内关穴穴位刺激预防子宫全切术后恶心呕吐（PONV）的临床研究

发布时间：2018-08-17 16:02

【摘要】：研究背景和目的术后恶心呕吐(Postoperative nausea and vomiting,PONV)是患者手术后常见的不良反应,不但给病人带来巨大痛苦,也会延长住院时间和患者的康复,还有可能造成不可想象的后果。因此如果能尽快让患者恢复康复,术后恶心呕吐的预防及治疗必不可少。尽管可用药物众多,但至今没有明确某类药物最适合于特定患者或特定手术,大量使用同类药物,不能有效减少PONV发生,联合不同药物又有可能增加副作用。近年来非药物治疗受到关注,中医传统疗法与穴位刺激结合,穴位刺激与内脏关系密切,对机能起到调节作用。中医中内关穴取穴方便易于操作和暴露,本研究旨在通过观察子宫全切患者佩戴压力腕带是否能预防和减轻子宫全切术后恶心呕吐,进而探讨中医内关穴位刺激对防治子宫全切患者PONV的可行性,也为后续相关推广和研究提供一定的参考。对象与方法经郑州大学第二附属医院伦理委员会批准,选取郑州大学第二附属医院2016年3月至7月在我院接诊并收治的子宫肌瘤和/或子宫腺肌病患者82例进行研究,筛选条件为:ASA分级Ⅰ~Ⅱ级,无高血压病史,年龄30~65岁,体重50~80kg,选择将患者按随机数字表法分为研究组A组和对照组C组各41例。对照组C组术后采用镇痛泵镇痛,镇痛泵的配方为舒芬太尼2μg/kg+托烷司琼4mg+地塞米松10mg;研究组A组在对照组的基础上在患者内关穴上贴上压力腕带。记录患者包括年龄、疾病类型、身高、手术时间、体重、出血量等相关内容,分别于术后12h、24h、48h评定患者的恶心、呕吐情况,采用SAS和SDS分别于手术前和手术后48h评价患者抑郁、焦虑及术后治疗不良反应发生情况。本研究数据均采用SPSS 22.0进行统计学处理,计量资料如:年龄、身高、体重、手术时间、出血量书写格式为均值±标准差,并使用t检验,计数资料如:疾病类型、呕吐及不良反应发生率采用百分比表示,用χ2检验,等级数据如ASA分级、恶心、焦虑及抑郁程度采用Ridit值计算,组内不同时间数据比较采用单因素方差检验,组间比较采用独立样本t检验,均以P0.05为差异有统计学意义。结果1.两组患者基本情况差异无统计学意义(P0.05)。2.研究组A组术后12h恶心发生例数及恶心程度分级低于对照组C组,差异有统计学意义(P0.05);术后24h恶心发生例数及程度分级低于对照组C组,差异有统计学意义(P0.01);术后48h恶心发生例数及程度分级低于对照组C组,差异有统计学意义(P0.05)。3.研究组A组在12h、24h、48h呕吐人数总发生率低于对照组C组,差异有统计学意义(P0.05)。4.两组术前抑郁程度和焦虑程度差异无统计学意义(P0.05);A组术后48h抑郁程度和焦虑程度均低于C组,差异有统计学意义(P0.05)。5.术后不良反应发生率研究组A组低于对照组C组,差异有统计学意义(P0.05)。结论内关穴穴位刺激可安全用于子宫切除患者,能够降低子宫全切术后PONV的发生率及其程度,缓解患者不良情绪,减少术后不良反应,效果安全有效,具有临床推广价值。
[Abstract]:BACKGROUND AND OBJECTIVE Postoperative nausea and vomiting (PONV) is a common adverse reaction after surgery. PONV not only brings great pain to patients, but also prolongs hospitalization time and recovery of patients, and may have unimaginable consequences. Therefore, if patients can recover as soon as possible, postoperative nausea and vomiting will occur. Although there are many available drugs, it is not clear that a certain kind of drug is most suitable for a particular patient or surgery. The large number of similar drugs can not effectively reduce the incidence of PONV, and the combination of different drugs may increase side effects. Neiguan acupoint selection is convenient and easy to operate and expose. The purpose of this study is to observe whether wearing pressure wristband can prevent and alleviate nausea and vomiting after hysterectomy, and further explore the effect of Neiguan acupoint stimulation on prevention and treatment of total hysterectomy. Objectives and Methods With the approval of the Ethics Committee of the Second Affiliated Hospital of Zhengzhou University, 82 patients with uterine leiomyoma and/or adenomyosis who were admitted to our hospital from March to July 2016 were selected to study. ASA grade I-II, no history of hypertension, age 30-65 years old, weight 50-80 kg, selected patients according to random number table method for study group A and control group C 41 cases each. Control group C postoperative analgesia pump, analgesia pump formula for sufentanil 2 ug/kg + tropisetron 4 mg + dexamethasone 10 mg; The patients were recorded including age, disease type, height, operation time, weight, bleeding volume and other related contents. Nausea and vomiting were assessed at 12, 24 and 48 hours after operation. Depression, anxiety and adverse reactions were evaluated by SAS and SDS before operation and 48 hours after operation respectively. Data in this study were statistically analyzed by SPSS 22.0. Measurements such as age, height, weight, operation time, bleeding volume were written in a mean (+ standard deviation) format, and t test was used. Data such as disease type, vomiting and adverse reaction rate were expressed by percentage, and_2 test, grade data such as ASA classification, nausea were used. Results 1. There was no significant difference in the basic condition between the two groups (P 0.05). 2. The number of nausea cases and the degree of nausea 12 hours after operation in group A. Grading was lower than the control group C, the difference was statistically significant (P 0.05); postoperative 24 hours of nausea and degree of classification lower than the control group C, the difference was statistically significant (P 0.01); postoperative 48 hours of nausea and degree of classification lower than the control group C, the difference was statistically significant (P 0.05). 3. Study group A in 12 hours, 24 hours, 48 hours of total incidence of vomiting. There was no significant difference in preoperative depression and anxiety between the two groups (P Conclusion Neiguan acupoint stimulation can be safely used in patients with hysterectomy, can reduce the incidence and degree of PONV after total hysterectomy, alleviate patients'bad mood, reduce postoperative adverse reactions, the effect is safe and effective, with clinical popularization value.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R614

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