耳穴按压作用于第三产程预防产后尿潴留的临床研究

发布时间：2018-06-15 07:16

本文选题：耳穴按压 + 预防产后尿潴留　；参考：《广州中医药大学》2017年硕士论文

【摘要】：研究背景产后尿潴留是指在阴道分娩后6 h内不能排出尿液或剖宫产术后拔除导尿管后不能自主排尿仍需再次插入导尿管的称为产后尿潴留[1]。目前一般认为是产后6～8 h出现排尿困难,一般表现为尿液排出不畅点滴而下,或完全闭塞不通,伴有小腹胀急疼痛等不适;或产后多日小便不能排尽,彩超或留置导尿测膀胱残留尿膀胱残留尿多于100mL。产后尿潴留是产后常见的一种并发症,发生率约14%。产后尿潴留是继发产后泌尿系统感染,及产后大出血的重要因素;对产妇产后的的身心健康以及产后的康复情况产生诸多困扰。临床目前的处理分为级而来,对于病情稍轻,以热敷及听流水声及局部按摩等辅助治疗,鼓励产妇多做局部肌肉收缩运动,促进排尿;病情不缓解则采用肌肉注射新斯的明;症状进一步加重则采用导尿管导尿。对于一般治疗临床首选肌肉注射新斯的明,但疗效一般;而留置导尿管则增加产妇泌尿系感染机率,同时也没有改变产妇自我排尿的功能,没有解决根本问题;产后尿潴留发生,目前的治疗措施较局限。国内近几年研究及相关文献报道[2]联合传统中医的思路及治疗方法能提高产后尿潴留和产后疾病的治愈率,并且缩短治疗时间,因而可以认为采用中医的辨证思维,并以此为指导,应用中医传统疗法及西医药物能提高疾病康复水平,这为产后康复提供一个人思路。在传统中医理论中提倡未病先防,预防重于治疗的观点,产妇在分娩过程中耗气耗血,分娩后的产妇在气血虚弱情况下,出现产后疾病的概率增加,而如何积极预防这些产后疾病的发生,西医目前能采用的措施较少。产妇为特殊人群,常规中药药物及针刺艾灸等疗法有一定的局限性,因此在传统疗法中寻找一种可简便操作而且有疗效的预防产后疾病的办法具有很好的临床意义。相较传统疗法,耳穴较其他的治疗手段方便易操作,容易被产妇接受,耳穴按压在以往文献报道[3]中,产科的诸多疾病中运用较多,但是对产后尿潴留提及不多,同时一般多用于治疗疾病,对于疾病预防提及很少。而对于产后尿潴留,结合耳穴的特点,在不影响产妇正常分娩情况下,尽早进行耳穴按压能提高预防效果;故而考虑可以在第三产程时采用耳穴按压预防产后尿潴留。传统医学认为尿潴留的发生主要是与膀胱失施、三焦的气化不足有关,同时人体的肺、脾、肾三脏失调有关;而产妇情况较为特殊,如何预防产后尿潴留需更全面及整体考虑;根据已有的文献研究[4]中的耳穴按压治疗产后尿潴留只选取肾、膀胱等与泌尿系相关的耳穴,未体现出中医整体思路,加之产后一般多虚多瘀,故尿潴留的发病还与血脉不通、中气不足大气陷下等有关,故在预防产后疾病中,选穴则应整体考虑。本课题采用中医治未病思路,结合中医整体观,采用传统耳穴按压,探讨产后尿潴留的预防,拟为预防产后其他疾病提供新的思路。研究目的研究遵循临床科研设计和方法,运用临床随机对照试验,本研究通过随机对照实验,于第三产程中应用中医辨证整体观采用耳穴按压,观察第一、二、三产程时间、新生儿体重、会阴是否侧切、产后2 h出血量、产后6 h、24 h排尿是否顺畅、产后6 h及24 hB超残余尿量,探讨第三产程中运用耳穴按压是否能更好减少产后尿潴留的发生率。以此为据,通过第三产程使用耳穴按压预防产后疾病,减少产褥感染及预防产后大出血,提高产妇产后康复水平提供基础。研究方法本研究应用随机对照临床试验,将符合纳入标准的研究对象120例,随机分为对照组(无任何干预治疗组)、治疗组一(耳穴肾+膀胱+三焦按压)、治疗组二(耳穴肾+膀胱+三焦+心+脾+肺按压)各40例,观察第一、二、三产程时间、新生儿体重、会阴是否侧切、产后2h出血量、产后6h、24h排尿是否顺畅、产后6h及24hB超残余尿量。建立数据库,统计分析数据,判定第三产程耳穴按压预防产后尿潴留的疗效,并三组进行对比。研究结果1、三组病例中在第一产程时间、第二产程时间、新生儿体重、会阴是否侧切的比较,统计结果无显著性差异(P0.05);2、三组病例在第三产程时间、产后两小时出血量比较,二组治疗组分别较对照组,第三产程时间、产后两小时出血量统计有显著性差异(P0.05),两组治疗组相互比较,第三产程时间、产后两小时出血量组间统计结果无显著性差异(P0.05);3、三组病例在产后6 h、24 h排尿是否顺畅、B超产后6 h残余尿量及24 h残余尿量比较中,三组在产后6 h、24 h排尿是否顺畅、B超产后6 h残余尿量及24 h残余尿量差异统计有显著性差异(P0.05),两组治疗组两两比较,产后6 h排尿是否顺畅及产后6hB超残余尿量统计有显著性差异(P0.05),产后24hB超残余尿量及产后24h排尿是否顺畅统计结果无显著性差异(P0.05)。结论耳穴按压能促进产后排尿,对产后尿潴留、产后出血有预防作用,并能减少第三产程时间;辨证选用穴位能提高预防效果;但对已发生的产后尿潴留,耳穴按压作用欠佳。
[Abstract]:Research background postpartum urine retention is the 6 h after vaginal delivery can not discharge urine or cesarean section after the extraction of urethral catheter can not be extracted after the urethral catheterization still need to insert urethral catheter again called postpartum urinary retention [1]. is generally considered to be postpartum urination difficulties, generally showing the urine excretion of unobstructed drops, or complete occlusion Discomfort, accompanied by abdominal distention and pain, etc., or multi day postpartum urine can not be exhausted, color Doppler ultrasound or indwelling catheterization for residual urinary bladder residual urine more than 100mL. postpartum urinary retention is a common postpartum complication, the incidence of 14%. postpartum urinary retention is secondary postpartum urinary system infection, and postpartum hemorrhage important factors; to parturients The physical and mental health of the postpartum and the postpartum recovery have a lot of trouble. The treatment of the clinic is divided into grade, which is slightly lighter, with the aid of hot compress and hearing water sound and local massage, encourage the parturient to do the local muscle contraction and promote urination. Step aggravation is the use of urinary catheter catheterization. For general treatment, the first choice of intramuscular injection of neostigmine, but the curative effect is general, but the indwelling catheter increases the probability of maternal urinary infection, at the same time it does not change the function of parturients' self urination, does not solve the fundamental problem; postpartum retention occurs, the current treatment measures are limited. In recent years, the domestic treatment measures are limited. The thought and treatment of traditional Chinese medicine ([2]) combined with traditional Chinese medicine can improve the cure rate of postpartum urine retention and postpartum diseases, and shorten the treatment time. Therefore, it can be considered that the dialectical thinking of traditional Chinese medicine can be used as a guide, and traditional Chinese medicine and Western medicine can be used to improve the recovery level of the disease, which is the postpartum health. In the traditional theory of traditional Chinese medicine, we advocate the prevention of disease first, the prevention of heavy than treatment, maternal consumption of blood in the process of childbirth, the incidence of postpartum diseases after childbirth is increased, and how to prevent these postpartum diseases actively, the measures that western medicine can adopt are less. As a special group, traditional Chinese medicine and acupuncture and moxibustion have some limitations. Therefore, it is of great clinical significance to find a simple and effective way to prevent postpartum diseases in traditional therapy. Compared with traditional therapy, the ear acupoint is easier to operate than other treatment methods, and it is easily accepted by the parturient. Acupoint press in the previous literature report [3], many obstetric diseases are used more, but the postpartum urine retention is not mentioned much, at the same time, it is usually used to treat diseases, and the prevention of disease is seldom mentioned. In order to prevent the effect, it is considered that the auricular acupoint pressure can be used to prevent the retention of postpartum urine in the third course of labor. Traditional medicine believes that the occurrence of urinary retention is mainly related to the inadequacy of bladder application, the insufficiency of the gasification of the triple coke, and the three dirty disorders of the lung, spleen and kidney of the human body; and the maternal situation is more special, and how to prevent postpartum retention needs a more comprehensive and overall examination. According to the existing literature, the study on the treatment of postpartum urine retention in [4] is only the selection of kidney, bladder and other auricular points related to urinary system, which does not reflect the whole idea of traditional Chinese medicine, and the general deficiency and blood stasis after postpartum, so the incidence of urinary retention is also related to the inability of blood vessels and the lack of air depression, so the selection of points should be in the prevention of postpartum diseases. Overall consideration. This subject uses traditional Chinese medicine to cure the disease, combined with the overall view of traditional Chinese medicine, and adopts the traditional auricular acupoint press to discuss the prevention of postpartum urinary retention. The purpose of this study is to provide new ideas for the prevention of other postpartum diseases. In the third course of labor, the application of TCM syndrome differentiation on the basis of auricular acupoint press, observation of first, second, three period of labor, newborn weight, perineum side cut, postpartum 2 h hemorrhage, 6 h after postpartum, 24 h urination, 6 h and 24 hB after postpartum urine residual urine, explore the possibility of using auricular point pressing to reduce postpartum urinary retention in the third production process According to this, the basis of using auricular acupoint pressing to prevent postpartum diseases, reducing puerperium infection and preventing postpartum hemorrhage, and raising the level of postpartum recovery of puerpera were provided by the third process. A randomized controlled clinical trial was used in this study, and 120 cases were randomly divided into the control group (without any intervention treatment group). The treatment group (auricular kidney + bladder + triple coke Press), the treatment group two (auricular kidney + bladder + triple coke + heart + spleen + lung Press) each, observe first, second, three process time, newborn weight, perineum side cut, postpartum 2H bleeding, postpartum 6h, 24h urination is smooth, postpartum 6h and 24hB ultra residual urine volume. Establish a database, statistical analysis data, determination The effect of third process ear acupoint pressing on prevention of postpartum urinary retention was compared. The results were compared between the three groups. The results of the study were 1. In the three cases, there was no significant difference in the first labor time, the second labor time, the weight of the newborn and the lateral perineum (P0.05); 2, the three groups were in third labor time and two hours after postpartum hemorrhage, two Group treatment group compared with the control group, third period of labor time, two hours after postpartum hemorrhage statistics have significant difference (P0.05), two groups of treatment groups, third labor time, two hours after postpartum hemorrhage group statistical results of no significant difference (P0.05); 3, three groups of cases in the postpartum 6 h, 24 h urination is smooth, B-mode postpartum 6 h residual urine volume and 6 h postpartum and the residual urine volume and 24 h residual urine volume, three groups in postpartum 6 h, 24 h urination is smooth, postpartum 6 h residual urine volume and 24 h residual urine volume difference statistically significant difference (P0.05), two groups of treatment group 22 comparison, postpartum 6 h micturition is smooth and postpartum 6hB ultra residual urine statistics have significant difference (P0.05), postpartum 24hB ultra residual urine volume and postpartum 2 The results of 4H urination have no significant difference (P0.05). Conclusion auricular acupoint pressing can promote postpartum urination, have preventive effect on postpartum urine retention, postpartum hemorrhage, and reduce third period of labor; differentiation of points can improve the effect of prevention, but the effect of postpartum retention of postpartum urine is not good.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R714.64

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