Abdominal Massage for Postoperative Adhesions and Ileus

腹部按摩治疗术后粘连和肠梗阻

• 批准号: 8583468
• 负责人: GEOFFREY M BOVE
• 金额: $ 27.84万
• 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/8583468
• 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）：该项目将是第一个研究腹部按摩（腹部内容物和壁的治疗性动员）对术后腹膜后腹膜粘连和ileus的影响的影响。腹腔内粘连（腹膜损伤后发育的纤维结缔组织的病理带）是肠梗阻，不育，慢性疼痛和反复手术的主要原因。尽管它们可以自发地发生，但据报道，粘连是手术的不良副作用，其中一个多世纪以95％或更高的速度发生。仅在美国，对术后粘附相关发病率相关的发病率的经济负担的最新估计是50亿美元。腹部手术也总是会导致肠道功能的暂时改变，称为Ileus。艾勒斯（Ileus）是术后不适和长时间住院期间的重要原因，并且在医疗保健提供系统上也承受着巨大的财务负担。尽管做出了巨大的努力，但在这两种情况下，有效的预防和治疗方法仍然不令人满意。腹部按摩的方法已经使用了几个世纪来治疗各种腹部抱怨，并轶事报道以治疗粘连症状和回肠症状。我们使用大鼠模型的初步实验导致了腹部按摩阻止术后粘附形成的假设，并减轻了术后肠球菌。测试将解决腹部按摩对以下方面的影响：1）术后回肠。在整个炎症和粘附时期，将对大鼠进行腹部按摩。胃肠功能，炎症和纤维蛋白水解系统的测定将在许多端点进行。 2）术后粘附形成。在整个炎症和粘附时期，将对大鼠对大鼠进行腹部按摩，而大鼠可以生存7天。将解剖腹部并定量评估粘附。 3）迷走神经传入，以及完整的迷走性感觉系统是否需要按摩的影响。炎症是卵巢和粘附形成的关键，并且由迷走神经调节。在一组实验中，将在腹部按摩期间记录统一的迷走神经传入特性，并比较手术与无手术大鼠。在一个单独的实验中，将在迷走神经的大鼠中测量腹部按摩对回肠的作用，并将其与持续不良但未治疗的大鼠进行比较。 4）大鼠结肠狭窄成形术的愈合。将对两组大鼠进行狭窄成形术，其中一组将接受按摩。 7天后，将测试结肠的操作部分，以承受腔内压力。术后粘连的存在也将进行评估。