Tongxiang City Hospital of Chinese Medicine, Zhejiang 314500, China

CLINICAL STUDY

Effect Observation on Heat-sensitive Moxibustion for Abdominal Distension Following Laparoscopic Cholecystectomy

Fei Hua-hua

Tongxiang City Hospital of Chinese Medicine, Zhejiang 314500, China

Author:Fei Hua-hua, undergraduate, nurse-in-charge.

E-mail: 632368930@qq.com

Objective: To observe the clinical effect of heat-sensitive moxibustion on abdominal distension following laparoscopic cholecystectomy.

Methods: A total of 240 cases were randomly allocated into an observation group and a control group according to their admission sequence, 120 in each group. Cases in the observation group were treated with conventional care, glycerol enema and heat sensitive moxibustion, whereas cases in the control group were only treated with conventional care and glycerol enema. Then the passage of gas by anus within 24 h and improvement of abdominal distension were observed in both groups.

Results: There were statistical differences in the emergence time of bowel sounds and the initial passage of gas by anus between the two groups (bothP＜0.05). The therapeutic effect in the observation group was better than that in the control group (P＜0.05) .

Conclusion: Heat-sensitive moxibustion has reliable effect for abdominal distension following laparoscopic cholecystectomy.

Moxibustion Therapy; Suspended Moxibustion; Heat-sensitive Moxibustion; Cholecystectomy, Laparoscopic; Complications; Abdominal Distention

Laparoscopic cholecystectomy (LC) has now become the first option for benign gallbladder problems[1]. However, postoperative abdominal distension often affects the recovery of patients[2]. Long-term clinical studies have proven that heat-sensitive moxibustion, a new moxibustion method developed by Prof. Chen Ri-xin, is remarkably effective for numerous conditions[3-4]. I treated abdominal distension in 120 cases after LC with conventional postoperative care, glycerol enema and heat-sensitive moxibustion between January 2013 and December 2013. The report is now given as follows.

1 Clinical Materials

1.1 Inclusion criteria

Patients having no passage of gas by anus 48 h after LC, subjective feeling of abdominal fullness and distension, percussive tympany, weakened or disappeared bowel sounds by auscultation; no gender limit; and those who were willing to sign the informed consent.

1.2 Exclusion criteria

Those who did not meet the inclusion criteria; women during pregnancy or lactation; having severe primary heart, liver, lung, kidney or blood diseases or other life-threatening conditions (such as cancer or HIV/AIDs); and those lacking self-control such as psychosis.

1.3 Statistical method

The SPSS 13.0 version statistical software was used for data analysis,t-test for measurement data (expressed by) and Chi-square test for rate comparison. APvalue of less than 0.05 indicates a statistical significance.

1.4 General data

Between January 2013 and December 2013, a total of 468 cases received LC with general anesthesia in our department. Then 240 eligible cases having postoperative abdominal distension were randomly allocated into an observation group and a control group, 120 in each group. There were no statistical differences in gender, age and primary diseases (allP＞0.05), indicating that the two groups were comparable (Table 1).

Table 1. Between-group comparison of general data

2 Treatment Methods

2.1 Observation group

2.1.1 Conventional postoperative care

After regaining consciousness from the anesthesia, patients were helped to take a comfortable position and encouraged to walk as early as possible. In addition, they were given low flow oxygen inhalation to increase the oxygen concentration in blood, decrease the absorption of CO2and avoid hypercapnia. Patients were guided to have liquid diet 6 h after the surgery.

2.1.2 Glycerol enema

The glycerol enema was used for patients 48 h after the surgery to increase intestinal peristalsis.

2.1.3 Heat-sensitive moxibustion

The first step was to locate the heat-sensitive points[5]. The patients were asked to take a comfortable posture and fully expose the body parts for moxibustion. One or more of the following signs can indicate a heat-sensitive state: heat penetration, heat spreading, a heat sensation in distal instead of local area, a heat sensation in deeper instead of superficial layer and occurrence of non-heat sensations in local or distal area such as soreness, distension, heaviness, pain, numbness, cold. The heat-sensitive points were labeled. Common points are Zhongwan (CV 12), Shenque (CV 8), Guanyuan (CV 4), Zusanli (ST 36) and Shangjuxu (ST 37).

The next step was to apply suspended (approximately 3 cm away from the point) heat-sensitive moxibustion using an ignited moxa stick to one or more heat-sensitive points. The patients should feel the heat sensation penetrating or radiating. One treatment often lasted 30-40 min until disappearance of the heat spreading sensation. The treatment was done twice a day.

Cautions: The locations of heat-sensitive points need to be accurate. It is important to keep a close look at the patients and adjust the location of points in case the patients had no or only mild sensation; it is also important to avoid burns by removing ashes in time; and to keep warm during moxibustion in winter.

Contraindications: Heat syndrome; major blood vessels or thin skin/muscles; fascia; and testis, nipples, private parts and joints[6].

2.2 Control group

Patients in the control group only received conventional postoperative care and glycerol enema.

3 Therapeutic Efficacy Observation

3.1 Therapeutic efficacy evaluation indexes

I observed the recovery indexes of gastrointestinal motility[7], recorded the emergence time of bowel sounds, using 1-2 bowel sounds per minute (with a stethoscope) as recovery index of intestinal peristalsis). The initial passage of gas by anus was recorded.

3.2 Criteria for therapeutic efficacy[6]

Marked effect: Emergence of bowel sounds and passage of gas by anus within 24 h after intervention, absence of abdominal distension or tension.

Improvement: Emergence of bowel sounds and passage of gas by anus within 24 h after intervention, alleviation of abdominal distension.

Failure: Absence of bowel sounds or passage of gas by anus within 24 h after intervention, persistent abdominal distension and tension.

3.3 Results

3.3.1 Between-group comparison of recovery time of gastrointestinal motility

The emergence time of bowel sounds in the observation group was significantly earlier than that in the control group (P＜0.05). Also, the initial passage of gas by anus in the observation group was significantly earlier than that in the control group (P＜0.05), indicating a faster recovery of gastrointestinal motility in the observation group than that in the control group (Table 2).

3.3.2 Between-group comparison of clinical efficacy

The total effective rate in the observation group was 95.8%, versus 88.3% in the control group, showing a significance difference (P＜0.05) and indicating a better effect in the observation group than that in the control group (Table 3).

Table 2. Between-group comparison of recovery time of gastrointestinal motility (, h)

Table 2. Between-group comparison of recovery time of gastrointestinal motility (, h)

Note: Compared with the control group, 1)P＜0.05

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Table 3. Between-group comparison of clinical efficacy (case)

4 Discussion

Abdominal distension is a common complication after abdominal surgery, especially after laparoscopic surgery. Studies have found that artificial pneumoperitoneum is the major contributing factor. Other factors include surgical trauma, anesthesia, ion disorder and nutrition deficiency, etc.[8]Chinese medicine holds that the spleen and stomach are located in the middle jiao and considered as the pivot of qi activity in ascending and descending. Laparoscopic surgery can stimulate the gastrointestinal mucosa, and damage the spleen and stomach. Since the spleen governs transportation and transformation and is known as the source of qi and blood regeneration, spleen-qi injury can affect distribution of nutrients from water and food and lead to downward flow of dampness to the abdomen. Since the stomach receives water and food, failure of stomach qi to descend can affect the transduction of the large intestine and result in discomforts such as abdominal distension and constipation. In addition, surgery or removal of tissues can damage the Conception Vessel (the sea of the 12 regular meridians), leading to blood loss and deficiency of Yuan-Primordial qi. Since qi is the commander of blood, qi stagnation of Zang-fu organs may cause blood stasis, further leading to abdominal distension. Based on the principle of ‘unblocking the Fu organs’, the treatment aims to unblock the intestine, regulate gastrointestinal qi activity and harmonize qi and blood.

As an external therapy of Chinese medicine, heat-sensitive moxibustion applies suspended moxibustion to heat-sensitive points to enhance heat penetration and transmission to distal and deeper layers along meridians, coupled with individualized saturated desensitized moxa amount[9]. Since heat-sensitive points are highly sensitive to moxa heat, this method can obtain better effect in relieving symptoms than conventional moxibustion method. Normally, the occurrence rate of heat-sensitive state of points was only 5%-15%, whereas the occurrence rate can be up to 70% in a morbid state[9]. Upon external stimulation, points in heat-sensitive state can produce specific ‘big response to small stimulation’. There were little studies on the role of (nondrug) heat-sensitive moxibustion for abdominal distension after LC. Based on the characteristics of high-frequency areas for heat-sensitive points and years of clinical experience, I’ve found that these points are often located around Zhongwan (CV 12), Shenque (CV 8), Guanyuan (CV 4), Zusanli (ST 36) and Shangjuxu (ST 37). Applying moxibustion to heatsensitive points (until the heat penetration disappears) can activate transduction of meridian qi, circulate blood, regulate functions of the five Zang organs[10-12], restore the gastrointestinal motility and thus alleviate abdominal distension.

This study has shown that heat-sensitive moxibustion has remarkable effect on abdominal distension due to LC. It can effectively activate gastrointestinal motility, improve abdominal fullness and distension, and speed up passage of gas by anus. This therapy is safe, effective, convenient (good compliance) and therefore worth further clinical use.

Conflict of Interest

The author declared that there was no conflict of interest in this article.

Acknowledgments

This work was supported by Tongxiang City Hospital of Chinese Medicine.

Statement of Informed Consent

All of the patients in the study signed the informed consent.

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Translator:Han Chou-ping

Received Date:June 25, 2014

R245.8

: A

received heat-sensitive moxibustion 48 h after the surgery.