Integrative approach to a patient following rumenotomy ˗ case report

ABSTRACT Concern with antimicrobial resistance in animal production systems increases the interest toward integrative therapies. The objective of the present report was to report an integrative approach to a goat undergoing rumenotomy. A goat with ruminal acidosis underwent rumenotomy, corrective rumen suture, moxibustion, and treatment of the surgical wound (TFO) with sugar. In the first twenty days, acupuncture was performed on ST36, indirect moxibustion on Sp6 and CV8, and TFO with antibiotic ointment and sugar. The wound contracted 2cm, there was gradual return of ruminal dynamics, and moderate pain. Acupuncture continued from D21 to D50 on Yin tang, BL13, BL20, BL23, and BL22. Although there was drainage of ruminal fluid, the wound contracted 4cm during this period, pain was absent, and ruminal dynamics normal. During the last thirty days, the acupuncture technique surround the dragon was used and BL13 point needled, with complete closure of the wound. The TFO from D21 was performed solely with sugar. During treatment, there was modulation of the inflammatory response, with formation of granulation tissue and neovascularization. On D84, fibrinogen was 100mg/dL. The authors conclude that the use of sugar, acupuncture, and moxibustion contributed to return of normal ruminal motility, wound contraction, and complete tissue reepithelization.摘要：抗菌耐药性（antimicrobial resistance）在动物生产体系中的受关注度日益提升，推动综合疗法（integrative therapies）的研究与应用价值愈发凸显。本报告旨在介绍一例针对山羊瘤胃切开术（rumenotomy）的综合诊疗方案。一例患有瘤胃酸中毒的山羊接受了瘤胃切开术、瘤胃矫正缝合术，并辅以艾灸及葡萄糖外科创面处置（treatment of the surgical wound，缩写TFO）。治疗初期的20日内，对该山羊实施足三里（ST36）穴位针刺，三阴交（Sp6）与神阙（CV8）穴位间接艾灸，并采用含抗生素软膏与葡萄糖的TFO实施创面处置。该阶段创面收缩2cm，瘤胃蠕动逐渐恢复，疼痛程度为中度。第21日至第50日的治疗阶段，继续实施针刺治疗，所选穴位包括印堂（Yin tang）、肺俞（BL13）、脾俞（BL20）、肾俞（BL23）与三焦俞（BL22）。尽管此阶段仍有瘤胃液渗出，但创面收缩达4cm，疼痛症状消失，瘤胃蠕动恢复正常。此阶段的TFO仅以葡萄糖进行处置。后续30日的治疗阶段中，采用围龙针刺法（acupuncture technique surround the dragon）仅对肺俞（BL13）穴位实施针刺，最终创面实现完全闭合。整个治疗过程中，机体炎症反应得到有效调控，肉芽组织（granulation tissue）形成并伴随新生血管生成（neovascularization）。第84日的实验室检测结果显示，纤维蛋白原（fibrinogen）水平为100mg/dL。作者总结指出，葡萄糖、针刺与艾灸的联合应用，可促进瘤胃蠕动恢复、创面收缩及组织完全上皮化（reepithelization）。