摘要
目的
本研究采用靳三针组穴中的“足三针”远道取穴防治腹部术后胃肠运动功能紊乱,深入探讨针刺对腹部术后胃肠运动功能紊乱的调整作用和机制。临床研究部分采用传统手法针刺与电针治疗进行对照,旨在丰富针刺调整腹部术后胃肠运动功能紊乱的治疗方式。临床研究严格按照随机对照原则进行,可为针刺调整腹部术后胃肠运动功能紊乱提供有力的循证医学支持。机理研究部分以胃肠起搏细胞ICC为主要切入点,从ICC的数量,超微结构,ENS-ICC-SMC网络结构,Kit-SCF系统的SCF基因表达,血液胃肠激素,胃肠组织的炎症反应等不同层面对针刺调整腹部术后胃肠功能紊乱的机制做了较为全面的探讨,旨在为其临床的推广应用提供科学的理论基础。
方法
文献研究
回顾了近20年来术后胃肠运动功能紊乱的临床研究和实验研究文献,对现代医学关于术后胃肠运动功能紊乱的认识、机理研究和治疗进展,以及中医对其病因病机的认识和治法进行了归纳总结,并采用系统评价的方法对所查及的文献进行分析。临床研究
严格按照诊断标准和纳入、排除标准收集广州中医药大学第一附属医院胃肠外科和肝胆外科患者105例,按随机数字表法随机分为手法针刺组、电针组、空白组,每组35人。手法针刺组与电针组取穴相同,均取靳三针组穴里的“足三针”(足三里、三阴交、太冲)进行治疗。手法针刺组的针刺操作为垂直刺入腧穴后持针候气,拇、食、中三指微用力握持针柄,将辨证与辨针下气结合,补虚泻实,施行徐疾提插补泻。若正气不实不虚则采用导气同精手法徐入徐出导之,并配合呼吸调气,随患者一呼一吸将针插入相应深度,再随患者一呼一吸将针提出浅层,待感觉针下正气充实平和,患者自觉症状改善。每穴每次行针约2分钟,治疗30分钟后出针。电针组的针刺操作为足三里和太冲针刺后接一对电极,足三里负极,太冲正极,双三阴交只针刺不加电针。连续疏波,脉冲频率2Hz,电流1～2mA,以患者耐受为度,治疗30分钟后出针。两组均每日2次,直至患者出现排气,最长治疗5天,5天仍未排气者终止治疗。空白组不予针刺。观察并记录术后第一次肛门排气时间,第一次肛门排便时间,恢复流质饮食时间,肠鸣音出现时间及恢复正常时间,腹胀痛分级,胃肠反应分级,对观察结果进行统计分析。实验研究
制作大鼠结肠肠肠吻合模型。设针刺组、模型组、假手术组(开腹操作)、空白组进行比较。术后麻醉清醒即予针刺。针刺组、假手术组取穴均为足三针(足三里、三阴交、太冲),用直径0.18mm,长10mm的针直刺入穴位,每5分钟缓慢提插捻转2～3次。模型组、空白组每天同一时间放于自制固定器中15min。每日针刺1次,每次15分钟,连续治疗3天。观察并记录大鼠术后首次排便时间,术后1-3天每天排便粒数、排便重量。术后第四天采用双探头可变角度单光子发射型计算机断层显像仪(SPECT)对大鼠进行核素扫描胃液相排空实验检测,观察大鼠胃半排时间和60min胃排空率的改变。处死采血进行血浆胃动素和血清胃泌素的含量检测。取胃体中部距贲门1／3的胃运动起搏区、盲肠下2cm处结肠(相当吻合口处)组织,分为四部分：一部分制作病理切片观察组织炎症反应情况；一部分制作冰冻切片后,用C-Kit和VAChT免疫荧光双重标记,用激光扫描共聚焦显微镜观测ENS-ICC-SMC网络结构的改变；一部分用于制作电镜标本以观察ICC超微结构的改变；最后一部分用RT-PCR法检测SCF、CALM1的基因表达。
结果
临床研究
1.术后第一次肛门排气情况：手法组与空白组的差异具有显著性(P<0.05),而手法组与电针组、电针组与空白组的差异均无显著性(P>0.05)
2.术后第一次肛门排便情况：术后排便时间手法组与空白组、手法组与电针组的差异均具有显著性(P<0.05)。就首次排便质量(是否成形)看,手法组与电针组比较P<0.0125。
3.恢复流质饮食时间：手法组与空白组、电针组与空白组均有显著差异,手法组较电针组的差异更大(P手法<0.01,P电针＜0.05)。
4.肠鸣音情况：
①肠鸣音出现与恢复情况：肠鸣音从出现到恢复所需的时间,手法组与电针组、电针组与空白组间有显著性差异(P<0.05),手法组与空白组无明显差异(P>0.05)。
②肠鸣音评分：电针组与空白组评分差值两组差异显著(P<0.01),手法组与空白组评分差值两组差异显著(P<0.01)。
5.腹胀痛评分：电针组的治疗前后评分差值与空白组相比有显著差异(P<0.05)。
6.胃肠反应评分：电针组治疗前后胃肠反应评分差值与空白组比较,差异有显著性(P<0.05)。
7.疗效评定
①症状积分评价：手法组治疗前后评分差值与空白组比较有显著性(P<0.05),电针组治疗前后症状评分差值与空白组比较具显著性差异(P<0.01)。
②疗效指数分析：手法组与空白组、电针组与空白组均具有显著性差异(P<0.01)。
③疗效分级：手法组与空白组在等级程度和总有效率方面的差异具有显著性(P<0.01)。
8.术后首次排气时间与针刺介入时间的相关分析：以排气时间为y,针刺介入时间为x,采用曲线拟合,求得曲线方程为y=x1.4(5 实验研究
1.排便观察
①首次排便时间：针刺组术后首次排便时间与模型组比较有显著性差异(P<0.05)。
②术后第一天大鼠排便例数：术后第一天大鼠排便例数模型组与空白组(P<0.01)、针刺组与空白组(P<0.01)、假手术组与空白组(P<0.05)均有显著性差异。
③术后大鼠排便粒数变化：术后第一至三天排便粒数模型组与空白组、针刺组与空白组、假手术组与空白组均有显著性差异(P<0.01)。针刺组与模型组比较,术后第一天无明显差异,术后第二第三天出现显著性差异(P<0.05)
④术后大鼠排便重量变化：术后第一至三天排便重量模型组与空白组、针刺组与空白组、假手术组与空白组均有显著性差异(P<0.01)。针刺组与模型组比较,术后第一天排便重量无明显差异,术后第二第三天出现显著性差异(P<0.05)。
2.核素扫描胃液相排空实验
①半排时间(GET1,2)：模型组与空白组存在显著性差异(P<0.05)。针刺组与模型组比较差异显著(P<0.01)。针刺组与空白组比较无显著性差异。
②60分钟排空率：模型组与空白组存在显著性差异(P<0.05)。针刺组与模型组比较差异显著(P<0.01)。针刺组与空白组比较无显著性差异。
3.血浆胃动素和血清胃泌素的改变：模型组与空白组比较,差异显著(P<0.01)。针刺组与模型组比较差异显著(P<0.01)。针刺组与空白组比较无显著性差异。
4.胃肠组织光镜下病理形态变化：模型组炎症水肿最重,可见急慢性炎症细胞浸润,肉芽肿组织。针刺组炎症水肿程度较模型组轻。模型组和针刺组均可见手术线头和异物反应,存在粘膜溃疡。
5.胃肠ENS-ICC-SMC网络结构的变化：模型组ICC数量明显减少,荧光强度减弱,与空白组比较P<0.05。ICC细胞突起不明显,完整的网络样结构消失,网络出现大片空缺,ICC之间以及与其平滑肌和神经纤维之间的紧密样连接缺损。胆碱能神经网状结构严重残缺,呈片状分布,神经纤维间的连接大大减少,VAChT阳性神经纤维明显减少,荧光强度减弱,与空白组比较P＜0.05。ICC与胆碱能神经纤维分布不均匀,胆碱能神经-ICC-平滑肌网络结构紊乱。针刺组ICC分布较为连续,保持网络状结构,ICC细胞突起可见,细胞突触以及与平滑肌和神经纤维之间连接较紧密,无明显的间隙,细胞的数量以及荧光强度比模型组有所增强(P均<0.05),较空白组无显著性差异(P>0.05)。VAChT阳性神经纤维较模型组明显多,维持神经网络样结构,胆碱能神经节之间的连接较为紧密,荧光强度有所增强(P均<0.05),较空白组无显著性差异(P>0.05)。ICC与胆碱能神经纤维间的长突起较模型组增多,相互间的连接结构较为完整,维持网络样结构。
6.胃肠ICC电镜超微结构的改变：模型组ICC细胞核皱缩,异染色质趋边,呈斑块状；突起明显减少或消失,许多末梢突起破裂,失去胞浆内容物；胞浆空泡形成,胞膜泡状化；胞浆内细胞器数量明显减少,结构出现异常：线粒体数量减少,出现肿胀、嵴断裂、溶解、形成空泡、甚至破裂；内质网扩张,粗面内质网脱颗粒；许多中间丝排空；出现大的脂滴和空的膜结合泡；次级溶酶体增多,与融合性脂滴和成簇的糖原颗粒密切相关；基底膜缺乏或不完整。部分细胞胞浆内微细结构辨认不清。针刺组ICC细胞核保持正常形态,细胞突起损伤不明显,异染色质部分趋边；存在大量线粒体、核糖体、内质网和高尔基体；胞浆内细胞器形态结构较为清楚,少量线粒体肿胀、内质网扩张；基底膜维持完整。
7.胃肠组织SCF基因表达的改变：模型组与空白组存在显著性差异(P<0.01)。针刺组与模型组比较差异存在显著性(P<0.05)。针刺组与空白组无显著性差异。
8.胃动素与胃肠排空的关系：胃动素与胃半排时间的方程为y=165.179-0.732x(0 结论
1.针刺能缩短腹部术后首次排气时间,改善术后排便,促使患者提前恢复流质饮食,减轻腹胀痛、恶心呕吐等胃肠反应。
2.手法针刺和电针各有优势。手法针刺在整体调节首次排气排便时间、改善排便质量、促使患者提前恢复流质饮食方面疗效较好,而电针在改善和促进肠鸣音恢复、减轻腹胀和胃肠反应方面疗效较好。不同的优势特点可能与其作用机理有关。手法针刺善于整体调节,而电针则长于改善胃肠电节律,提高阈值。
3.术后首次排气时间与针刺介入时间呈幂相关。
4.针刺对腹部术后胃肠运动功能紊乱的调整作用主要在于促进胃肠蠕动和排空功能的恢复,此功效可能是通过调节血浆胃动素的含量,减轻术后炎症反应,改善胃肠起搏细胞ICC的数量、结构和功能等多方面机制共同作用的结果。
4.针刺能促进腹部术后ICC细胞的再生,ENS-ICC-SMC网络结构的恢复,改善ICC超微结构,这可能与针刺具有调整Kit-SCF系统中SCF基因表达的作用有关。
Objective
To further discuss the regulative effects and its mechanism of acupuncture on abdominal postoperative gastrointestinal dysmotility, this research used the 3-Leg point in Jin'3-needle technique to prevent abdominal postoperative gastrointestinal dysmotility. In the clinical research part comparison of traditional acupuncture and electroaucpuncture was made in order to enrich acupuncture treatment modality on abdominal postoperative gastrointestinal dysmotility. And this also benefits to inheritance of traditional culture in TCM. The controlled and randomized clinical research part could offer a strong surpport of evidence-based medicine to acupuncture treatment on abdominal postoperative gastrointestinal dysmotility. The experimental research part made gastric movement's pacemaking cell ICC (interstitial cell of Cajal) as the incision, comprehensively studied the mechanism of acupuncture on abdominal postoperative gastrointestinal dysmotility from different aspects, for example, the number and ultrastructure of ICC, the network structure of ENS-ICC-SMC, the gene expression of SCF mRNA in Kit-SCF system, blood gastrointestinal hormone, inflammatory reponse of gastrointestinal tissue, etc. This could offer a scientific theoretical basis to further clinical application of acupuncture treatment on abdominal postoperative gastrointestinal dysmotility.
Method
Literature research
Reviewed literatures of clinical and experimental research on postoperative gastrointestinal dysmotility in the past 20 years, summarized the understanding of domestic and foreign scholars on postoperative gastrointestinal dysmotility, the study methods of gastrointestinal movement, the machanism study and the treatment progress in this field. Analysed the literature by using the method of systematic review.
Clinical research
105 patients was selected out strictly according to the diagnostic criteria and inclusive and exclusive criteria in gastrointestinal surgery and hepatobiliary surgery department of the No.l Affiliated Hospital of Guangzhou University of TCM. They were divided randomly into traditional acupuncture group, electroacupuncture group and blank group by means of random number table, each group 35 persons. The 3-Leg point in Jin'3-needle technique(Zusanli, Sanyinjiao, Taichong) was used in both acupuncture group and electroacupuncture group.
The acupuncture operation of traditional acupuncture group was to insert the needle perpendicularly into the point, hold the needle lightly by using thumb, forefinger and midfinger waiting for Qi. When Qi arrived, made discrimination and compared it with the differentiation of symptoms and signs, then did aucupuncture manipulation, reinforced deficiency and reduced excess by lifting and thrusting the needle. If there was no deficiency or excess, the manipulation of guiding Qi was used coordinately with regulating patient's breathing. Inserted the needle to certain depth while the patient breathed once, then lifted it to the surficial layer while patient breathed again. Manipulation was done 2 min per time each point. The total treatment lasted 30minutes. In the electroacupuncture group Zusanli and Taichong were given electrol stimulation. Zusanli was connected to cathode while Taichong was connected to anode. Sanyinjiao was not given electrol stimulation. Used rarefaction wave, impulse frequency was 2Hz, current was 1-2mA, according to patient's tolerence. The total treatment lasted 30minutes. Both traditional acupuncture group and electroacupuncture group were treated twice a day till the patient exhausted. The longest treatment lasted 5 days. Stop treating when 5 day came though the patient still didn't exhaust. Blank group had no acupuncture treatment.
Obsevred and recorded the time of first exhaust, first defecation after operation, the time began to take liquid diet, the time bowelsound appeared and recover, classification of abdominal distension and pain, classification of gastrointestinal reaction, etc. Analyzed and did statistics.
Experimental research
40 rats were devieded randomly into acupuncture group, model group, sham-operation group and blank group, each group 10 rat. Rats in acupuncture group and model group were given colon transection and anastomosis. Rats in sham-operation group were given open abdominal operation. Both acupuncture group and sham-operation group were given acupuncture treatment when came round after operation. The 3-Leg point in Jin'3-needle technique (Zusanli, Sanyinjiao, Taichong) was used. Inserted the needle and do manipulation like lifting and thrusting, twirling and rotating 2-3 times every 5 minutes. The treatment lasted 15 minutes and was given once a day for 3 days. The model group and blank group were trapped into the same self-made fixator for 15min each day.
Observed and recorded the time of first defecation after operation, everyday's granule and weight of excrement in the first 3 days after operation. Radionuclide scanning on gastric emptying was taken on the forth day after operation to observe the gastric emptying. Rats were killed and the blood was taken to detect plasma MLT and seru GAS. Tissue in pacemaking eara of gas, which was in the middle part of gas 1/3 from cardia and tissue of colon which was 2cm under caecum (anastomosis part) were taken and divided into 4 parts: one was used to make pathology section to observe the inflammatory reponse; one was used to make frozen section, do immunofluorescence double labeling combined with confocal microscopic to observe the network structure of ENS-ICC-SMC; one was used to make electron microscope specimen to observe ultrastructure of ICC; the last one was used to detect gene expression of SCF mRNA and CALM1 mRNA by RT-PCR.
Result
Clinical research
1. The time of first exhaust after operation:The time in traditional acupuncture group was significantly shorter than that in blank group(P<0.05). While the difference between traditional acupuncture group and electroacupuncture group, the difference between electroacupuncture group and blank group, had no significant meaning(P>0.05).
2. The time of first defecation after operation:The time in traditional acupuncture group was significantly shorter than that in blank group and electroacupuncture group(P<0.05). The quality of first defecation in traditional acupuncture group was also significantly better than that in electroacupuncture group(P<0.0125).
3. The time began to take liquid diet:Both the traditional acupuncture group (P<0.05) and the electroacupuncture group(P<0.01) had signifucantly difference with blank group. And the difference between traditional acupuncture group and blank group was more significant.
4. Bowelsound:The time bowelsound from appeared to recovered had significant difference between traditional acupuncture group and blank group, electroacupuncture group and blank group(P<0.05). While there was no significant difference between traditional acupuncture group and electroacupuncture group(P>0.05). The grade change from before and after treatment in both traditional acupuncture group and electroacupuncture group was significantly greater than that in blank group(P<0.01).
5. Grade of abodaomimal distension and pain:The grade change from before and after treatment in electroacupuncture group was significantly greater than that in blank group(P<0.05).
6. Grade of gastrointestinal reaction:The grade change from before and after treatment in electroacupuncture group was significantly greater than that in blank group(P<0.05).
7. Effecacy evaluation:The symptoms score change from before and after treatment in traditional acupuncture group(P<0.01) and electroacupuncture group(P<0.05) was significantly greater than that in blank group. The therapeutic index of traditional acupuncture group and electroacupuncture group was significantly greater than that in blank group(P<0.01). The traditional acupuncture group had significant difference with blank group in therapeutic grade constitution and total effective rate(P<0.01).
8. Correlation analyze of the first exhaust time and acupuncture inervention time:The first exhaust time was seen as y, the acupuncture inervention time was seen as x, according to curve fitting, such equation was get:y=x1.4 (5 Experimental research
1. Defecation:The first defecation time after operation in acupuncture group was significantly shorter than that in blank group(P<0.05). The number of rats which defecated on the first day after operation had significant difference with blank group(P＜0.05). The decrease of granule and weight of excrement was significant different in acupuncture group, model group and sham-operation group from that in blank group(P<0.01). Compared the acupuncture group with model group, there was no significant difference on the first day after operation, but from the second day on the difference became significant(P<0.05).
2. Radionuclide scanning on gastric emptying:GET1/2 was significantly longger in model group than that in blank group(P<0.05) and acupuncture group(P<0.01). The 60min emptying rate was significantly smaller in model group than that in blank group(P<0.05) and acupuncture group(P<0.01). There was no significant difference between acupuncture group and blank group(P>0.05) in both GET1/2 and 60min emptying rate.
3. Blood gastrointestinal hormone change:The plasma MLT was significantly less in model group than that in blank group and acupuncture group(P<0.01). There was no significant difference between acupuncture group and blank group(P>0.05). There was no significant difference of seru GAS among the four groups(P>0.05).
4. The pathological morphology change of gastrointestinal tissue observed under microscope:The inflammation and hydroncus was most serious in model group. Acute and chronic inflammatory cells soaked. Granuloma was seen. The inflammation and hydroncus in acupuncture group was not so serious. Thread ends and foreign body reaction was seen in both model group and acupuncture group. Mucosa ulcer existed.
5. The gastrointestinal ENS-ICC-SMC network structure change:The number of ICC and the fluorescence intensity was greatly decreased in model group compared to blank group(P<0.05). The synapsis were not obvious. The integrated network structure disappear, huge vacancy was found. The tightness connects between ICCs, ICC and SMC, ICC and nerve fibre were deficient. Cholinerqic nerve network structure was seriously imcomplete, present schistose distribution. Connect between nerve fibre were greatly decreased. VAChT positive nerve fibre was obviously reduced, the fluorescence intensity was significantly weaken compared to blank group. The distribution of ICC and cholinerqic nerve was nonuniform. The ENS-ICC-SMC structure was confused. The ICC distribution in acupuncture group was kept network structure. The synapsis were seen. The connections of ICCs, ICC and SMC, ICC and and nerve fibre were tight and there were no obvious gaps. The number of ICC and the fluorescence intensity were increased compared to the model group(P<0.05) and there were no difference with blank group. VAChT positive nerve fibre was obviously increased compared to model group. The network structure was kept and connects between cholinerqic nerves were tight. The fluorescence intensity was significantly stronger than model group(P<0.05) and there were no difference with blank group. Long tubers between ICC and cholinerqic nerve increased. Connect structure was integrated. Network structure existed.
6. The gastrointestinal ICC ultrastructure change under electron microscope:The nucleus of ICC in model group contracted, heterochromatin appeared near the nucleus membrance shaped like spot. Tubers were greatly decreased and the tip fractured, cytoplasm content were lost. Vacuole was formed in cytoplasm. The number of organelle was greatly reduced, the structure of organelle was abnormal:the number of mitochondria decreased, mitochondria swelled and dissolved, ridge broke, vacuole formed; endoplasmic reticulum expanded, rough surfaced endoplasmic reticulum dropped granule; lots of intermediate fiber evacuation; large lipid droplet and empty membrane concrement vacuole was seen; secondary lysosome increased, closely related with fused lipid droplet and cluster glycogen grain; basement membrane was incompleted. Some cytoplasm ultrastructure was hard to identified. The nucleus of ICC in acupuncture group kept normal shape. Damage of tubers was not obvious. Heterochromatin partly appeared near the nucleus membrance. Lots of mitochondrion, ribosome, endoplasmic reticulum and Gorky existed. The shape and structure of organelle was clear. A few mitochondrion swelled. some endoplasmic reticulum expanded. basement membrane was completed
7. The gene expression of SCF mRNA change:The gene expression of SCF mRNA was significantly less in model group than that in blank group(P<0.01) and acupuncture group(P<0.05). There was no significant difference between acupuncture group and blank group(P>0.05).
8. Correlation analyze of plasma MLT and gastrointestinal emptying:MLT was seen as x, the GET1/2, gas emptying rate and granule of excrement were seen as y, according to curve fitting, such equations were get: y=165.179-0.732x(0 Conclusion
1. Acupuncture can shorten the time of first exhaust after abdominal operation, improve the quality of defecation, help patient take in liquid diet earily, reduce abdominal distension and pain, reduce gastrointestinal reaction like nausea, vomit, etc.
2. Both traditional acupuncture and electroacupuncture have its own superiority. Traditional acupuncture is good at shortening the time of first exhaust after abdominal operation, improving the quality of defecation, helping patient take in liquid diet earily. While electroacupuncture is good at recovering bowlsound, reduce abdominal distension and pain, reduce gastrointestinal reaction. Different superiority is likely related to the different mechanism of these two therapy. Traditional acupuncture emphasizes on entire accommodation while electroacupuncture emphasizes on regulate gastrointestinal electrical rhythm and improve threshold.
3. The first exhaust time and acupuncture inervention time have a power relation.
4. The regulative effect of acupuncture on abdominal postoperative gastrointestinal dysmotility is mainly on helping gastrointestinal movement and emptying function to recover. This effect is achieved perhaps through the combined action of improving plasma MLT, reducing inflammatory reaction, increasing ICC's number, bettering ICC's structure and function, etc.
5. Acupuncture can increase ICC's number, better ICC's ultrastructure and function, recover the gastrointestinal ENS-ICC-SMC network structure. And this is perhaps related to the effect of regulate the gene expression of SCF mRNA in Kit-SCF system.
引文
[1]孙备,许军,周尊强等,腹部手术后功能性胃排空障碍36例临床分析[J],中国实用外科杂志,2003,23：465.
[2]Barnatan Mlarson, GM Stepheng, et al, Delayed gastricemptying after gastric surgery[J], Am J Sung.1996,172(1):24.
[3]周易冬,肖毅,赵玉沛,Whipple术后功能性胃排空障碍诊治问题的探讨[J],中华普通外科杂志,2002,11(17)：671-672.
[4]Matsunaga H, Tanaka M, Takahata s, et al, Manometric evidence of improved early gastric stasis by erythromycin after pylorus-preserving pancreato-duodenectomy[J], World J Surg,2000,24(10):1236.
[5]章镜平,食管(贲门)癌手术治疗456例及其并发症分析[J],中国肿瘤临床,1986,13(4)：207.
[6]EL-BOROLOSSY K, The potential constipating efect of tramaelol hydroclonde in experimental animals in compariscon to morphine[J],7th World Congress on Pain,1993, (7):22-27.
[7]任骏,吴彪,龚昭,胃穿孔腹腔镜修补术与开腹修补术术后胃肠动力恢复的对比研究[J],腹腔镜外科杂志,2009.1,14(1)：38-40.
[8]张云贵,腹腔镜结直肠癌根治术对胃肠动力与血清胃肠激素的影响[J],陕西医学杂志,2009.12,38(12)：1652-1653.
[9]陈长江,钟晓红,刘桂月,李院明,蔡剑波,赖伟荣,贾海峰,自控镇痛对术后胃肠运动功能恢复的影响[J],基层医学论坛,2009.5,13：406-407.
[10]郎堡,范天仁,王绍明,不同硬膜外镇痛方法对上腹部手术后胃肠动力恢复的影响[J],中国现代医药杂志,2009.2,11(2)：18-20.
[11]Ladas SD, Katscgridakis J, Malamou H, et al, Helicobacter pylori may induce bile reflux:link between H pylori and bile-induced injury to gastric epithelium[J], Gut 1996,38:15-18.
[12]陈允锋,红霉素对肝胆疾病术后病人胃肠功能恢复的影响[J],海南医学,2009,20(8)：45-46.
[13]秦裕,刘风林,重视腹部手术后消化道功能障碍的诊治[J].中国实用外科杂志,2003,23(8)：448-449.
[14]Ferraz A A, Cowles V E, Condon R E, et al, Nonopioid analgesics shorten the duration of postoperative ileus[J], AmSurg,1995,61(12):1079.
[15]张卓军,张维燕,陈玉琼,前列腺素E1对腹部手术后行持续硬膜外镇痛胃肠功能恢复的临床观察[J],海南医学院学报,2006,12(2)：121-123.
[16]戴书元,11例胃肠道术后患者肠内营养的应用体会[J],工企医刊,2009,22(1)：25.
[17]Cheatham ML, Chapman WC, Key SP, et al, A meta-analysis of selective versus routine nasogastric decompression after elective laparotomy[J], Ann Surg, 1995,221:469-476.
[18]吴琴珍,促进腹部手术患者肠蠕动的探讨[J].护理与康复,2004,3(4)：268.
[19]王磊,咀嚼口香糖促进腹部手术后胃肠功能恢复临床观察[J],淮海医药,2003.10,21(5)：378-379.
[20]牛忠辉,马杰,嚼口香糖对腹部手术后肠动力恢复的影响[J],新疆医学,2009,39：12-13.
[21]Lobo D N, BostockK A, NealK R, et al, Effect of salt and water balance on recovery of gastrointestinal function after elective colonic resection: a randomised controlled trial[J], Cancer,2002,359(9320):181.
[22]Correia MI, da Silva RG, The impact of early nutrition on metabolic reponse and postoperative ileus [J], Curt Opin Cl in Nutr Metab Care,2004,7:577-583.
[23]王继娟,王维华,阮新民,吴焕林,腹针治疗心脏外科术后并发胃肠功能紊乱的临床观察[J],中国中西医结合杂志,2008.4,28(4)：310-313.
[24]李道五,温中理气健脾和胃法治疗腹部术后胃肠功能紊乱30例观察[J],中国中医药信息杂志,2001.4,8(4)：60.
[25]陈建飞,曹羽,厚朴三物汤加半夏高位灌肠治疗胃肠道术后肠麻痹的临床体会[J],中国临床医生,2004,32(9)：46-47.
[26]武雪宇,针灸辨证治疗术后胃肠功能紊乱[J],中华实用中西医杂志,2007,20(13)：1117.
[27]刘光喜,厚朴排气合剂治疗腹部非胃肠吻合术后早期肠麻痹(气滞证)临床研究[J],中南药学,2008.10,6(5)：619-621.
[28]金保亮,高瞻,宽中排气汤促进腹部非胃肠吻合术后胃肠动力恢复的临床研究[J],中国临床医生,2005,33(8)：37-38.
[29]查保国,刘敏,王智勇,王美华,五磨脐贴促进腹部手术患者胃肠功能恢复及对血管活性肠肽的影响[J],上海中医药杂志,2008,42(8)：29-31.
[30]王滨,梁小宁,周春字等,通腑冲剂直肠高位滴注的临床应用与研究[J],中国中药杂志,2001,26(11)：781-782.
[31]王民.阎世明.王静远等.番泻叶浸剂灌肠在腹部手术后应用的1临床与实验研究[J],中国中西医结合杂志,1998,18(9)：540-542.
[32]宋向晖,周小民,应用大黄促进粘连性肠梗阻术后肠功能的恢复[J],广东微量元素科学,2001,8(1)：47-49.
[33]沈平,许阳贤,郑昱等,大承气汤促进胆道术后肠功能恢复的疗效与机理研究[J],中国中西医结合外科杂志,1999,5(6)：360-361.
[34]沈平,章学林,高炬等,大承气汤对大鼠结肠手术后肠蠕动恢复的疗效初探[J],江苏中医药,2004,2(5)：53-54.
[35]邓丽芳,复方大承气汤保留灌肠促进腹部术后胃肠功能恢复的疗效观察[J],广西中医药,2001,24(1)：19-20.
[36]王振文,尤胜义,莱菔承气汤对腹部术后胃肠及肺功能的影响[J],中国中西医结合外科杂志,2007.6,13(3)：218.
[37]李慎贤,王宝胜,王廷振,厚朴三物汤空肠给药促进胃十二指肠术后胃肠功能恢复的临床观察[J],中国中西医结合急救杂志,2005.5,12(3)：162-164.
[38]金保亮,高瞻,补中益气汤保留灌肠对上消化道溃疡穿孔修补术后胃肠功能恢复的影响[J],中国中西医结合杂志,2005,25(7)：667-668.
[39]谢建兴,赵先明,通腑泻热灌肠合剂对促进腹部手术后胃肠蠕动功能恢复的临床观察[J],新中医,1995,27(4)：17-18.
[40]石卫人,林梓凌,周琦石等,祛瘀通腑法防治腹部术后肠粘连的临床观察[J].新中医,2001,33(9)：27-28
[41]张月珍,王君.中药外熨治疗肠粘连26例[J],中医外治杂志,1992,(4)：11-12.
[42]马朝群,陈德轩,朱永康等,加味暖脐散敷脐对手术后胃肠功能的影响[J],中国中西医结合消化杂志,2006,14(5)：328-329.
[43]陈德轩,马朝群,姚毅,朱永康,敷脐巴布剂的制备及对大鼠胃肠动力与胃肠激素的影响[J],中国生化药物杂志,2009,30(6)：404-406.
[44]朱其卉,张剑,胡春峨,高春芳,通气散外敷治疗腹部手术后腹胀效果观察[J].护理学杂志.2003,18(8)：57.
[45]崔树兴,李桂,巴英伟,冯保恒,王静铭,刘洪亮,中药敷脐疗法对剖腹术后患者胃肠功能恢复的临床研究[J],河北中医,2007.6,29(6)：500-501.
[46]谭晓红,吴茱萸贴脐促进腹部手术后胃肠功能恢复38例疗效观察[J],实用中西医结合临床,2003,3(2)：27-28.
[47]徐九云,葱白敷脐促进腹部术后肠蠕动恢复的观察与护理[J],2006.8,3(8)：32-33.
[48]肖素香,通腑散敷脐合穴位按摩对术后胃肠功能的影响[J],现代中西医结合杂志,13(12)：1600.
[49]黄继东,陈国盛,大承气汤熨剂对急腹症术后恢复的临床观察[J],辽宁中医药大学学报,2007.7,9(4)：10-11.
[50]刘满君,张红英,葛建立,贾力辉,足三里贴膏对腹部术后胃动素的影响[J],陕西中医,2008,29(3)：345.
[51]刘礼秀,刘绍安,张志丽等,参花茶口腔喷雾促进外科术后胃肠功能恢复的观察[J],现代护理,2001,7(4)：256.
[52]常海宏,魏万田,番泻叶对急性腹膜炎术后肠蠕动功能恢复的应用观察[J],甘肃中医,1996,9(4)：13.
[53]康复笑,韩宜印,何淑贤,葛新茹,生大黄促进术后胃肠功能恢复的临床观察[J],中国中西医结合外科杂志,2002.6,8(3)：167-168.
[54]汪梦莲,莱菔汤促进妇产科术后肠功能恢复的临床观察[J],安徽医学,1997,18(5)：53-53.
[55]顾天娣,徐宁芳,汤德意,红萝卜汤促进妇科病人术后肠蠕动功能恢复90例[J].人民军医,1995,(1)：44.
[56]时学芳,王春香,朱海燕,白豆蔻用于妇产科腹部术后肠功能恢复的临床观察[J],河北中医,2003,25(12)：950-950.
[57]余秀村,杨维琼,许瑞华等,中药排气法代替胃肠减压用于胆囊于术病人的观察[J],中华护理杂志,1998,33(11)：653-654.
[58]黄朝,辨证治疗240例术后胃肠功能紊乱的临床观察[J],上海中医药杂志,1996,(6)：40
[59]孟祥兰,程琪辉,戴建萍,辨证治疗妇科术后胃肠功能恢复不良52例[J],中医药研究,1996,(6)：26.
[60]蔡北源,李建华,何宜斌,岭南地区腹部胃肠手术后的辨证论治体会[J],山东中医杂志,2007.8,26(8)：536.
[61]尤胜义,吴成中,刘满林,大承气汤对胆囊切除术后胃肠激素及肠运动的影响[J],中国中西医结合杂志,1994,14(9)：523-525.
[62]齐清会,王简,回建峰等,大承气冲剂对人体胃肠运动功能的影响[J],中国中西医结合杂志,2004,24(1)：21-24.
[63]高洪生,伊红梅,许建,武鹏,中西医结合治疗腹部手术后腹胀48例体会[J],基层医学论坛,2006,10(3B)：221.
[64]蔡北源,苏丹,任东林,小承气合剂早期灌服对结肠吻合术后胃肠功能恢复影响的临床观察(附30例报告)[J],中华实用中西医杂志,2006,19(16)：1941-1942.
[65]杨玉国,蔡敬国,戚东峰,胃肠动力胶囊促进胃部术后功能恢复疗效分析,实用中医药杂志,2009.1,25(1)：4-5.
[66]赵迅,麻子仁汤对术后胃肠功能恢复的临床观察[J],云南中医中药杂志,1997,18(5)：11-12.
[67]田伯乐,胡伟明,陈光远等,朴实颗粒对腹部术后患者胃肠蠕动功能的双盲双模 拟研究[J],华西药学杂志,2004,19(4)：315-317
[68]易健,刘杰民,蔺晓源等,四磨汤对腹部非胃肠手术后大鼠胃肠运动的影响[J],中南药学,2010.2,8(2)：84-86.
[69]张仁岭,张胜华,冯寿全,四君子汤加味对胃肠道手术后肠粘膜屏障功能的作用[J],中国中西医结合外科杂志,2006.2,12(1)：6-9.
[70]张永华,粱保康,江志良等,桃蛭枳朴合剂疆防术后脑粘连的临床研究[J],中国中西医结合杂志,1999,19(5)：273-275.
[71]赵青,中药治疗盆腔手术后胃肠功能紊乱80例[J],中医研究,2004.4,17(2)：27-28.
[72]曾莉,凌立君,周玉春等,活血通腑方对大鼠术后腹腔粘连的实验研究[J],中国中西医结合外科杂志,2005,11(2)：13.
[73]李建军,杨小军,轩原清史等,清胰汤对豚鼠离体结肠平滑肌收缩活动的影响[J],山东中医杂志,2002,21(3)：17.
[74]叶诚焯,王万青,柴可夫等,消痞舒胃口服液治疗功能性消化不良的实验研究[J],中国中医药科技,2001,8(6)：362.
[75]熊军,王尧华,中西医结合腹部术后胃肠动力紊乱临床研究[J],中西医结合外科杂志,2003,9(1)：58.
[76]李玲,谈斐,莱菔子、蒲公英、白术对家兔离体胃十二指肠的动力作用[J],中国中西医结合脾胃杂志,1998,6(2)：10.
[77]朱金照,冷恩仁,陈东风,木香对大鼠胃肠运动的影响及其机制探讨[J],中国中西医结合脾胃杂志,2000,8(4)：23.
[78]王晶,侯家玉,力胃颗粒对胃肠动力的影响[J],世界华人消化杂志,2000,8(4)：377.
[79]沈富春,何庄建,金文翔,四磨汤对腹膜后腔镜术后早期肠功能恢复的影响[J],中国中西医结合外科杂志,2005,11(6)：48.
[80]赵国海,张义胜,蒋勇等,血浆胃动素及血管活性肠肽在腹部手术胃肠动力恢复前后的含量变化[J],放射免疫学杂志,2001,14(6)：323.
[81]毛秉豫,黄国锋,健脾理气中药对功能性消化不良患者胃肠动力及血浆胃动素作用的研究[J],新中药,2003,35(5)：31.
[82]李万瑶,梁楚京,林锦泉,连至诚,黄志新,针刺提插补泻手法的胃电信息检测观察[J],中国针灸,1993,(3)：29-30.
[83]何智明,针刺提插补泻对脾胃患者胃电图的影响[J],辽宁中医杂志,1985,12(4)：37.
[84]何智明,郑关毅,邹香云,周健洪,激光针电针手针疾徐补泻对人体胃电图影响的比较观察[J],辽宁中医杂志,1993,(8)：43-45.
[85]王先幢等.关于针感冲动的传入纤维奥秘[J],全国针灸针麻学术讨论会论文摘要(二),1979：76.
[86]许冠荪,郭原,张群群,刘维洲,冷建平,针刺补泻手法对家兔实验性胃节律紊乱的影响[J],安徽中医学院学报,1992,11(2)：36-39.
[87]邢文堂,马瑞林,不同针刺手法对人体胃电影响的研究[J],山西中医,1991,7(4)：33.
[88]张宏,唐纯志,陈永萍,林锦泉,冼志红,赖秀丽,提插、捻转法针刺足三里对新西兰兔胃电和血浆胃泌素、cAMP、cGMP的影响[J],广州中医药大学学报,2002.6,19(2)：112-114.
[89]刘学岐,刘玮,针刺治疗术后麻痹性肠梗阻疗效观察[J],针灸临床杂志,2004,20(9)：12-13.
[90]董承统等,针灸疗法对中枢神经系统的机能影响——重刺激和轻刺激时中枢神经系统的机能变化[J],中华医学杂志,1958,44(5)：461.
[91]林松青,远端取穴针刺治疗术后胃肠动力不足疗效观察[J],针灸临床杂志,2009,25(10)：24-25.
[92]张亚玲,针刺特定穴治疗腹部手术后胃瘫综合征46例[J],中国民间疗法,2009.1,17(1)：5.
[93]高燕,吕凯,古竹霞,温针灸治疗术后胃瘫综合征30例观察[J],甘肃中医,2008,21(9)：36-37.
[94]林晓华,杨军,赤凤迎源针法促进术后肠功能恢复的对比观察[J],邯郸医学高等专科学校学报,2002,15(1)：34-35.
[95]陈玲琳,刘枫林,赵孝珍,子午捣臼针刺手法配合艾条灸治疗术后肠麻痹38例疗效观察[J],针灸临床杂志,2003,19(9)：26-27.
[96]刘云建,刘孟安,张俊娥,针刺治疗腹部术后胃肠功能恢复33例[J],滨州医学院学报,1997,20(4)：347-348.
[97]秦军,电针治疗术后麻痹性肠梗阻36例[J],浙江临床医学,2002.7,4(7)：537.
[98]蒋晗,针刺治疗术后胃肠功能紊乱综合征105例[J],时珍国医国药,2003,14(6)：364-365.
[99]潘克宁,穴位电疗法对腹部手术后胃肠功能恢复的影响[J].,贵阳中医学院学报,2001,23(2)：24-24.
[100]张炳熙,丁斌,任蓉等.耳穴压迫对硬膜外吗啡镇痛病人血浆胃动素及术后胃肠功能恢复的影响[J],中华麻醉学杂志,1998,18(3)：186-187.
[101]万茜,耳压配合针刺对术后肠功能恢复的影响[J],南京中医药大学学报,1999.1,15(1)：37.
[102]刘景洋,欧阳国林,针灸治疗腹部手术后麻痹性肠梗阻临床观察[J],广西中医 药,2007.8,30(4)：36-37.
[103]贺必梅,廖敏,高小云,头针麻醉对肠癌患者术后胃肠功能恢复的影响[J],江苏中医药,2006,27(12)：50-51.
[104]郭亚雄,陈育忠,柳东杨,腹针疗法促进胃切除术后胃肠蠕动67例疗效观察[J],新中医,2006,38(7)：68-68.
[105]纪艳华,王霆,针刺为主综合治疗术后单纯性肠梗阻[J],针灸临床杂志,2005,21(12)：8.
[106]陈晴,安应成,针刺防治腹部术后早期常见并发症28例[J],江苏中医,1996,17(4)：28-29.
[107]诸葛军,针灸治疗术后肠麻痹86例临床观察[J],中华临床医学研究杂志,2007.9,13(17)：2561.
[108]赵利军,刘改荣,针灸磁圆针治疗术后胃瘫综合征疗效观察[J],山西职工医学院学报,2007.11,17(4)：49-50.
[109]王丙军,苑林军,秦如,穴位封闭加中药口服治疗胸腹部手术后胃肠功能紊乱62例[J],中国中西医结合外科,1997,3(5)：328.
[110]李财宝,沈冲,棘长卿穴位注射用于腹部手术后的疗效观察[J],上海中医药杂志,1994,(10)：42.
[111]秦文栋,刘文君,高树中,穴位埋线预处理对剖宫产产妇术后肠蠕动及乳汁分泌的影响[J],中国针灸,2007,27(6)：417-420.
[112]李立,富永明,董齐,苍爱军,柳青峰,针灸介导体外胃电起搏改善腹部手术后胃肠动力的临床观察[J],中国现代医学杂志,2005.10,15(20)：3155-3157.
[113]李国良,李龙海,付新民,李欢龙,艾炷隔姜灸治疗术后肠粘连11例[J],新中医,1994,(9)：34-35.
[114]王紫英,许粉年,艾灸促进腹部手术后肠蠕动恢复98例临床观察[J],黑龙江中医,2007,(5)：37-38.
[115]祝木星,针刺加艾灸在腹部手术后胃肠功能恢复中的应用[J].中医外治杂志,2000,9(6)：37-37.
[116]韩景贤,穴位按摩用于腹部术后胃肠功能恢复的观察[J],现代中西医结台杂志,2000.8,9(15)：1507-1508.
[117]蒋俊梅,促进腹部手术后胃肠蠕动功能恢复的研究[J],南方护理学报,2004.11,11(11)：7-8。
[118]白家英,按摩促进腹部手术后肛门排气效果的探讨[J],实用护理杂志,2001,17(11)：14.
[119]高丽虹,郑玉梅,刘英菊,张红,足底按摩对腹部手术后胃肠道蠕动功能的影响[J],护理学杂志,1998,13(1)：39-40.
[120]周红玲,足浴和足部按摩对腹部术后患者情绪及胃肠功能的影响[J],中国临床康复,2004,8(14)：2700-2701.
[121]封进启,足部反射区保健按摩[M],天津：天津科技翻译出版公司,1992：21.
[122]刘莉,区爱武,林蕾等.足部保健对妇科腹部术后病人胃肠功能恢复的作用[J],护理学杂志,2003,18(11)：861.
[123]俞伟珍,王亚莲,唐喜珍,张艳艳,介丽霞,盛燕妃,足部按摩结合穴位按揉对胃肠道术后肠蠕动影响的研究[J],护理与康复,2007.8,6(8)：507-510.
[124]李杰,周凌云,薛东波,魏云巍,张伟辉,电针对Roux-en-Y吻合术后空肠袢肌电活动的影响[J],中国针灸,2006.2,26(2)：133-135.
[125]郭景财,张爱军,郑向红,腹部手术后肠蠕动功能变化的实验性研究[J],中国误诊学杂志,2007.7,7(13)：2946-2948.
[126]尹兆均,刘应金,梁伯进,骆宇戟,加味大承气汤对腹部手术后肠功能恢复的实验研究[J],辽宁中医学院学报2005.11,7(6)：628-629.
[127]刘少杰,杨小红,刘建伟,外用芒硝促进大鼠腹部手术后胃肠运动的实验研究[J],广东医学,2006.7,27(7)：958-959.
[128]张雪梅,董蕾,刘丽娜,畅碧侠,何谦,李谦,胆囊切除术对豚鼠胃肠移行性复合波与胆酸池大小的影响[J],第四军医大学学报,2005,26(18)：1649-1652.
[129]田易军,王磊,耿世佳,包呈梅,金芳,胡森,电针足三里穴减轻大鼠术后腹腔粘连的实验研究[J],感染、炎症、修复,2008.9,9(3)：153-156.
[130]冯秉安,张立志,黄磷,王选琢,陈海波,裴德恺,王冬梅,丰冬冬,杜闻姜,姜玲,程卫东,中药腑安治疗术后肠麻痹的实验与临床研究[J],大连医科大学学报,1997,19(2)：83-89.
[131]王祖耀,胡延泽,韦福康,王益民,不同腹腔手术操作对胃肠蠕动功能影响的动物实验研究[J],华西医学,1999,14(4)：406-407.
[132]姬志伟,罗连城,何清字,薛文斗,大承气冲剂对腹腔感染家兔肠运动功能的影响[J],中国中西医结合外科杂志,1998.6,4(3)：142-146.
[133]李全福,曹月敏,马会敏,腹腔镜麻醉方法与胃肠功能变化的相关性研究[J],腹腔镜外科杂志,2004.9,9(3)：170-171.
[134]廖琴,王明安,欧阳文,段开明,侯丽,不同麻醉方法对腹腔镜胆囊切除术围术期胃肠动力的影响[J],湖南医科大学学报,2003,28(1)：73-75.
[135]于泳浩,硬膜外用药对胃肠动力的影响[J],《国外医学》麻醉学与复苏分册,2003,24(1)：13.
[136]黄莛庭,杨拔贤,安友仲等,腹部外科手术并发症[M],北京：人民卫生出版社,2000,第1版：245-250.
[137]俞振宝,许艳花,周艳伟,张晋生,黄明,通腑汤促进腹部术后胃肠功能恢复 的临床研究[J],河北中医,2006.3,28(3)：172-174.
[138]钱国,通腑汤对腹部手术后胃肠功能的影响[J],实用中医药杂志,2007.10,23(10)：617-618.
[139]罗付珍,大承气汤治疗术后腹胀的临床观察[J],中华现代中医学杂志,2006,2(2)：173-174.
[140]刘宝清,杨成城,余文,吴伟,王尧华,糖尿病对腹部术后胃肠功能的影响[J],中国中西医结合外科杂志,2008.8,14(4)：360-362.
[141]罗成江,赵颖贤,亢斌,r-羟基丁酸钠预处理促进腹部手术后胃肠功能恢复的观察[J],宁夏医学院学报,2008.4,30(2)：229-230.
[142]蒋基令,何葵,腹部手术后应用西沙必利促进胃肠动力恢复的观察[J],衡阳医学院学报,1999.5,27(2)：145-146
[143]刘丽娟,张利平,薛凌娟,甲氧氯普胺在剖宫产术后的应用[J],《中国保健》医学研究版,2008,16(5)：151.
[144]马冬惠,张建青,胃复安与新斯的明预防剖宫产术后胃肠反应及胃肠功能紊乱[J],河北中西医结合杂志,1995,4(2)：47.
[145]刘学岐,刘玮,针刺治疗术后麻痹性肠梗阻疗效观察[J],中国针灸,2004.12,24(12)：831-832.
[146]王宽宇,魏殿龙,孙晓龙,电针足三里、上巨虚促进腹部术后胃肠功能紊乱恢复40例临床观察[J],中国中医药科技,2005.9,12(5)：316-317.
[147]迟达超,戴毅,刘小凤等,中西医结合治疗术后早期炎性肠梗阻41例[J],陕西中医,2004,25(9)：792-793.
[148]米鑫,郑健,党彤等,剖宫产术后应用吗丁啉促进胃肠功能恢复90例临床分析[J],医学理论与实践1999年12卷6朗：327-328.
[149]翟美玉,陈昆洲,潘建辉,疏树华,穴位电针对全麻下血浆胃动素值的影响,中国针灸,1999,(6)：371-372.
[150]邵乐文,俞小玲,择时选穴按摩对胃肠道术后肠蠕动恢复的影响[J],中华护理杂志,2006.8,41(8)：752-753.
[151]黄文燕,陈蓓琳,不同穴位处方治疗术后肠麻痹的疗效比较[J],上海针灸杂志,2004.7,23(7)：19-20.
[152]李珍,赵元印,陈劲,针刺治疗胃大部切除术后残胃无力症36例[J],甘肃中医学院学报,2004.9,21(3)：36-38.
[153]牛亚清,吴宁霞,针灸治疗腹部手术后腹胀的体会[J],新疆中医药,2007,25(4)：62.
[154]党同英,陈爱民.针刺治疗手术后腹胀8例[J],局解手术学杂志,1996,5(3)：51.
[155]王雪苔,中国针灸大全[M],河南：河南科学技术出版社,1992,第1版：660-684.
[156]严洁,常小荣,邓元江等.电针足阳明经穴对家兔胃粘膜损伤细胞保护作用的研究[J],针刺研究,2001,26(4)：264.
[157]严洁,李江山,常小荣,易受乡,林亚平,电针足阳明经穴对正常家兔胃运动功能的影响[J],中华现代中西医杂志,2003,1(3)：193-194.
[158]张安莉,陈日新,康明非等,针灸治疗胃动力障碍症临床疗效和研究[J],中国针灸,1994,14(5)：1.
[159]刘玉华,邹英杰,解基良等.中医药促进术后胃肠功能恢复的临床研究[J],天津中医,1996,13(6)：16-18.
[160]司呈泉,宿广峰,许振国,针刺足三里对腹部手术后胃肠功能的影响[J],中国中西医结合外科杂志,2007.12月,13(6)：547-549.
[161]宫兆竹,孙心红,针刺治疗术后麻痹性肠梗阻[J],中国民间疗法2002.6,10(6)：11.
[162]尹兆光,韩德昌,孙立芬,针刺足三里、内庭穴对腹部手术后脾虚证患者胃排空的影响[J],河北中医,2008.8,30(8)：843-844.
[163]刘言寿,试论电针疗法临床补泻的模拟运用[J].中国针灸,1997.9,(36)：569-571.
[164]张压西,陈友梅,余红樱,针刺肺俞穴改善肺功能时效关系研究,中国针灸,1997,(10)：581-582.
[165]刘建欣等,创伤对小白鼠Mφ功能的影响及Mφ激活在抗感染中的作用[J],上海免疫学杂志,1988,8(4)：265.
[166]黄胜和,马金鉴等,酶在临床上的应用[M],天津：天津科技出版社,1983：53.
[167]刘建欣,赵琦,许德华,王炜,唐云,李仲安,针刺对围手术期肠运动功能和血清酶活性的影响[J],中西医结合杂志,1991,11(3)：156-157.
[168]张经济,连至诚,许冠荪等,消化道生理及病理生理学基础与临床[M],广东科技出版社,1997,21(4)：152-152.
[169]严洁,常小荣,藏敬跃,李克林,徐慧玉,林亚平,易受乡,阳仁达,针刺足阳明经不同部位腧穴对人体胃窦容积变化的动态观察,针刺研究,1995,20(1)：60-65.
[170]钱立伟,韦志群,刘凌宇等,电针足三里穴对人体幽门运动功能影响的研究,中国中西医结合杂志,1993,13(6)：336.
[171]唐家槐,陈玉珍.针刺内关引起幽门运动的观察[J],中国针灸,1997,17(11)：655-665.
[172]张中一,陈家莉,朱生梁等,胃镜下观察针刺内关、足三里的反应150例[J],上海针灸杂志,1995,14(1)：11.
[173]邵雷,B超显像观察针刺足三里对胃蠕动的影响[J],上海针灸杂志,1991,10(1)： 13-14.
[174]周吕,胃肠生理学基础与临床[M].北京,科技出版牡,1991,25-26.
[175]扬德治,毕庆和,应崇智等,电针“足三里对大白鼠小肠电活动的影响[J],铁道医药,1989,(4)：211.
[176]许冠荪,耳穴电针家兔“足三里”穴对肠活动的影响[J],中西医结合杂志,1988,(1)：67.
[177]苏微微,针刺对血浆胃肠激素和胃分泌机能的影响[J],中华消化杂志,1989,9(3)：14.
[178]吴亚丽,陈少夫,潘莉莉,电针对胃炎患者胃酸分泌及胃肠激素的影响[J],中国中西医结合杂志,1994,14(12)：709.
[179]Liu L, Zhou L, ZhangD, Li J, Effects of acupuncture on antral G cells in patients with gastric disease, Zhenci Yanjiu,1994,19:75-78.
[180]常小炎,严洁,林亚平,易受乡,刘辉,针刺足阳明经穴对健康人血浆胃动素及胃泌素含量的影响[J],中国中西医结合消化杂志,9(2)：69-70.
[181]褚自宏,黄裕新,史恒军,许才绂,张忠惠,壬庆莉,针刺健康人肠经募合穴前后胃动素的变化[J],中国针灸,1998,(6)：341-342.
[182]郑关毅,陈为民,针刺足三里穴治疗肠道易激综合征的临床观察甲上海针灸杂志[J],1996,15(4)：20-21.
[183]易受乡,林亚平,严洁等.电针对大鼠胃运动、P物质和胃动素的影响[J].世界华人消化杂志,2001,9(3)：28。
[184]Tien IB, Shen S, Han JS, Effect of electroacuPuncture frequency on SOM and CGRP of sPinalin rats, Acedemic of Physiology,1998,50(4):101-105.
[185]段淑香,王东岩,针刺足三里影响胃运动神经的研究概况[J],针灸临床杂志,1999,15(2)：50.
[186]李端午,李翠红,汪智民,足三里穴区不同层次感觉和运动神经元的节段性分布研究[J],中国针灸,2000,20(3)：161.
[187]韩平,足三里-胃肠机能相关及其反射途径的研究进展[J],皖南医学院学报,2001,20(4)：302.
[188]逯波,晋志高,蔡虹等.新生大鼠足三里穴区感觉神经元的节段性分布[J].中国中医基础医学杂志,2002,8(9)：61.
[189]常小荣,严洁,针刺足阳明经穴对健康人血浆胃动素、胃泌素含量的影响[J],中国中医药科技,2001,8(1)：5.
[190]Tada H, Fujita M, Harris M, Tatewaki M, Nakagawa K, Yamamura T, Pappas TN, Takahashi T, Neural mechanism of acupuncture-induced gastric relaxations in rats[J], Dig Dis Sci,2003,48:59-68.
[191]Noguchi E, Ohsawa H, Tanaka H, Ikeda H, AikawaY, Electro-acupuncture stimulation effects on duodenal motility in anesthetized rats[J]. Jpn J Physiol,2003,53:1-7
[192]Zhou L, Liu LG, Chen HL, Zhou WY, Li YF, Shi MH, The effect of acupuncture on gastric antral motility and its relation to peripheral 5-hydroxytryptamine[J], Zhenci Yanjiu,1987,12:130-138
[193]Qian LW, Lin YP, Effect of electroacupuncture at zusanli(ST36)point in regulating the pylorus peristaltic function, Zhongguo Zhongxiyi Jiehe Zazhi, 1993,13:336-339,324.
[l94]LiuL, Zhou L, ZhangD, Li J, Effects of acupuncture on antral G cells in patients with gastric disease[J], Zhenci Yanjiu,1994,19:75-78.
[195]李芳,孔德玲,赵道霞,PCIA与PCEA对下腹部手术后患者功能恢复影响的对比研究,山西医科大学学报,2007.9,38(9)：842.
[196]蔡逊,卢绮萍,腹腔镜与开腹胆囊切除术后胃肠动力恢复临床研究,西南国防医药,2006,16(3)：253-256.
[197]楼文晖,术后肠麻痹的药物治疗[J],中华疾学杂志,2007.5,87(18)：1271.
[198]林翠珍,雷伟娜,苏合丸联合微波治疗促进术后胃肠功能恢复[J],护理学杂志,2007.8,22(16)：62-63.
[199]胡勇,王明时,刘文晖.肠鸣音分析仪的研制[J].电子测量与仪器学报.1995,9(1)：58-63.
[200]任福军,曾衍钧,钱红缨等.人体肠鸣音的记录和分析[J].北京生物医学工程,1991,10(4)：214-220.
[201]李义,魏玮,陈全利等.针刺对肠动力影响的即刻性效应临床分析[J].遵义医学院学报,2004,27(5)：459-460.
[202]JOHN T. FARRAR. FRANz J. INGELFINGER. Gastmintestinal momity as revealed by study of abdominal sounds[J]. Gastroenleflogy,1955,29(5):789-800.
[203]李洪立,郭修田,司井夫,谷文英,李淼焱,电针对腹部术后镇痛及胃肠功能恢复的作用临床观察[J],安徽中医临床杂志,2003.2,15(1)：18-19.
[204]杨广印.胡翔龙,陈凌,刘庆城,肠鸣音与胃肠运动相关性的初步观察[J],福建中医学院学报,2009.6,19(3)：41-43.
[205]李韶山,胃肠复原汤预防手术后胃肠道无力症[J],中国乡村医药杂志,2005.8,12(8)：46-48.
[206]李红星,中西医结合治疗手术后胃瘫27例[J],新乡医学院学报,2006,23(6)：607-608.
[207]张美秀,三、四类腹部外科术后早期抬臀运动对胃肠功能恢复的影响[J],中华 现代护理学杂志,2007,4(8)：677-678.
[208]覃向红,吴茱萸敷脐治疗胃肠道积气的效果观察[J],广西医科大学学报,2007.10,24(5)：820.
[209]陆桂玲,李光仪,西甲硅油对妇科腹腔镜术后胃肠功能恢复的影响[J],海南医学,2008,19(9)：48-49.
[210]闵杰,吗丁啉对胆囊切除术后的胃肠蠕动作用[J],重庆医学,1998.9,27(5)：324-325.
[211]潘亚兰,辛玲芳,朱丽萍,中药灌肠加艾灸对腹腔镜胆囊切除术后胃肠功能恢复的影响[J],湖北中医杂志,2008,30(2)：45.
[212]黄胜等,酶在临床上的应用[M],天津：天津科技出版社,1983：53.
[213]贺必梅,李万瑶,李万山,招伟贤,头针对手术期氧化应激反应调节能力的观察,中国针灸,2006.4,26(4)：291-294.
[214]陈贵延,薛赛琴,最新国内外疾病诊疗标准[J],北京：学苑出版社,1991：907-908.
[215]张伟成,王钢,戴耀明,陆建明,张小波,行气活血汤促进术后胃肠功能恢复的临床研究[J],现代中西医结合杂志,2005.3,14(5)：612.
[216]张庆华,朱洪生,陆黎,电针对术后使用硬膜外镇痛泵胃肠蠕动的观察[J],上海针灸杂志,2003.11,22(11)：28-29.
[217]宋春辉,李桂,崔树星,贾凤新,巴英伟,刘洪亮,中药敷脐疗法对经腹术后患者胃肠功能恢复及T细胞亚群变化的影响[J],辽宁中医药大学学报,2008.1,10(1)：5-6.
[218]李道成,许丽绵,邓高丕,平胃散促进官颈癌根治术后胃肠功能恢复的临床研究[J],新中医,2008.3,40(3)：20-21.
[219]胡盛书,针药干预对腹式全子宫切除术后胃肠功能恢复的疗效观察,广州中医药大学2006届硕士学位论文.
[220]陈铭,毕洁亮,彭战英,王峻,通腑泻热灌肠合剂促进腹腔镜胆囊切除术后胃肠功能恢复的临床观察[J],中医药学刊,2005.10,2(10)：1925-1926.
[221]申屠珍兰,张晓群,艾灸神阙双天枢穴治疗胆道术后腹胀的临床观察[J],中华护理杂志,1998.6,33(6)：349-350.
[222]张洪,孙万军,术后早期补钾对促进胃肠功能恢复的临床意义[J],中国校医,2002.10,16(5)：432.
[223]李爱娜,陆晓燕,改进腹部非胃肠道手术后促进肠蠕动方法的临床研究[J],临床和实验医学杂志,2006.3,5(3)：242.
[224]贾文慧,中药治疗腹部手术后胃肠功能紊乱1047例[J],中国中医药科技,2002,9(5)：302.
[225]聂振声,王浩田,王中举,田五洲,肠功能恢复汤的临床应用体会[J],实用医技杂志,2008.2,15(4)：505-506.
[226]申屠阳,周允中,胃肠动力剂对术后胸腔胃状态的影响[J],中国胸心血管外科临床杂志,2000.2,7(1)：18-20.
[227]李国康,衷小东,康健,梁劲军,李茹柳,扶正理气逐瘀汤合通关散治疗腹部手术后胃肠道功能紊乱的临床与实验研究[J],中国中医药科技,2002,9(3)：133-134.
[228]刘寒,牛伟新,孙益红,秦新裕,胃次全切除术后早期肠内营养对胃肠动力的影响[J],中华消化杂志,2004.4,24(4)：215-217.
[229]王崇树,刘崇清,鄢佳程,魏寿江,陈玉祥,陈晋,黄九龄,中药热疗腹带“康腹帝”对腹部手术后胃肠道功能恢复的促进作用研究,消化外科,2005,4(5)：316-319.
[230]万仁平,罗德源,黄淼龙,姜月平,生长激素促进心脏术后胃肠功能恢复的效果观察[J],实用诊断与治疗杂志,2004,18(1)：12-13.
[231]周鹏天,毕士佐,针刺法在小肠X线造影检查中应用价值的初步探讨[J],针灸临床杂志,1995,11(10)：27-28.
[232]邹多武,功能性胃肠病的药理学和药代动力学进展[J],胃肠病学,2006,11(12)：713.
[233]李学会,王拥军,郝洪升,陈健,李君曼,胃大部切除术后血浆胃肠激素水平变化及其对胃排空的影响,山东医药,1998,38(10)：14-15.
[234]张静苗,朱培庭,王以实,沈平,周文琴,夏永和,高炬,宋华荣,中医药对胆道术后胃肠功能恢复的临床研究[J],上海中压药大学上海市中医药研究院学报,1997,11(2)：34-36.
[235]Schwartz NT, Beer-Stolz D, Simmons RL, et al, Pathogenesis of paralytic ileus:intestinal manipulation opens a transient pathway between the intestinal lumen and the leukocytic infiltrate of the jejunal muscularis[J], Ann Surg,2002,235:31-40.
[236]De Winter BY, Robberecht P, Boeckxsmens GE, et al, Role of VIP1/PACAP receptors in postoperative ileus in rats[J], Br J Pharmocol,1998,124: 1181-1186.
[237]Kalf JC, Carlos TM, Schraut WH, et al, Surgically induced leukocytic infiltrate within the rat intestinal muscularis mediate postoperative ileus [J], Gastroenterology,1999,117:378-387.
[238]Kalf JC, Schraut WH, Billiar TR, et al, Role of inducible nitric oxide synthase in postoperative intestinal smooth muscle dysfunction in rodents[J], Gastroenterology,2000,118:316-327.
[239]Ferraz A A, Cowles V E, Condon R E, et al, Nonopioid analgesics shorten the duration of postoperative ileus[J], AmSurg,1995,61(12):1079.
[240]Salmhofer H, Neuhuber WL, Ruth P et al. Pivotal role of the interstitial cells of cajal in the nitric oxide signaling pathway of rat small intestine[J]. Cell Tissue Res,2001,305(3):331-340
[241]Epperson A, Hattons WJ,Callaghan B et al. Molecular markers expressed in cultured and freshly isolated interstitial cells of cajal [J]. Am J Physiol, 2000,279(2):529-539
[242]Schernann M, Schaaf C, Mader M, Neurcchernical coding of enlenc neurons in the guinea pig stomach, J Comp Neurol,1995,353:161-178.
[243]Torihashi S, Nishi K, Tokutomi Y, et al. Blockade of kit signaling induces transdifferentiation of interstitial cells of cajal to a smooth muscle phenotype[J]. Proc Nati Acad Sci USA,1999,117:140.