Abdominal Massage for Postoperative Adhesions and Ileus

腹部按摩治疗术后粘连和肠梗阻

• 批准号: 8740511
• 负责人: GEOFFREY M BOVE
• 金额: $ 25.47万
• 依托单位: UNIVERSITY OF NEW ENGLAND
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-09-24 至 2016-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8740511
• 关键词: Abdomen; Acute; Address; Adhesions; Adverse effects; Affect; Afferent Neurons; Attenuated; Biological Assay; Charcoal; Clinical Research; Collagen; Colon; Connective Tissue; Deafferentation procedure; Deposition; Development; Economic Burden; Fibrin; Foundations; Healed; Healthcare Systems; Hospitalization; Hour; Ileus; Infertility; Inflammation; Inflammatory; Injury to Peritoneum; Intestinal Obstruction; Intestines; Intra-abdominal; Irrigation; Length of Stay; Life; Liquid substance; Massage; Measures; Methodology; Methods; Modeling; Morbidity - disease rate; Neuraxis; Operative Surgical Procedures; Organ; Outcome Measure; Output; Peritoneal; Postoperative Complications; Postoperative Period; Prevention; Preventive; Process; Production; Property; Proteins; Rattus; Repeat Surgery; Reporting; Research; Resistance; Severities; Surgical Models; Symptoms; System; Testing; Therapeutic; United States; Vagus nerve structure; White Blood Cell Count procedure; abdominal wall; base; chronic pain; cost; effective therapy; gastrointestinal function; healing; health care delivery; inflammatory marker; intraperitoneal; lipoxin A4; mortality; neuromechanism; pressure; prevent; public health relevance; research study; sensory system

DESCRIPTION (provided by applicant): This project will be the first to examine the effects of abdominal massage (therapeutic mobilization of the abdominal contents and wall) on the prevention and treatment of postoperative peritoneal adhesions and ileus. Intra-abdominal adhesions (pathological bands of fibrous connective tissue that develop after peritoneal injury) are a leading cause of bowel obstruction, infertility, chronic pain, and repeated surgeries. Although they can occur spontaneously, adhesions have been reported as an adverse side effect of surgery for over a century, occurring at a rate of 95% or higher. The most recent estimate of the economic burden of the associated morbidity of postoperative adhesions is $5 billion in the United States alone. Abdominal surgery also invariably causes a temporary alteration of intestinal function, called ileus. Ileus is an important cause of postoperative discomfort and prolonged hospital stay, and also places a huge financial burden on the health care delivery system. Despite substantial efforts, effective prevention and treatment methodologies remain unsatisfactory for both of these conditions. Methods of abdominal massage have been used for centuries to treat various abdominal complaints, and are anecdotally reported to treat symptoms of adhesions and ileus. Our preliminary experimentation using rat models has led to the hypotheses that abdominal massage prevents postoperative adhesion formation, and attenuates postoperative ileus. Testing will address the effect of abdominal massage on: 1) postoperative ileus. Abdominal massage will be performed on rats following cecal abrasion throughout the inflammatory and adhesiogenic periods. Assays of gastrointestinal function, inflammation, and the fibrinolytic system will be performed at numerous endpoints. 2) postoperative adhesion formation. Abdominal massage will be performed on rats following cecal abrasion throughout the inflammatory and adhesiogenic periods, and the rat allowed to survive for 7 days. The abdomens will be dissected and quantitatively evaluated for adhesions. 3) vagal afferent discharge, and whether an intact vagal sensory system is necessary for the effects of massage. Inflammation is key to both ileus and adhesion formation, and is modulated by the vagus nerve. In one set of experiments, unitary vagal afferent discharge properties will be recorded during abdominal massage, comparing operated to unoperated rats. In a separate experiment, the effect of abdominal massage on ileus will be measured in vagal-deafferented rats, and compared to deafferented but untreated rats. 4) the healing of a rat colonic strictureplasty. Strictureplasty will be performed on two groups of rats, one of which will receive massage. After 7 days, the operated section of colon will be tested for the ability to withstand intraluminal pressure. The presence of postoperative adhesions will also be evaluated.

描述（由申请人提供）：本项目将首次研究腹部按摩（治疗性动员腹部内容物和腹壁）对预防和治疗术后腹膜粘连和肠梗阻的作用。腹膜内粘连（腹膜损伤后形成的纤维结缔组织病理带）是肠梗阻、不孕症、慢性疼痛和重复手术的主要原因。虽然粘连可以自发发生，但一个多世纪以来，粘连一直被报道为手术的不良副作用，发生率为95%或更高。据最新估计，仅在美国，术后粘连相关发病率的经济负担就高达50亿美元。腹部手术也总是引起肠道功能的暂时改变，称为肠梗阻。肠梗阻是术后不适和延长住院时间的重要原因，也给医疗保健系统带来了巨大的经济负担。尽管作出了巨大努力，但有效的预防和治疗方法对这两种情况仍然不能令人满意。几个世纪以来，腹部按摩的方法一直被用来治疗各种腹部疾病，并且据说可以治疗粘连和肠梗阻的症状。我们使用大鼠模型进行的初步实验已经得出假设，腹部按摩可以防止术后粘连形成，并减轻术后肠梗阻。试验将解决腹部按摩对术后肠梗阻的影响：1)术后肠梗阻。在炎症和粘连发生期间，对盲肠磨损后的大鼠进行腹部按摩。胃肠道功能、炎症和纤溶系统的检测将在多个终点进行。2)术后粘连形成。在炎症和粘连发生期间，对盲肠磨损后的大鼠进行腹部按摩，并让大鼠存活7天。剖开腹部，定量评估粘连情况。3)迷走神经传入放电，以及是否需要一个完整的迷走神经感觉系统来达到按摩的效果。炎症是肠梗阻和粘连形成的关键，并由迷走神经调节。在一组实验中，记录腹部按摩时单一迷走神经传入放电特性，比较手术和未手术大鼠。在另一项实验中，腹部按摩对迷走神经失传入大鼠肠梗阻的影响将被测量，并与失传入但未治疗的大鼠进行比较。4)大鼠结肠狭窄置换术的愈合。将对两组大鼠进行严格修复，其中一组将接受按摩。7天后，将测试手术结肠的承受腔内压力的能力。术后粘连的存在也将被评估。