耳穴揿针对胃癌患者术后胃肠功能及肠道菌群的影响  

Effects of thumbtack-needle embedding therapy of auricular acupuncture on gastrointestinal function and intestinal microflora in patients with gastric cancer after operation

作　　者：景梦娇 张园园 沈圆娟 彭拥军 王和生 JING Mengjiao;ZHANG Yuanyuan;SHEN Yuanjuan;PENG Yongjun;WANG Hesheng(Department of Acupuncture-Moxibustion and Rehabilitation,Affiliated Hospital of Nanjing University of Chinese Medicine,Nanjing 210029,Jiangsu Province,China;Department of Nursing,Affiliated Hospital of Nanjing University of Chinese Medicine,Nanjing 210029,Jiangsu Province,China)

机构地区：[1]南京中医药大学附属医院针灸康复科,江苏南京210029 [2]南京中医药大学附属医院护理部,江苏南京210029

出　　处：《中国针灸》2025年第3期300-311,共12页Chinese Acupuncture & Moxibustion

基　　金：国家中医临床研究基地(江苏省中医院)开放课题项目:JD2022SZ14;江苏省中医院科技项目:Y23025。

摘　　要：目的:观察耳穴揿针对胃癌患者术后胃肠功能及肠道菌群的影响,并探讨其作用机制。方法:将80例行根治术胃癌患者随机分为观察组(40例,中止3例)和对照组(40例,中止3例)。两组均实施胃癌患者加速康复围术期护理,观察组在此基础上予耳穴揿针治疗,穴取单侧胃、脾、大肠、小肠、缘中、耳中、三焦、角窝中,留针72h。观察两组患者术后胃肠功能恢复时间(术后肠鸣音恢复时间、首次排气时间、首次排便时间)、术后住院时间及疼痛视觉模拟量表(VAS)评分;检测两组患者术前、术后第5天血清胃泌素含量;采用三代16S rRNA测序技术检测两组患者手术前后肠道菌群组成及相对丰度。结果:观察组患者术后肠鸣音恢复时间、首次排气时间、首次排便时间均早于对照组(P<0.05),术后24、48、72 h时疼痛VAS评分低于对照组(P<0.05);两组患者术后住院时间、血清胃泌素含量比较差异无统计学意义(P>0.05)。α多样性分析结果显示,两组患者干预后Shannon指数、Simpson指数、Pielou_J指数和Pd_faith指数比较,差异无统计学意义(P>0.05)。干预后,两组患者粪便样本在各分类学水平上的群落结构大致相似,各物种间所占比例比较差异无统计学意义(P>0.05);干预后两组患者之间共有55个物种存在差异,观察组相对丰度差异显著的物种有17个,对照组相对丰度差异显著的物种有38个;属水平上,观察组克雷伯氏菌属(Klebsiella)、肠杆菌属(Enterobacter)升高(P<0.05),链球菌属(Streptococcus)降低(P<0.05)。观察组中起到重要作用的微生物类群主要有粪杆菌科(Coprobacillaceae)、萨特氏菌科(Sutterellaceae)和耶尔森氏菌科(Yersiniaceae);KEGG功能预测结果显示肠道菌群的功能主要与辅因子和维生素的代谢、碳水化合物代谢、氨基酸代谢等过程相关。结论:耳穴揿针可能通过调节肠道菌群的结构和相对丰度,影响能量代谢过程,从而改善�Objective To observe the effects of thumbtack-needle embedding therapy of auricular acupuncture on gastrointestinal function and intestinal microflora in the patients with gastric cancer after operation,and to explore its mechanism.Methods A total of 80 patients with gastric cancer after radical operation were randomly divided into an observation group(40 cases,3 cases discontinued)and a control group(40 cases,3 cases discontinued).The patients of both groups received the perioperative care for accelerating recovery.Additionally,in the observation group,the thumbtack-needle embedding therapy of auricular acupuncture was delivered at the auricular points of unilateral side,including Wei(CO4),Pi(CO13),Dachang(CO7),Xiaochang(CO6),Yuanzhong(AT2,3,4i),Erzhong(HX1),Sanjiao(CO17)and Jiaowozhong(TF3),and the needles were embedded and retained for 72 h.The postoperative recovery time of gastrointestinal function(the postoperative bowel sound recovery time,the first exhaust time,the first defecation time),the postoperative hospital stay and pain visual analogue scale(VAS)score were observed in the two groups.Before operation and on day 5 after operation,the serum gastrin level was detected in the two groups.The third-generation 16S rRNA sequencing technology was used to detect the composition and relative abundance of intestinal flora in the two groups before and after operation.Results Compared with the control group,the postoperative bowel sound recovery time,the first exhaust time and the first defecation time were shortened in the observation group(P<0.05).In the observation group,the VAS scores at 24 h,48 h,and 72 h after surgery were lower than those of the control group,respectively(P<0.05).There was no significant differences in postoperative hospital stay and serum gastrin level between the two groups(P>0.05).The alpha diversity analysis showed that the differences in Shannon index,Simpson index,Pielou_J index and Pd_fath index were not significant statistically after intervention between the two groups(P>0.05).Af

关 键 词：胃癌 胃肠功能 耳穴揿针 肠道菌群 16S rRNA 

分 类 号：R246.5[医药卫生—针灸推拿学]