耳穴贴压联合电针对疝气患儿术后疼痛及炎性细胞因子的影响
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摘要
目的:探讨耳穴贴压联合电针治疗疝气患儿术后疼痛的临床疗效及作用机制。方法:选择腹股沟疝术后患儿93例,随机分为耳穴组、电针组和耳穴联合电针组,每组31例。3组术后均予常规治疗和护理,并且必要时使用镇痛镇静药物。3组患儿苏醒后,耳穴组予耳穴贴压,取神门、交感、皮质下,将王不留行籽贴压在其穴区,同一护士双手的示指、拇指于同侧耳前后进行按压,2 min/次,每30分钟重复1次,每天按压时间段为8:00-11:00及14:00-17:00,连续治疗3d;电针组予电针干预,取三阴交、足三里,毫针直刺,平补平泻,进针后接电针治疗仪,电流强度以患儿能耐受为度,留针20min,每日3次,连续治疗3d;耳穴联合电针组采用耳穴组治疗联合电针组治疗的方法,连续治疗3 d。采用Wong-Baker面部表情评估法观察各组不同年龄段患儿术后1～3 h、4～24 h、25～48 h、49～72 h时间段疼痛评分;比较各组患儿术后第1、2、3天肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)及白细胞介素-8(IL-8)含量;比较各组患儿使用镇痛镇静药物例数及平均住院日。结果:①耳穴联合电针组8～15岁患儿术后4～24 h及25～48 h疼痛评分低于耳穴组和电针组(均P<0.05);各组4～7岁患儿术后各时段疼痛评分比较差异均无统计学意义(均P>0.05)。②耳穴联合电针组术后第1、2、3天血清TNF-α、IL-6及IL-8含量均低于耳穴组和电针组(均P<0.05)。③耳穴联合电针组术后使用镇痛镇静药物例数少于耳穴组和电针组(均P<0.05);④耳穴联合电针组术后平均住院日短于耳穴组和电针组(均P<0.05)。结论:耳穴贴压联合电针较单纯耳穴贴压或电针不仅可有效缓解疝气患儿术后疼痛,而且能有效减少TNF-α、IL-6及IL-8炎性细胞因子表达,提高临床疗效。
Objective To explore the clinical efficacy and action mechanism of auricular point pressing combined with electroacupuncture(EA) on postoperative pain in children with hernia. Methods A total of 93 children with inguinal hernia were randomly divided into an auricular point group, an EA group and a combination group, 31 cases in each group. All the three groups were treated with routine postoperative treatment and nursing, and analgesic and sedative drugs were used when necessary. After awaking, the children in the auricular point group were treated with auricular point pressing at Shenmen(TF4), Jiaogan(AH6 a) and Pizhixia(AT4); the seeds of cowherb were placed at the auricular points and the same nurse used index finger and thumbs to press the points for 2 min, and repeated after 30 min. The pressing time was 8-11 AM and 14-17 PM for 3 days. The children in the EA group were treated with EA at Sanyinjiao(SP 6) and Zusanli(ST 36); the needles were perpendicularly inserted with mild reinforcing-reducing method; EA instrument was connected with needles and the current intensity was under the maximal tolerance of children; the needles were retained for 20 min, three times a day for continuous 3 days. The children in the combination group were treated with auricular point pressing and EA for 3 days. The Wong-Baker facial expression evaluation method was used to observe the pain scores 1-3 h, 4-24 h, 25-48 h and 49-72 h after operation; the contents of TNF-α, IL-6 and IL-8 were compared 1 day,2 days and 3 days after operation; the number of cases using sedative drugs and average hospitalization days were compared among the three groups. Results ①Among the children aged 8-15 years old, the pain scores 4-24 h and 25-48 h after operation in the combination group were lower than those in the auricular point group and the EA group(all P<0.05); among the children aged 4-7 years old, differences of the pain scores in each time after operation were not significant statistically among the three groups(all P>0.05). ②The contents of TNF-α, IL-6 and IL-8 in serum 1 day,2 days and 3 days after operation in the combination group were lower than those in the auricular point group and the EA group(all P<0.05). ③The number of cases using analgesic and sedative drugs after operation in the combination group was fewer than that in the auricular point group and the EA group(all P<0.05). ④The average hospitalization days in the combination group were shorter than those in the auricular point group and the EA group(all P<0.05).Conclusion Compared with auricular point pressing or EA alone, the combination of auricular point pressing and EA could not only effectively relieve the postoperative pain, but also reduce the expression of inflammatory cytokines in children with hernia, improving the clinical efficacy.
Objective To explore the clinical efficacy and action mechanism of auricular point pressing combined with electroacupuncture(EA) on postoperative pain in children with hernia. Methods A total of 93 children with inguinal hernia were randomly divided into an auricular point group, an EA group and a combination group, 31 cases in each group. All the three groups were treated with routine postoperative treatment and nursing, and analgesic and sedative drugs were used when necessary. After awaking, the children in the auricular point group were treated with auricular point pressing at Shenmen(TF4), Jiaogan(AH6 a) and Pizhixia(AT4); the seeds of cowherb were placed at the auricular points and the same nurse used index finger and thumbs to press the points for 2 min, and repeated after 30 min. The pressing time was 8-11 AM and 14-17 PM for 3 days. The children in the EA group were treated with EA at Sanyinjiao(SP 6) and Zusanli(ST 36); the needles were perpendicularly inserted with mild reinforcing-reducing method; EA instrument was connected with needles and the current intensity was under the maximal tolerance of children; the needles were retained for 20 min, three times a day for continuous 3 days. The children in the combination group were treated with auricular point pressing and EA for 3 days. The Wong-Baker facial expression evaluation method was used to observe the pain scores 1-3 h, 4-24 h, 25-48 h and 49-72 h after operation; the contents of TNF-α, IL-6 and IL-8 were compared 1 day,2 days and 3 days after operation; the number of cases using sedative drugs and average hospitalization days were compared among the three groups. Results ①Among the children aged 8-15 years old, the pain scores 4-24 h and 25-48 h after operation in the combination group were lower than those in the auricular point group and the EA group(all P<0.05); among the children aged 4-7 years old, differences of the pain scores in each time after operation were not significant statistically among the three groups(all P>0.05). ②The contents of TNF-α, IL-6 and IL-8 in serum 1 day,2 days and 3 days after operation in the combination group were lower than those in the auricular point group and the EA group(all P<0.05). ③The number of cases using analgesic and sedative drugs after operation in the combination group was fewer than that in the auricular point group and the EA group(all P<0.05). ④The average hospitalization days in the combination group were shorter than those in the auricular point group and the EA group(all P<0.05).Conclusion Compared with auricular point pressing or EA alone, the combination of auricular point pressing and EA could not only effectively relieve the postoperative pain, but also reduce the expression of inflammatory cytokines in children with hernia, improving the clinical efficacy.
引文
[1]陈晓琳.438例小儿疝气手术前后的观察和护理体会[J].航空航天医学杂志,2011,22(9):1128-1129.
[2]陆艳春.腹腔镜下行疝气高位结扎手术的配合及护理[J].山东医药,2009,49(21):117.
[3]单同合.小儿小切口疝气500例临床分析[J].中国现代药物应用,2011,5(7):58-59.
[4]王颖,钟剑,汪泉,等.横切口手术治疗小儿疝气的临床效果分析[J].现代诊断与治疗,2013,24(17):4048.
[5]王晓琴,张颖,张碧芳.小儿术后疼痛的临床护理[J].中国医药指南,2013,11(22):338-339.
[6]魏庆.抚触及穴位按摩对小儿疝气术后疼痛的影响[J].护理研究,2011,25(9):2399-2400.
[7]谢娴,叶增杰,庞秀霏,等.耳穴压豆联合电针在腹部术后疼痛护理中的应用研究[J].护理研究,2015,29(6):1938-1940.
[8]邓宝贵,全小明,谭彩霞,等.电针刺配合耳穴压豆治疗人工全髋置换患者术后疼痛效果观察[J].护理学报,2013,20(6B):58-60.
[9]中华医学会外科学分会.成人腹股沟疝诊疗指南(2014年版)[J].中国实用外科杂志,2014,34(6):484-486.
[10]中华中医药学会.中医体质分类与判定(ZYYXH/T157-2009)[J].世界中西医结合杂志,2009,4(4):303-304.
[11]刘彩霞,刘晓虹.Wong-Baker面部表情量表在剖宫产术后疼痛管理中的应用[J].大家健康,2014,8(6):222.
[12]中华医学会重症医学分会.中国重症加强治疗病房患者镇痛和镇静治疗指导意见(2006)[J].中华外科杂志,2006,44(17):1158-1166.
[13]郑闽江,程芳,颜凤凤,等.腹横肌平面阻滞联合酮咯酸氨丁三醇多模式镇痛用于小儿疝气术后镇痛效果观察[J].医学理论与实践,2017,30(12):1789-1791.
[14]Scherrer PD.Safe and sound:pediatric procedural sedation and analgesia[J].Minn Med,2011,94(3):43.
[15]张旭珉.小儿腹股沟疝复发的原因分析[J].临床医学实践,2014,23(3):193-194.
[16]危早梅,贾杰,赵根容,等.耳穴贴压法用于潜伏期分娩镇痛的临床研究[J].护理与康复,2016,15(8):732-734.
[17]黄耀佳.电针镇痛[C]//针灸治疗痛症国际学术研讨会论文汇编.广州:广东省科学技术协会科技交流部,2009:337-343.
[18]关新民.外周乙酰胆碱对电针镇痛作用的影响[J].针刺研究,1990,15(2):136-139.
[19]吴杞.图解耳穴疗法[M].北京:人民军医出版社,2007.
[20]张杰,师永学.籽穴位按压促进分娩的临床观察[J].中国误诊学杂志,2011,11(19):4573.
[21]李秋月,许海玉,杨洪军.促炎因子TNF-α,IL-1β,IL-6在神经病理性疼痛中的研究进展[J].中国中药杂志,2017,42(19):3709-3711.
[22]陈国宝,苏亦斌,陈德波,等.结肠癌术后肠梗阻患者白介素-6、-10及肿瘤坏死因子-α水平的变化[J].中国老年学杂志,2015,35(6):1536-1537.
[23]代坤吾.地佐辛对乳腺癌患者术后疼痛及炎性因子的影响[J].中国药房,2016,27(5):688-690.
[24]王宝君,刘艳嫦.耳穴压豆对妇科腹腔镜术后肩痛及细胞因子的影响[J].护士进修杂志,2016,31(4):302-303.
[25]Liu F,Fang J,Shao X,et al.Electroacupuncture exerts ananti-inflammatory effect in a rat tissue chamber model of inflammation via suppression of NF-kappaB activation[J].Acupunct Med,2014,32(4):340.
[26]胡森,张立俭,白慧颖,等.电针足三里对脓毒症大鼠小肠促炎症因子、二胺氧化酶活性及组织含水率的影响[J].世界华人消化杂志,2009,17(20):2079-2082.
[27]许剑雄,沐榕.针刺对急性脑梗死炎症因子表达影响的研究进展[J].中医药通报,2017,16(2):46-48.
[2]陆艳春.腹腔镜下行疝气高位结扎手术的配合及护理[J].山东医药,2009,49(21):117.
[3]单同合.小儿小切口疝气500例临床分析[J].中国现代药物应用,2011,5(7):58-59.
[4]王颖,钟剑,汪泉,等.横切口手术治疗小儿疝气的临床效果分析[J].现代诊断与治疗,2013,24(17):4048.
[5]王晓琴,张颖,张碧芳.小儿术后疼痛的临床护理[J].中国医药指南,2013,11(22):338-339.
[6]魏庆.抚触及穴位按摩对小儿疝气术后疼痛的影响[J].护理研究,2011,25(9):2399-2400.
[7]谢娴,叶增杰,庞秀霏,等.耳穴压豆联合电针在腹部术后疼痛护理中的应用研究[J].护理研究,2015,29(6):1938-1940.
[8]邓宝贵,全小明,谭彩霞,等.电针刺配合耳穴压豆治疗人工全髋置换患者术后疼痛效果观察[J].护理学报,2013,20(6B):58-60.
[9]中华医学会外科学分会.成人腹股沟疝诊疗指南(2014年版)[J].中国实用外科杂志,2014,34(6):484-486.
[10]中华中医药学会.中医体质分类与判定(ZYYXH/T157-2009)[J].世界中西医结合杂志,2009,4(4):303-304.
[11]刘彩霞,刘晓虹.Wong-Baker面部表情量表在剖宫产术后疼痛管理中的应用[J].大家健康,2014,8(6):222.
[12]中华医学会重症医学分会.中国重症加强治疗病房患者镇痛和镇静治疗指导意见(2006)[J].中华外科杂志,2006,44(17):1158-1166.
[13]郑闽江,程芳,颜凤凤,等.腹横肌平面阻滞联合酮咯酸氨丁三醇多模式镇痛用于小儿疝气术后镇痛效果观察[J].医学理论与实践,2017,30(12):1789-1791.
[14]Scherrer PD.Safe and sound:pediatric procedural sedation and analgesia[J].Minn Med,2011,94(3):43.
[15]张旭珉.小儿腹股沟疝复发的原因分析[J].临床医学实践,2014,23(3):193-194.
[16]危早梅,贾杰,赵根容,等.耳穴贴压法用于潜伏期分娩镇痛的临床研究[J].护理与康复,2016,15(8):732-734.
[17]黄耀佳.电针镇痛[C]//针灸治疗痛症国际学术研讨会论文汇编.广州:广东省科学技术协会科技交流部,2009:337-343.
[18]关新民.外周乙酰胆碱对电针镇痛作用的影响[J].针刺研究,1990,15(2):136-139.
[19]吴杞.图解耳穴疗法[M].北京:人民军医出版社,2007.
[20]张杰,师永学.籽穴位按压促进分娩的临床观察[J].中国误诊学杂志,2011,11(19):4573.
[21]李秋月,许海玉,杨洪军.促炎因子TNF-α,IL-1β,IL-6在神经病理性疼痛中的研究进展[J].中国中药杂志,2017,42(19):3709-3711.
[22]陈国宝,苏亦斌,陈德波,等.结肠癌术后肠梗阻患者白介素-6、-10及肿瘤坏死因子-α水平的变化[J].中国老年学杂志,2015,35(6):1536-1537.
[23]代坤吾.地佐辛对乳腺癌患者术后疼痛及炎性因子的影响[J].中国药房,2016,27(5):688-690.
[24]王宝君,刘艳嫦.耳穴压豆对妇科腹腔镜术后肩痛及细胞因子的影响[J].护士进修杂志,2016,31(4):302-303.
[25]Liu F,Fang J,Shao X,et al.Electroacupuncture exerts ananti-inflammatory effect in a rat tissue chamber model of inflammation via suppression of NF-kappaB activation[J].Acupunct Med,2014,32(4):340.
[26]胡森,张立俭,白慧颖,等.电针足三里对脓毒症大鼠小肠促炎症因子、二胺氧化酶活性及组织含水率的影响[J].世界华人消化杂志,2009,17(20):2079-2082.
[27]许剑雄,沐榕.针刺对急性脑梗死炎症因子表达影响的研究进展[J].中医药通报,2017,16(2):46-48.
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