distribution and quantity of intestinal neurons: the morphology,distribution and quantity of corresponding neurons were observed under laser confocal microscope by immunofluorescence labeling ACh E,SP,VIP and n NOS,and images were collected and analyzed by fv10-asw software.3 the results 3.1 clinical trial results There was no statistically significant difference in general data between the two groups(P>0.05).Observation of the recovery time of bowel sounds: the patients in the control group were 47.11±4.27 h,and the patients in the qi-huang decoction group were 41.91±3.96 h.Compared with the control group,qi-huang decoction group could significantly shorten the recovery time of postoperative bowel sounds(P<0.01).Anal exhaust time: 69.32±3.94 h in the control group and 41.91±3.9661.74±4.42 h in the qi-huang decoction group.Compared with the control group,qi-huang decoction group can significantly shorten the postoperative anal exhaust time of the patients(P<0.01).Anal defecation time: 75.46±4.17 h in the control group and 69.21±4.52 h in the qi-huang decoction group.Compared with the control group,qi-huang decoction group could significantly shorten the postoperative anal defecation time of the patients(P<0.01).The time of contrast agent to the colon was 9.35±2.16 h in the control group and 7.30±1.63 h in the qi huang decoction group.Compared with the control group,the time of the contrast agent to the colon was significantly shortened in the qi huang decoction group(P<0.01).3.2 results of animal experiments 3.2.1 intestinal propulsion rate in rats The intestinal propulsion rate of the sham operation group was 63.3±4.2%.The intestinal propulsion rate of rats in standard nutrition group was 36.5±4.0%.The small intestine propulsion rate in the immunotrophic group was 36.1±4.1%.The small intestine propulsion rate of rats in qi-huang decoction group was 45.9±4.0%.Compared with the sham operation group,the intestinal propulsion rate of the standard nutrition group,the immunonutrition group and the qi huang decoction group all decreased(P<0.01).There was no significant difference in intestinal propulsion rate between the standard nutrition group and the immunonutrition group,P=1.000.Compared with the standard nutrition group and the immunonutrition group,the small intestine propulsion rate of the rats in the qi-huang decoction group was significantly increased(P<0.01).3.2.2 morphological structure and distribution of ENS neurons This study by immunofluorescence staining,confocal microscope and filmmaking,discovered ENS positive nerve cells are mainly distributed in rat small intestinal myenteric and submucous ganglion are round,oval,long band or irregular shape,size,each of ganglion neuronal cell bodies are clearly visible,dyed to blue.(1)Ach neurons and SP neurons observation results: the Ach and SP intestinal neurons in the sham operation group and the qi-huang decoction group had larger cell bodies,deeper staining,shorter internode distance and closer distribution.In the standard enteral nutrition group and the enteral immunonutrition group,the cell bodies were relatively small,the staining was shallow,the internode distance was large and the distribution was loose.(2)observation results of VIP neurons and NO neurons: in the sham operation group and the qi-huang decoction group,the cell bodies of VIP and NO intestinal neurons were smaller,the staining was lighter,the internode distance was larger and the distribution was looser.In the standard enteral nutrition group and the enteral immunonutrition group,the cell bodies were large and the staining was relatively deep.3.2.3 number of ens-positive neurons(1)the number of Ach E positive nerve cells in the sham operation group was 17.6±2.7;The number of nerve cells with Ach E in the standard nutrition group was 6.0±1.2.The number of Ach E positive nerve cells in the immunotrophic group was 8.4±1.1.The number of Ach E positive nerve cells in the qi huang decoction group was 15.4±3.4.Compared with the sham group,the number of positive cells in the standard nutrition group and the immunonutrition group decreased significantly,with P<0.0001 and P=0.0001,respectively.Compared with the sham operation group,the number of positive cells in the qi huang decoction group did not decrease significantly,P=0.2930.Compared with the standard nutrition group and the immunonutrition group,the number of positive cells in the qi huang decoction group increased significantly,with P<0.0001 and P=0.0019,respectively.(2)the number of sp-positive nerve cells in the sham operation group was 20.0±1.8;The number of sp-positive nerve cells in the standard nutrition group was 5.6±1.5.The number of SP positive nerve cells in the immunotrophic group was 11.2±1.9.The number of sp-positive nerve cells in the qi huang decoction group was 18.8±3.3.Compared with the sham group,the number of positive cells in the standard nutrition group and the immunonutrition group decreased significantly,both P<0.0001.Compared with the standard nutrition group,the number of positive cells in the immunonutrition group increased significantly,P=0.0009.Compared with the sham operation group,the number of positive cells in the qi-huang decoction group did not decrease significantly,P=0.5039.Compared with the standard nutrition group and the immunonutrition group,the number of positive cells in the qi huang decoction group increased significantly,with P<0.0001 and P=0.0023,respectively.(3)the number of VIP positive nerve cells in the sham operation group was 4.2±1.0;The number of VIP positive nerve cells in the standard nutrition group was 15.8±3.1.The number of VIP positive nerve cells in the immunonutrition group was 17.8±2.1.The number of VIP positive nerve cells in qi-huang decoction group was 7.2±1.3.Compared with the sham group,the number of positive cells in the standard nutrition group and the immunonutrition group increased significantly,both P<0.0001.Compared with the standard nutrition group,there was no significant difference in the number of positive cells in the immunonutrition group(P=0.2800).Compared with the sham operation group,the number of positive cells in the qi huang decoction group increased significantly,P=0.0043.Compared with the standard nutrition group and the immunonutrition group,the number of positive cells in the qi-huang decoction group decreased significantly,with P=0.0005 and P<0.0001,respectively.(4)the number of n NOS positive nerve cells in the sham operation group was 5.0±1.2;The number of n NOS positive nerve cells in the standard nutrition group was 20.4±2.7.The number of n NOS positive nerve cells in the immunotrophic group was 22.0±2.0.The number of nnos-positive nerve cells in the qi huang decoction group was 8.8±1.3.Compared with the sham group,the number of positive cells in the standard nutrition group and the immunonutrition group increased significantly,both P<0.0001.Compared with the standard nutrition group,the difference in the number of positive cells in the immunonutrition group was not significant,P=0.3579.Compared with the sham operation group,the number of positive cells in the qi-huang decoction group increased significantly,P=0.014.Compared with the standard nutrition group and the immunonutrition group,the number of positive cells in the qi-huang decoction group decreased significantly,all of which were P<0.0001.4 conclusion(1)clinical and animal experimental results showed that qi huang decoction could significantly shorten the recovery time of bowel sounds,anal exhaust and defecation,and the time of the contrast agent reaching the colon in patients after gastrectomy,and had a promoting effect on the recovery of gastrointestinal motility after gastrectomy.(2)the observation of ENS network structure in animal experiments indicates that the mechanism of promoting gastrointestinal movement recovery by qi-huang decoction may be related to improving and repairing the activity of Vch and SP neurons in ENS network structure and increasing their number.At the same time,the activity of VIP and NO neurons was inhibited,and the number of them was reduced,so as to promote the recovery of gastrointestinal movement. |
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