砭石中药热熨在造血干细胞移植患者预处理期胃肠道反应中的应用研究

doi:10.3761/j.issn.0254-1769.2025.12.002

摘要/Abstract

摘要： 目的探讨砭石中药热熨在造血干细胞移植患者预处理期胃肠道反应中的应用效果。方法采用便利抽样法，选取2023年10月—2024年4月在杭州市某三级甲等中医医院血液科住院的造血干细胞移植患者68例作为研究对象，采用SPSS 26.0软件产生随机数进行分组，分为试验组和对照组，各34例，试验组在静脉止吐用药和常规护理的基础上实施砭石中药热熨；对照组采用静脉止吐用药和常规护理，两组干预时长均为14 d，其中7 d为1个疗程，共2个疗程。比较两组干预前后胃肠道反应发生率、胃肠道症状评定量表（Gastrointestinal Symptom Rating Scale，GSRS）评分、胃蛋白酶原Ⅰ、胃蛋白酶原Ⅱ、胃蛋白酶原Ⅰ/胃蛋白酶原Ⅱ的变化。结果最终纳入患者66例，对照组及试验组各脱落1例。干预14 d内，试验组恶心、呕吐、腹胀、腹泻症状发生率低于对照组（P<0.05）；干预第1、8、14天，两组GSRS评分存在时间和组间的交互效应（F_交互=5.338，P_交互=0.017）；干预第8天，试验组的胃蛋白酶原Ⅰ、胃蛋白酶原Ⅱ低于对照组，胃蛋白酶原Ⅰ/胃蛋白酶原Ⅱ高于对照组（均P<0.05）。两组治疗过程中，均无严重不良事件发生。结论砭石中药热熨能改善造血干细胞移植患者预处理期胃肠道症状，降低胃肠道反应发生率，为护士应用砭石中药热熨技术提供临床指导。

关键词: 药熨疗法, 造血干细胞移植, 胃肠道, 中医护理学

Abstract:

Objective Exploring the effect of Bian-stone-based herbal heat therapy on herbal heat ironing in gastrointestinal reactions during the preconditioning period of hematopoietic stem cell transplantation patients. Methods Convenience sampling method was used to select 68 cases of hematopoietic stem cell transplantation patients who attended the hematology department of a tertiary-level Chinese medicine hospital in Hangzhou from October 2023 to April 2024 as the study subjects，and the SPSS 26.0 statistical software was used to generate a random number for grouping into an experimental and a control group，with 34 cases in each group. On the basis of intravenous antiemetic medication and routine，the experimental group implemented the Bian-stone-based herbal heat therapy on the basis of intravenous antiemetic medication and conventional nursing care. In the control group，intravenous antiemetic drugs and routine care were used，and the intervention duration of both groups was 14 d，of which 7 d was a course of treatment，with a total of 2 courses of treatment. The incidence of gastroin-testinal reactions，Gastrointestinal Symptom Rating Scale（GSRS） score，Pepsin Ⅰ（PG Ⅰ），Pepsin Ⅱ（PG Ⅱ），and the ratio of PG Ⅰ to PG Ⅱ（PGR） before and after the intervention were compared between the 2 groups. Results The final sample of 66 cases was collected in this study，and 1 patient was dislodged from each of the control group and the experimental group. The comparison of the incidence of gastrointestinal reactions between the 2 groups within 14 days showed that the incidences of nausea，vomiting，abdominal distension，and diarrhea were lower in the experimental group than those in the control group（P<0.05）. GSRS scores on days 1，8，and 14 of intervention were compared，and there were effects between groups in both groups（F=5.338，P=0.017）. The levels of PG Ⅰ，PG Ⅱ in the experimental group on day 8 of the intervention were lower than those in the control group.The levels of PGR was higher than that in the control group（all P<0.05）.The safety of the 2 groups after treatment was evaluated，and the results showed that no serious adverse events occurred in the 2 groups. Conclusion Bian-stone-based herbal heat therapy can improve gastrointestinal reactions and reduce the incidence of gastrointestinal reactions during the preconditioning period of hematopoietic stem cell transplantation patients，which provides clinical guidance for the application of Bian-stone-based herbal heat therapy by nursing staff in the future.

Key words: Medicinal Ironing Therapy, Hematopoietic Stem Cell Transplantation, Gastrointestinal Tract, Traditional Chinese Medicine Nursing

姚斌莲, 徐敏, 毛小培, 彭敏, 祝瑞, 张晓兰, 叶梦华, 杨丹华. 砭石中药热熨在造血干细胞移植患者预处理期胃肠道反应中的应用研究[J]. 中华护理杂志, 2025, 60(12): 1420-1426.

YAO Binlian, XU Min, MAO Xiaopei, PENG Min, ZHU Rui, ZHANG Xiaolan, YE Menghua, YANG Danhua. Study on the effect of Bian-stone-based herbal heat therapy on gastrointestinal reactions during the preconditioning period of hematopoietic stem cell transplantation patients[J]. Chinese Journal of Nursing, 2025, 60(12): 1420-1426.

图/表 4

表1 两组一般资料的比较[例（百分比，%）]

Table 1 Comparison of general data between 2 groups [case（percentage，%）]

表2 两组胃肠道反应发生率的比较[例（百分率，%）]

Table 2 Comparison of the incidence of gastrointestinal reactions between the 2 groups[case（percentage，%）]

表3 两组不同时间点胃肠道症状评定量表评分的比较（分，$ \bar{x} \pm s$）

Table 3 Comparison of the gastrointestinal symptom rating scales between the 2 groups（scores，$ \bar{x} \pm s$）

表4 两组预处理前后胃蛋白酶原水平的比较（μg/L，$ \bar{x} \pm s$）

Table 4 Comparison of pepsinogen before and after pretreatment in the 2 groups（μg/L，$ \bar{x} \pm s$）

参考文献 20

[1]	赖耿良, 叶中绿. 造血干细胞移植的概述[J]. 中国医学创新, 2022, 19(20):179-184.
	Lai GL, Ye ZL. An overview of hematopoietic stem cell trans-plantation[J]. Med Innov China, 2022, 19(20):179-184.
[2]	di Renzo N, Musso M, Scimè R, et al. Efficacy and safety of multiple doses of NEPA without dexamethasone in preventing nausea and vomiting induced by multiple-day and high-dose chemotherapy in patients with non-Hodgkin's lymphoma undergoing autologous hematopoietic stem cell transplantation:a phase IIa,multicenter study[J]. Bone Marrow Transplant, 2020, 55(11):2114-2120.
[3]	刘芳勋, 赵林俊, 刘卫平, 等. 淋巴瘤患者自体造血干细胞移植期间腹泻的临床分析[J]. 中国继续医学教育, 2021, 13(34):159-163.
	Liu FX, Zhao LJ, Liu WP, et al. Analysis of diarrhea in pa-tients with lymphoma during autologous hematopoietic stem cell transplantation[J]. China Continuing Med Educ, 2021, 13(34):159-163.
[4]	肖红岩, 徐瑞荣. 胃复康膏穴位贴敷治疗化疗相关胃肠道反应临床观察[J]. 光明中医, 2023, 38(20):3999-4002.
	Xiao HY, Xu RR. Weifukang acupoint application in the treatment of gastrointestinal reactions related to chemotherapy[J]. Guangming J Chin Med, 2023, 38(20):3999-4002.
[5]	李潇, 柴燕燕, 吴艳妮, 等. 造血干细胞移植病人恶心呕吐护理管理最佳证据总结[J]. 循证护理, 2023, 9(8):1364-1369.
	Li X, Chai YY, Wu YN, et al. Summary of the best evidence for nursing management of nausea and vomiting in patients undergoing hematopoietic stem cell transplantation[J]. Chin Evid Based Nurs, 2023, 9(8):1364-1369.
[6]	赵若含, 李慧杰, 李秀荣. 中医药防治化疗后胃肠道反应的概况[J]. 中国中西医结合消化杂志, 2021, 29(10):749-752.
	Zhao RH, Li HJ, Li XR. Overview of Traditional Chinese Medicine in prevention and treatment of gastrointestinal reactions after chemotherapy[J]. Chin J Integr Tradit West Med Dig, 2021, 29(10):749-752.
[7]	于晓侠, 徐宾悦, 徐利霞. 砭石热熨治疗肠癌患者化疗相关性腹泻的疗效观察[J]. 浙江临床医学, 2022, 24(7):1013-1014.
	Yu XX, Xu BY, Xu LX. Observation on therapeutic effect of Bianshi hot ironing on chemotherapy-related diarrhea in patients with intestinal cancer[J]. Zhejiang Clin Med J, 2022, 24(7):1013-1014.
[8]	赵丹娜, 于明珠, 杨艾影, 等. 砭石循经按摩联合生物反馈治疗脾肾阳虚型出口梗阻型便秘的疗效观察[J]. 护理研究, 2023, 37(18):3404-3407.
	Zhao DN, Yu MZ, Yang AY, et al. Observation on the thera-peutic effect of acupoint massage with stone needles along the meridian combined with biofeedback therapy on outlet obstru-ctive constipation due to Spleen-Kidney Yang Deficiency[J]. Chin Nurs Res, 2023, 37(18):3404-3407.
[9]	戴益慧, 唐娅琴. 砭石隔药灸治疗中风患者肠内营养相关性腹泻的临床观察[J]. 中国中医药科技, 2022, 29(5):797-799.
	Dai YH, Tang YQ. Clinical observation on the treatment of enteral nutrition-related diarrhea in stroke patients with drug-separated moxibustion of Bianshi[J]. Chin J Tradit Med Sci Technol, 2022, 29(5):797-799.
[10]	黄砚萍, 田小冬, 李明珠, 等. 砭石熨摩中药透入法缓解慢性胃炎腹胀症状的效果观察[J]. 中西医结合护理(中英文), 2019, 5(6):51-52.
	Huang YP, Tian XD, Li MZ, et al. Effect observation on relieving abdominal distension symptoms of chronic gastritis by Chinese medicine infiltration method of Bianshi ironing[J]. Nurs Integr Tradit Chin West Med, 2019, 5(6):51-52.
[11]	蒋晓芳, 何竹, 陈曦, 等. 子午流注腕踝针疗法防治化疗所致恶心呕吐的效果研究[J]. 护理管理杂志, 2024, 24(2):180-184.
	Jiang XF, He Z, Chen X, et al. Effect of wrist-ankle acupun-cture with midnight-noon ebb-flow for nausea and vomiting caused by chemotherapy[J]. J Nurs Adm, 2024, 24(2):180-184.
[12]	褚彦香, 王颖, 熊欢. 分级管理方案在乳腺癌患者化疗所致恶心呕吐中的应用[J]. 中华护理杂志, 2019, 54(12):1815-1819. DOI URL
	Chu YX, Wang Y, Xiong H. Clinical practice of grading ma-nagement scheme for chemotherapy induced nausea and vo-miting in breast cancer patients[J]. Chin J Nurs, 2019, 54(12):1815-1819.
[13]	李旭英, 谌永毅, 石汉平, 等. 化疗不良反应预警系统的构建及应用进展[J]. 中华护理杂志, 2019, 54(5):760-764. DOI URL
	Li XY, Chen YY, Shi HP, et al. Construction and application progress of early warning system for adverse reactions of chemotherapy[J]. Chin J Nurs, 2019, 54(5):760-764.
[14]	秦宇宁, 赵天易, 刘凤斌, 等. 中文版胃肠道症状评定量表对胃肠道疾病患者测量学特性研究[J]. 中国全科医学, 2023, 26(18):2277-2285.
	Qin YN, Zhao TY, Liu FB, et al. Research of the measurement properties of the Chinese version of the Gastrointestinal Sym-ptom Rating Scale for patients with gastrointestinal diseases[J]. Chin Gen Pract, 2023, 26(18):2277-2285.
[15]	谭小雪, 徐敏, 王燕. 浙江省公立中医医疗机构中医护理门诊开展情况的调查研究[J]. 中华护理杂志, 2022, 57(3):312-317. DOI URL
	Tan XX, Xu M, Wang Y. Investigation and research of Tradi-tional Chinese Medicine nurse-led clinics in public tradi-tional Chinese medical institutions in Zhejiang Province[J]. Chin J Nurs, 2022, 57(3):312-317.
[16]	刘春蕾, 王立森. 穴位贴敷治疗化疗相关性恶心呕吐的取穴用药规律数据挖掘[J]. 中医临床研究, 2022, 14(6):109-112.
	Liu CL, Wang LS. Data mining of the rule of acupoint selec-tion in the treatment of chemotherapy related nausea and vo-miting by acupoint application[J]. Clin J Chin Med, 2022, 14(6):109-112.
[17]	金央, 冯莺, 徐秀玲, 等. 基于调周理论的火龙灸对痛经患者的中医护理效果研究[J]. 中华护理杂志, 2023, 58(17):2082-2087. DOI URL
	Jin Y, Feng Y, Xu XL, et al. Study on the effect of Fire Dragon moxibustion on dysmenorrhea based on the theory of regulating menstrual cycle[J]. Chin J Nurs, 2023, 58(17):2082-2087. DOI URL
[18]	陈英, 陈晓洁, 王舒洁, 等. 芳香疗法联合情绪释放技术对失眠乳腺癌患者影响的研究[J]. 中华护理杂志, 2022, 57(6):651-658. DOI URL
	Chen Y, Chen XJ, Wang SJ, et al. Effect of lavender aromatic therapy combined with emotional freedom techniques on insomnia cancer breast patients with heart and spleen deficiency[J]. Chin J Nurs, 2022, 57(6):651-658. DOI URL
[19]	刘玉, 杜娟. 癌症患者化疗过程中采用隔姜灸联合中药直肠滴注对胃肠道不良反应程度及胃蛋白酶原水平的影响[J]. 医学理论与实践, 2023, 36(1):142-144.
	Liu Y, Du J. Effect of ginger-separated moxibustion combined with rectal drip of traditional Chinese medicine on gastro-intestinal adverse reactions and pepsinogen level in cancer patients during chemotherapy[J]. J Med Theory Pract, 2023, 36(1):142-144.
[20]	徐敏, 黄馨睿, 刘婷, 等. 浙江省中医护理技术规范化管理方案的构建[J]. 中华护理杂志, 2023, 58(2):217-223. DOI URL
	Xu M, Huang XR, Liu T, et al. Construction of a standardized management scheme of traditional Chinese medicine nursing technology in Zhejiang Province[J]. Chin J Nurs, 2023, 58(2):217-223. DOI URL