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Combined Chinese and Western medicine therapy in elderly patients with acute cholecystitis in the application of perioperative_6778

By Holly Gray,2014-10-30 15:02
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Combined Chinese and Western medicine therapy in elderly patients with acute cholecystitis in the application of perioperative_6778

Combined Chinese and Western medicine therapy in elderly

    patients with acute cholecystitis in the application of

    perioperative

     Abstract Objective: To explore the Chinese medicine treatment of elderly patients with acute cholecystitis to improve perioperative safety and implications.

    Method: take appropriate cases, divided into treatment group and control group, two groups are to be general treatment and surgical treatment, in which the treatment group before and after surgery of large Bupleurum Decoction. The control group was

    not to be traditional Chinese medicine treatment, perioperative treatment were analyzed. Results: The combined treatment of Chinese and Western medicine can reduce the risk of some patients. Conclusion: Acute cholecystitis, common diseases for

    the elderly, combining Chinese and Western medicine therapy in their own time to get out of bed activity, intestinal function recovery time, postoperative hospital stay was significantly shorter in the control group, the difference was statistically significant (P

    <0.01), so In the perioperative period with the reasonable use of Chinese and Western medicine treatment is an effective guarantee for successful operation.

     Key words acute cholecystitis in Perioperative Medicine

     Acute cholecystitis is equivalent to Chinese medicine, "Xie Tong," Multi-

    documented in ancient literature, such as "Plain Questions Law on the dirty air": "liver disease who cited two Xiexia Shaofuzhuyu pain, it is good anger." "Qian Jin Yao Fang": "left off the clock Yin real persons, Foot Jue Yin Liver scriptures also, the sick painstakingly over the next kin, often two Xie Tong, the interest rate, such as anger fumed like, fine-sounding name liver excess heat of it." At the same time, as

    represented by minimally invasive laparoscopic technique is the main development trend of today's surgery. Along with constantly updated equipment, laparoscopic instruments, surgical techniques to improve and clinical experience is gained, laparoscopic widening range of applications, but the laparoscopic cholecystectomy (Lc) is still a certain degree of complications [1 ~ 3]. At present, preoperative control of internal diseases, intraoperative anesthesia, monitoring and other aspects of technology is a greater emphasis on the development of the surgical therapy of disease conditions, but if we can not do a good job to improve the elderly surgical perioperative safety of the health care work, will lead to postoperative recovery in patients with non-

    performing, or even induce or aggravate primary disease. More serious complications occur such serious consequences, leading to decline in the quality of life of older persons. In recent years, Chinese medicine in perioperative period to improve the safety play an increasingly important role in [4]. Through our hospital patients in the treatment of elderly patients with acute cholecystitis and found that TCM-WM therapy

    compared with Western medicine alone treatment can significantly reduce complications, reflecting a good curative effect, these are as follows.

     A clinical data

     Observations were all hospital inpatients, 60 cases of selected patients with the following characteristics: ? body temperature of 38 ? or above, or (and) WBC> 10.0

    × 109 / L. ? right upper quadrant tenderness, or muscle tension (and) Could it be's sign (). ? B super [5 ~ 6] shows the gallbladder wall thickness of> 5mm or (and) increased gallbladder. Were randomly divided into two groups, treatment group, 30 cases, 17 were males and 13 females, aged 61 ~ 75 years old, with an average age of 72.3 ? 4.1 years; control group of 30 cases, 16 males and 14 females, aged 62 to 77 years The average age of 71.5 ? 3.6 years. 57 cases were associated with preoperative morbidity, most common to the cardiovascular system. One treatment group, 13 patients with coronary heart disease, diabetes mellitus, 4 cases, 4 cases of chronic bronchitis, coronary heart disease, hypertension in 5 cases, coronary heart disease, hypertension, diabetes, 3 cases; control group: 12 patients with coronary heart disease, diabetes mellitus, 4 cases of chronic bronchial inflammation in 3 cases, coronary heart disease, 6 cases of hypertension, coronary heart disease, hypertension, diabetes mellitus in 3 cases. Two groups of patient's age, gender, and comorbidity was no significant difference in the distribution.

     Two treatment

     2.1 General treatment

     ? diet: to be liquid or semi-liquid diet, in a stable condition after the transition to light liquid diet; ? supportive therapy: intravenous nutritional supplements and liquid, vomiting and serious attention to review the situation electrolytes, correct water

    and electrolyte balance; ? decompression: severe cases underwent decompression to

    reduce the stimulation of bile secretion, favorable bile drainage and discharge to reduce Biliary Colic and vomiting; ? pain: You can use atropine 654-2, Vitamin K3, if severe

    pain can be intramuscular meperidine; ? anti-infective therapy: selection of the

    highest concentration in the bile, antibiotics, or according to the results of bile culture sensitivity choice of antibiotics, appropriate use of perioperative antibiotic prevention

    of postoperative infection related to [7 ~ 9]; ? gallbladder Treatment: use of

    magnesium sulfate, or dehydroepiandrosterone acid films and so on; ? be

    symptomatic treatment of complications.

     2.2 Surgical Treatment

     Wei Xu Huai-view of the following indications for surgery as soon as possible: ?

    chills, fever, white blood cell count is greater than 2.0 × 109 / L; ? aggravated by

    jaundice; ? the higher tension of the gallbladder enlargement; ? there is peritoneal

    irritation were localized; ? concurrent with severe pancreatic Yan persons [10]. Two groups of patients were admitted to hospital within 72 hours after surgery. Surgical method: are used endotracheal intubation under general anesthesia by closed establishment of pneumoperitoneum, with three puncture method or four barbed-hole

    laparoscopic cholecystectomy, three stab Kong and France that under the right clavicle midline umbilical Xiphoid rib margin the next three holes, four barbed-hole refers to

    three plus axillary puncture holes on the front under the rib margin, intraoperative home peritoneal drainage tube through the middle rib margin of the right subclavian

    puncture leads to the next, the general operation time is about 40 ~ 120 minutes. In addition to the treatment group 1 cases of transit operations, transit operations control group 2 cases, all completed under laparoscopic. Anatomy of the difficulties of laparoscopic cholecystectomy triangle transit laparotomy reasons [11], for heart failure patients with low-pressure pneumoperitoneum. Preoperative fully prepared to adjust to the best state of cardiac function, for a small number of patients with severe cardiac function changes, may suspend the operation, transit laparotomy [12 ~ 14].

     2.3 Perioperative treatment

     Both groups were to be general treatment and surgical treatment, in which the treatment group before and after surgery of large Bupleurum Decoction (Chai Hu 15g, rhubarb 10g, citrus aurantium 15g, Fascia 15g, white peony root 20g, ginger 15g, Taizishen 25g, Astragalus 15g, Atractylodes 15g, Poria 20g, licorice 10g), day 1, Jian Qu 200ml, warm clothes. The control group was not to be of Chinese medicine treatment for 3 weeks.

     3 Observation index

     Statistical treatment group and control group, operative time, independent

    ambulation time, intestinal function recovery time, intra-abdominal drainage,

    postoperative hospital stay.

     4 statistical processing

     Be SAS8.2 statistical software for statistical analysis and processing. Reposted

    elsewhere in the paper for free download http://

     5 results

     Treatment group 2 patients as well as the control group, 3 patients out of treatment due to poor compliance and finally into the statistical treatment group, 28 cases in the

    control group 27 cases, comparable. Control group, wound infection in 1 case of pulmonary infection in 3 cases. Chinese and Western medicine combined group did not occur wound infection, lung infection and bile leakage, intra-abdominal bleeding and

    other serious complications. Two sets of operative time, postoperative abdominal drainage were no significant differences (P> 0.05); independent ambulation time, intestinal function recovery time, postoperative hospital stay treatment group was significantly shorter than the control group, the difference was statistically significant ( P <0.01), in Table 1.

     Table 1 Comparison of the two groups after operation (abbreviated)

     6 Discussion

     Expansion of the gall bladder disease, responsible for the internal organs in the gall

    bladder of air-pass down disorder; patients internal organs located in the gall bladder, and liver close, its pathogenesis is mainly Qi stagnation, heat Yu, congestion, gravel, wet resistance led to liver-gallbladder qi biliary lost pass down, a long time and Yu Qi

    stagnation and blood, or rather of the fire. Bile is the body's "in the clear is not muddy," Qi-hang of the House. Six Hollow Organs "to pass for the use of", "down are to shun", which permits the treatment of gall bladder should be based on reconciliation

    can be reduced to the first; the same time, the development of minimally invasive surgery is an important direction of modern surgery, while the laparoscopic technique is minimally invasive technique are typical examples. China since the 90s since the

    beginning of the introduction of this technology, the rapid development of surgery greatly changed the traditional pattern is particularly true for abdominal surgery [15], and its increasingly widespread clinical application [16 ~ 18]. Laparoscopic

    cholecystectomy due to small incision, operative time is short, quick recovery in patients with highly welcome perioperative nursing and her treatment not be ignored. "Treatise on Febrile Diseases" great Bupleurum soup, Bupleurum for Shaoyang pass

    through to medicine, can Shuganlidan, Qing Xie Yu heat; rhubarb can be "flat stomach down," Tongfu Xiere, and cleaned up the stomach, biliary tract erosion, modern pharmacology confirmed that they have to promote bile secretion. Citrus

    aurantium Fascia and can be gas-breaking addition to swelling of the liver, eliminate

    the plot line of stagnation, TGP priorities pain, vomiting stomach warm ginger; the same time, in medicine, the spleen and stomach for the acquired book, is the source of

    qi and blood biochemistry, the spleen and stomach of the transport of absorption function was normal. Nutrients can be transported through its absorption of the human body play a role. And the patient is elderly, physical weakness, so be heterophylla, Astragalus, Atractylodes, Poria, licorice Gu protect righteousness; all parties played a total of Shuganlidan, Qi righting effect. Pei-Ting Zhu studies suggest that combined use

    of Chinese and Western medicine treatment, with herbal heat gallbladder, Qushi Tongfu. Not only can regulate the immune, inhibit kill bacteria, and bile ducts can be adjusted power, piperazine citrate row of stones, so that decompression of bile duct to make poly stay in the bile duct of bacteria have been eliminated, thus achieve the

    purpose of treatment [19 ~ 20]. In this observation, treatment group, the independent ambulation time, intestinal function recovery time, postoperative hospital stay to improve the situation much better than the control group, the difference was statistically significant, their rational use is conducive to protecting the success of the operation to show its clinical value, worthy of popularization and applications.

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