穴位贴敷预防妇科腹腔镜手术后恶心呕吐的临床研究
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摘要
目的：
观察中医方法吴茱萸加姜汁贴敷双侧内关、足三里穴防治气管全麻下妇科腹腔镜手术后恶心呕吐的临床效果,分析妇科腹腔镜手术后恶心呕吐的相关因素,探讨妇科腹腔镜手术后恶心呕吐的最佳预防策略。
方法：
本研究收集广东省中医院2010年6月-2012年3月气管全麻下妇科腹腔镜手术患者130例,将符合纳入标准的择期手术女性患者,按照随机的原则平均分配到治疗组和对照组,其中治疗组66例,对照组64例。治疗组以吴茱萸粉加姜汁贴敷双侧内关、足三里穴；对照组以红米粉、黑米粉、玉米粉按1：1：1比例贴敷双侧内关、足三里穴。两组均在术后回病房即予药膏敷贴4小时,并于次日早上8点再次敷药,每天-次,连用3天。观察比较治疗组与对照组患者术后0-6h、6-24h、24-48h、48-72h四个时间段恶心呕吐的发生情况及程度(WHO标准、恶心程度视觉模拟评分)、各组发生恶心呕吐的病人数、接受补救药物的病人数,以及记录不良反应。对与妇科腹腔镜术后恶心呕吐的影响因素进行统计学评价。
结果：
通过SPSS13.0统计分析表明：
1.治疗组在术后0-6h、6-24h两个观测时段的恶心呕吐发生率明显低于对照组,差异有统计学意义(P<0.05)；同时两组在术后0-6h、6-24h时间段的WHO标评价准以及NVAS评分比较,治疗组恶心呕吐程度低于对照组,两组差异有明显统计学意义(P<0.05),提示吴茱萸加姜汁穴位贴敷内关、足三里穴可减轻妇科腹腔镜手术后病人的恶心呕吐程度以及减少恶心呕吐发生率,作用时间主要在术后24h内,而在24-72h作用不明显。
2.治疗组与对照组接受补救药物的病人数比较差异无显著性意义,提示治疗组对已经发生的重度呕吐无明显减轻症状作用。
3.影响因素方面,术中出血量多的病人术后恶心呕吐发生率高于出血量少的病人,差异有统计学意义(P<0.05),年龄、术中输液量、体重指数、手术时间以及手术类型与术后恶心呕吐均无明显相关性,差异无统计学意义(P>0.05)。
结论：
吴茱萸加姜汁贴敷双侧内关、足三里穴可有效地降低妇科腹腔镜手术后恶心呕吐发生率、恶心呕吐程度,以术后24h内最为明显,有利于患者术后康复,提高住院质量,具有实际临床应用意义,值得推广。术中出血量可能是影响腹腔镜手术后恶心呕吐的因素。
Object ives
To observe the effect of acupoint sticking therapy preventing and controlling of postoperative nausea and vomiting (PONV) after gynecologic laparoscopy, and to investigate the relevant factors, search for the prevention strategy of postoperative nausea and vomiting.
Methods
The research had collected130patients who had underwent gynecologic laparoscopy in Guangdong hospital of traditional Chinese medicine during June2011to March2012.The female patients who were schedule for elective gynecologic laparoscopy, acording to the principle of random allocation to groups average:the treatment group was66cases and the control group was64cases. The patient in the treatment group were treated with WuZhuYu add ginger juice which posted in Nei Guang (both), Zu San Li (both). The control group were treated with red rice flour, black rice flour, corn flour which ratiod to1:1:1. Both groups were received acupoint sticking of four hours after surgery, and again after the next three days at eight o'clock. Observed the occurrence of PONV (standard of WHO, nausea visual analog seale), requirement of rescue method and adverse reactions were recorded at postoperative0-6h,6-24h,24-48h,and48-72h, respectively. To detect the relevant factors of the syndrome of postoperative nausea and vomiting after the operation.
Results
Though SPSS13.0analyzing:
1. The treatment group incidence of PONV were significantly lower than the control group time between postoperation0-6h and6-24h(P<0.05). The two groups time between postoperation0-6h and6-24h of standard of WHO and NVAS score compared with clear statistical significance, P<0.05, promt ing the acupoint sticking therapy relieve postoperative nausea and vomiting after gynecologic laparoscopy and reduce rate of PONV, especially in postoperative24h.
2. Requirement of rescue method between the two groups had no significant difference, promting the treatment group could not relieve severe vomiting.
3. Analysis showed rate of PONV with more bleeding volume was lower than those with less bleeding volume and the difference had statistical sense, P<0.05. The age of patients, transfusion, body mass index, duration of the operation, type of surgery have no significant association with PONV,P<0.05.
Conclusion
WuZhuYu add ginger juice which posted in Nei Guang and Zu San Li reduce the incidence and degree of PONV, especially in postoperative24h.The treatmemt facilitated their postoperative recovery and raised their living quality.It should be of clinical significance and be appropriate for general application.
观察中医方法吴茱萸加姜汁贴敷双侧内关、足三里穴防治气管全麻下妇科腹腔镜手术后恶心呕吐的临床效果,分析妇科腹腔镜手术后恶心呕吐的相关因素,探讨妇科腹腔镜手术后恶心呕吐的最佳预防策略。
方法：
本研究收集广东省中医院2010年6月-2012年3月气管全麻下妇科腹腔镜手术患者130例,将符合纳入标准的择期手术女性患者,按照随机的原则平均分配到治疗组和对照组,其中治疗组66例,对照组64例。治疗组以吴茱萸粉加姜汁贴敷双侧内关、足三里穴；对照组以红米粉、黑米粉、玉米粉按1：1：1比例贴敷双侧内关、足三里穴。两组均在术后回病房即予药膏敷贴4小时,并于次日早上8点再次敷药,每天-次,连用3天。观察比较治疗组与对照组患者术后0-6h、6-24h、24-48h、48-72h四个时间段恶心呕吐的发生情况及程度(WHO标准、恶心程度视觉模拟评分)、各组发生恶心呕吐的病人数、接受补救药物的病人数,以及记录不良反应。对与妇科腹腔镜术后恶心呕吐的影响因素进行统计学评价。
结果：
通过SPSS13.0统计分析表明：
1.治疗组在术后0-6h、6-24h两个观测时段的恶心呕吐发生率明显低于对照组,差异有统计学意义(P<0.05)；同时两组在术后0-6h、6-24h时间段的WHO标评价准以及NVAS评分比较,治疗组恶心呕吐程度低于对照组,两组差异有明显统计学意义(P<0.05),提示吴茱萸加姜汁穴位贴敷内关、足三里穴可减轻妇科腹腔镜手术后病人的恶心呕吐程度以及减少恶心呕吐发生率,作用时间主要在术后24h内,而在24-72h作用不明显。
2.治疗组与对照组接受补救药物的病人数比较差异无显著性意义,提示治疗组对已经发生的重度呕吐无明显减轻症状作用。
3.影响因素方面,术中出血量多的病人术后恶心呕吐发生率高于出血量少的病人,差异有统计学意义(P<0.05),年龄、术中输液量、体重指数、手术时间以及手术类型与术后恶心呕吐均无明显相关性,差异无统计学意义(P>0.05)。
结论：
吴茱萸加姜汁贴敷双侧内关、足三里穴可有效地降低妇科腹腔镜手术后恶心呕吐发生率、恶心呕吐程度,以术后24h内最为明显,有利于患者术后康复,提高住院质量,具有实际临床应用意义,值得推广。术中出血量可能是影响腹腔镜手术后恶心呕吐的因素。
Object ives
To observe the effect of acupoint sticking therapy preventing and controlling of postoperative nausea and vomiting (PONV) after gynecologic laparoscopy, and to investigate the relevant factors, search for the prevention strategy of postoperative nausea and vomiting.
Methods
The research had collected130patients who had underwent gynecologic laparoscopy in Guangdong hospital of traditional Chinese medicine during June2011to March2012.The female patients who were schedule for elective gynecologic laparoscopy, acording to the principle of random allocation to groups average:the treatment group was66cases and the control group was64cases. The patient in the treatment group were treated with WuZhuYu add ginger juice which posted in Nei Guang (both), Zu San Li (both). The control group were treated with red rice flour, black rice flour, corn flour which ratiod to1:1:1. Both groups were received acupoint sticking of four hours after surgery, and again after the next three days at eight o'clock. Observed the occurrence of PONV (standard of WHO, nausea visual analog seale), requirement of rescue method and adverse reactions were recorded at postoperative0-6h,6-24h,24-48h,and48-72h, respectively. To detect the relevant factors of the syndrome of postoperative nausea and vomiting after the operation.
Results
Though SPSS13.0analyzing:
1. The treatment group incidence of PONV were significantly lower than the control group time between postoperation0-6h and6-24h(P<0.05). The two groups time between postoperation0-6h and6-24h of standard of WHO and NVAS score compared with clear statistical significance, P<0.05, promt ing the acupoint sticking therapy relieve postoperative nausea and vomiting after gynecologic laparoscopy and reduce rate of PONV, especially in postoperative24h.
2. Requirement of rescue method between the two groups had no significant difference, promting the treatment group could not relieve severe vomiting.
3. Analysis showed rate of PONV with more bleeding volume was lower than those with less bleeding volume and the difference had statistical sense, P<0.05. The age of patients, transfusion, body mass index, duration of the operation, type of surgery have no significant association with PONV,P<0.05.
Conclusion
WuZhuYu add ginger juice which posted in Nei Guang and Zu San Li reduce the incidence and degree of PONV, especially in postoperative24h.The treatmemt facilitated their postoperative recovery and raised their living quality.It should be of clinical significance and be appropriate for general application.
引文
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