黄阳雪 武曼丽 赵舷宏 陈浩 曹立幸

摘要 目的：評价穴位贴敷对妇科腹腔镜术后患者胃肠功能障碍的影响。方法：检索国家知识基础设施数据库（CNKI）、中国学术期刊数据库（CSPD）、中文科技期刊数据库（CCD）、中国生物医学文献（CBM）、Embase、PubMed和Cochrane Library检索应用穴位贴敷于妇科腹腔镜术后患者的随机对照试验，时间为从建库到2020年5月。2名研究者独立地筛选文献和数据提取，用RevMan5.2软件进行数据分析。结果：纳入14篇随机对照试验，共计1 597例患者。与单用术后常规治疗比较，穴位贴敷疗法显著加快患者首次肠鸣音恢复（SMD=-1.65，95%CI为-2.51～-0.79，I2=97%，P<0.05），明显缩短首次肛门排气时间（SMD=-2.25，95%CI为-2.98～-1.53，I2=97%，P<0.05），明显缩短首次肛门排便时间（SMD=-1.98，95%CI为-3.06～-0.90，I2=98%，P<0.05），减少术后腹胀的发生（RR=0.25，95%CI为0.16～0.38，I2=44%，P<0.05），提高术后胃肠功能恢复有效率（RR=1.27，95%CI为1.17～1.38，I2=15%，P<0.05），提高术后24 h胃泌素（GAS）水平（SMD=0.65，95%CI为0.37～0.93，I2=0%，P<0.05）。结论：妇科腹腔镜术后患者使用穴位贴敷可有效促进术后胃肠功能的恢复，加快首次肠鸣音恢复，缩短首次肛门排气、排便时间，减少术后腹胀的发生，提高术后胃肠功能恢复有效率，提高术后24 h胃泌素水平。由于纳入文献的质量和数量有限，本研究结论仍须严格设计的高质量大样本的随机对照研究进一步验证。

关键词 穴位贴敷;妇科腹腔镜;胃肠功能恢复;随机对照试验;Meta分析

Acupoint Application For the Recovery of Gastrointestinal Function after Gynecological Laparoscopic Surgery：a Meta-Analysis

HUANG Yangxue1，WU Manli1，ZHAO Xianhong1，CHEN Hao1，CAO Lixing2

（1 Guangzhou University of Chinese Medicine，Guangzhou 510405，China; 2 Guangdong Provincial Hospital of Chinese Medicine，Guangzhou 510120，China）

Abstract Objective：To evaluate the influence of acupoint application in the dysfunction of gastrointestinal function after gynecological laparoscopic surgery.Methods：The searches were performed by reviewers in the Wan Fang database，CNKI，CBM，VIP database，Embase，PubMed and Cochrane library from inception until May 2020.Randomized controlled trials，where acupoint application was used in patients with gynecological laparoscopic surgery，were included.Two researchers independently screened the literature，extracted the data and analyzed the data with RevMan5.2 software.Results：A total of 14 randomized controlled trials were included，comprising 1597 women.Compared with conventional therapy after surgery，acupoint application significantly speeded up the initial recovery of bowel sounds [SMD=-1.65，95%CI（-2.51，-0.79），I2=97%，P<0.05]，shortened the postoperative initial exhaust time [SMD=-2.25，95%CI（-2.98，-1.53），I2=97%，P<0.05]，reduced the postoperative first defecation time[SMD=-1.98，95%CI（-3.06，-0.90），I2=98%，P<0.05]，decreased the incidence of abdominal distension in patients with gynecological laparoscopic surgery [RR=0.25，95%CI（0.16，0.38），I2=44%，P<0.05]，enhanced the effective rate for the recovery of gastrointestinal function after surgery [RR=1.27，95%CI （1.17，1.38），I2=15%，P<0.05]and increased the GAS 24 h after surgery[SMD=0.65，95%CI（0.37，0.93），I2=0%，P<0.05].Conclusion：It is effective to use acupoint application to promote recovery of gastrointestinal function after gynecological laparoscopic surgery，with speeding up the initial recovery of bowel sounds，shortening the initial exhaust time and the first defecation time，decreasing the incidence of abdominal distension after surgery，enhanced the effective rate for the recovery of gastrointestinal function after surgery and increased the GAS 24 h after surgery.Due to the limited quality and number of included studies，further large-sample and high-quality RCTs，which are designed strictly，are needed to further validate the results.

Keywords Acupoint application; Gynecological laparoscopy; Recovery of Gastrointestinal function; Randomized controlled trials; Meta-analysis

中图分类号：R271.1文献标识码：Adoi：10.3969/j.issn.1673-7202.2021.23.020

妇科腹腔镜手术具有切口小和术后恢复快等优点，为大多数女性所接受，但由于禁饮禁食、CO2气腹等因素[1]，妇科腹腔镜术后患者易出现胃肠功能障碍，多表现为腹胀腹痛，食欲减退，排气排便时间延后等，影响术后的整体康复，甚至可能会发生肠梗阻、电解质紊乱等严重并发症[2]。……