耳穴贴压在围手术期辅助镇痛和机体调整作用的研究
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摘要
目的：1、观察耳穴贴压用于围手术期辅助镇痛的效果。2、观察耳穴贴压在围手术期对机体的调整作用。3、探讨耳穴贴压相关的作用机制。4、基于研究结论,总结出一套简便、行之有效的耳穴贴压用于围手术期的方法。
方法：1、分组方法：将符合纳入标准的病人92例,采用完全随机设计法分为三组：①耳穴贴压组(耳穴组),31例；②安慰对照组(对照组),31例；③空白对照组(空白组),30例。
2、实验步骤：(1)各组操作方法：全部病例均需进行耳廓视诊,并记录阳性反应的类型、部位。①耳穴组：术前一日利用耳穴探测器,选取双侧神门、皮质下、内分泌、耳中、肺、脾和子宫、盆腔等耳穴,常规消毒后敷压磁贴。以拇指、食指对压耳穴,以局部发红、发热,病人可耐受为限。术中操作者每隔30分钟按压1次,每次以60-90次／分的频率按压耳穴,每穴30秒,用力均匀。叮嘱患者或其家属手术前后自行按压耳穴,按压3-5次后,则不痛不压,痛时再压,3天后去除耳穴贴。②对照组：在所选耳穴区敷贴同样外观、数量的无磁珠胶布,不予任何刺激。③空白组：不予任何干预措施。(2)所有患者麻醉前30分钟肌肉注射阿托品0.5毫克和苯巴比妥钠100毫克,术中静脉输注5%乳酸钠林格注射液或羟乙基淀粉130／0.4氯化钠注射液(万汶),输液速度统一为8ml·kg-1·h-1,并根据失血量按晶体：胶体为2：1补充液体。(3)所有患者进入手术室后,连接多功能监测仪(Marquette EA-GLE 3000)常规监测,开放外周静脉。右侧卧位下行两点法腰-硬联合麻醉穿刺,麻醉平面控制在T6以下。以术中保持病人安静、无痛和手术能顺利进行为前提。记录术中麻醉药的用量。(4)术中保持患者意识清醒,并常规鼻导管吸氧,必要时面罩辅助给氧。(5)术毕时利用耳穴探测器,在耳穴组患者的耳穴区内探查大、小肠及胃、脑点并加敷磁贴。
3、观察指标：(1)分别于手术前一天、术后第三天时采用SAS自评量表记录患者神志情绪评分,以评价耳穴贴压对机体神志情绪状况的调整作用。(2)记录麻醉前、麻醉诱导时、手术开始切皮时、分离肿物时、术毕时、术后第一天各个时期的心率(HR)、血压(BP)、脉搏氧饱和度(SPO2)、呼吸频率(RR)、Ramesay评分,以评价耳穴贴压对机体功能的调整作用。(3)观察并记录各种不良反应,以及术后并发症的发生情况,以评价耳穴贴压对机体的调整作用。(4)记录患者术后排气及排便时间,以评价耳穴贴压对机体胃肠功能恢复的调整作用。(5)分别于贴压耳穴前、术后第三天抽取外周静脉血,检测外周血白细胞构成比、生化等相关指标,以探明耳穴贴压对于氧化应激反应的相关作用机制。(6)分别于术前准备期、术毕时抽取外周静脉血,应用酶联免疫法检测外周静脉血β-内啡肽和C-反应蛋白等相关指标,以探明耳穴贴压镇痛抗炎的相关作用机制。
结果：1、三组病人按照年龄、体质指数、ASA分级、疾病构成、孕产史构成、手术方式构成、中医证型等方面进行对比,其组间比较差异均无统计学意义(p>0.05),具有可比性。2、三组病例耳穴阳性反应的比较：三组的阳性率依次为93.5%、96.8%、93.3%,总阳性率达到94.6%,其中子宫和盆腔穴处血管充盈的阳性反应类型占较大的比例。说明耳穴阳性反应具有一定的辅助诊断意义。3、三组病例术前SAS评分的组间比较差异无显著性统计学意义(p>0.05),但术后耳穴组的SAS评分分别与对照组、空白组的分数相比较,差异存在统计学意义(p<0.05)；而对照组与空白组的SAS评分相比较,差异无显著性统计学意义(p>0.05)。4、三组病例各时间点的心率、脉搏氧饱和度、呼吸频率、Ramesay评分自身及组间比较差异无统计学意义(p>0.05),说明各组的心率、脉搏氧饱和度、呼吸频率、Ramesay评分在各时间点虽有变化,但无显著的影响。而在术始切皮时、分离肿物时、术毕时各时间点的三组血压的组内比较,以及耳穴组与对照组、空白组的组间比较,差异存在统计学意义(p<0.05),说明耳穴刺激对患者术中的血压有良好的稳定、调整作用。5、术前各组症状程度差异无显著性统计学意义(p>0.05),对照组、空白组在手术前后比较在腹胀痛、神疲乏力、纳呆、恶心呕吐、失眠、皮肤瘙痒等症状方面差异均存在统计学意义(p<0.05)；手术后耳穴组在腹胀痛、神疲乏力、纳呆、恶心呕吐、失眠方面,分别与对照组、空白组比较,差异均存在统计学意义(p<0.05)。说明耳穴刺激可降低患者使用麻醉药物后的不良反应发生率。6、耳穴组的排气、排便时间分别与对照组、空白组相比较,差异均存在统计学意义(p<0.05)：而对照组与空白组相比较,差异无显著性统计学意义(p>0.05)。7、三组病例的手术时间组间比较差异无显著性统计学意义(p>0.05)。但耳穴组的硬膜外用药量、加用芬氟合剂的例数分别与对照组、空白组相比较,差异均存在统计学意义(p<0.05)；而对照组与空白组相比较,差异无显著性统计学意义(p>0.05)。8、三组病例术前血分析组间比较差异无显著性统计学意义(p>0.05),但术后耳穴组的单核粒细胞总数分别与对照组、空白组相比较,差异存在统计学意义(p<0.05)；而对照组与空白组的单核粒细胞总数相比较,差异无显著性统计学意义(p>0.05)。9、三组病例术前血清β-内啡肽的组间比较差异存在统计学意义(p<0.05)。三组病例术后血清β-内啡肽的组间比较、C-反应蛋白的组间及手术前后比较差异无显著性统计学意义(p>0.05)。说明耳穴刺激可使血清β-内啡肽水平升高而起到镇痛的作用。
结论：本研究表明,耳穴磁疗在妇科开腹手术的围手术期中对机体功能的调整作用是肯定的。手术前期通过耳穴刺激可以缓解患者的紧张、恐惧等负面情绪,调整体内失调、紊乱的代谢过程或功能状态,使机体朝着正常生理状态方向发展转化,并降低术后腹胀痛、神疲乏力、纳呆、恶心呕吐、失眠等麻醉药物不良反应的发生率。手术中期可以即时调整、稳定患者的血压,不同程度地减轻病人手术中因内脏牵拉引起的胃部不适、恶心等症状,利于手术的顺利进行。手术后期患者的排气、排便时间明显缩短,说明耳穴贴压可改善术后胃肠功能恢复的情况。但其具体作用机理有待进一步探讨。
在麻醉方面,手术中期耳穴组的硬膜外用药量比对照组、空白组的药量少15%-20%,需加用芬氟合剂的例数也较对照组、空白组少,仅占16.1%。目前针药复合麻醉主要还在于辅助镇痛,减少麻醉药用量,减少术后不良反应、并发症的发生。此外,本研究还观察到耳穴刺激可使血清β-内啡肽水平在术前升高；抑制单核粒细胞总数的增加,从而稳定了机体的免疫系统功能。
Objectives:1. Observe the effect of combined auricular points magnet therapy for auxiliary analgesia in gynecological peri-operation.2. Observe the effect of combined auricular points magnet therapy for the adjustment of body function in gynecological peri-operation.3. Explore the mechanism of auricular points magnet therapy.4. Based on the above, summed up a set of simple, effective auricular point therapy method for the gynecological peri-operation.
Method:1. Group Methods:The patients who met the inclusion criteria,92 cases of completely random design with three groups:①auricular point pressing group (ear group),31;②comfort control group (comfort group),31;③control group (control group),30.
2. Experimental Steps:(1) Auricular point sticking:all patients are required to ear visual examination, and the operator record the positive type, location.①Ear group:the day before the operation the operator uses the auricular-point detector and selectes bilateral Shenmen, subcortex, endocrine, diaphragm, lung, spleen and uterus, pelvic cavity, disinfecting the skin and sticking magnets on the points. The thumb and index finger on the ear pressure, to local redness, heat, patients can tolerate is limited. During the surgery the operator press once every 30 minutes, each time with 60-90 times/min in the frequency of pressing ear,30 seconds per point, pressure well-distributed. Told patients or their families to press their own ears before and after surgery, after pressing 3-5 times, no pain no pressure, when the patient feels pain again, she could press the auricular-point. After three days they could remove the magnets on the points themselves.②Control group:in the same ear area selected sticking the same appearance, number of plaster, no magnetic beads, no stimulation.③Control group:no any intervention. (2)30 minutes before anesthesia all patients are intramuscular injected atropine 0.5 mg and Luminal 100 mg. During the surgery the intravenous infusion rate required consistent with 8ml·kg-1·h-1. According to blood loss the intravenous infusion alternate Ringer's injection and 5% hydroxyethyl starch 130/0.4 and sodium chloride injection, using of the ratio of 2:1. (3) When all patients enter the operation room, they should be linked with the multifunction monitor (marquette EA-GLE 3000), injected the intravenous liquid. Put them right lateral body position, and use combined spinal and epidural anesthesia(CSEA), controlling the plane of anesthesia under T6. It is all-important to keep the patient quiet, painless and smooth operation. Record the amount of narcotic drugs. (4) Keep all patients remaining conscious and supply conventional nasal catheter oxygen, if necessary plus the oxygen mask. (5) When the Ear group's operation are over, the operator would use the auricular-point detector, explore for large, small intestine and stomach, brain point and add magnets on their ears.
3. Outcome Measures:(1)In the day before operation and the third day after operation, the operator estimates all patients with Self-Rating Anxiety Scale (SAS). The score were recorded to evaluate the effect of auricular points magnet therapy to the emotional state of mind and adjustment of the function. (2) Record in stable state, induction period of anesthesia, beginning of operation, the separation of tumor, end of operation, the first day after operation, the heart rate (HR), blood pressure (BP), pulse oxygen saturation (SPO2), respiratory rate (RR), Ramesay score of each period to evaluate the auricular points magnet therapy effect on the body to adjust the cardiopulmonary function. (3)Observe and record the dizziness, nausea and vomiting, lack strength, insomnia, skin pruritus, hypotension (systolic blood pressure〈90mmHg, or diastolic blood pressure<60mmHg) and other bad side effects, and the incidence of postoperative complications to evaluate the auricular points magnet therapy on the role of the body to adjust. (4)Record the time of all patients excreting flatus and stool, to evaluate the auricular points magnet therapy on the body to adjust the recovery of digestive system function. (5)In the day before operation and the third day after operation, collect all the patients'venule blood samples, and test hemanalysis and biochemical indicator.By the analysis of blood leukocyte, it's proved that the auricular points magnet therapy could stabilize immune system of the body. (6)At the beginning and end of operation, collect all the patients'venule blood samples, and test the amount ofβ-endorphin and C-reactive protein in blood serum, to evaluate the auricular points magnet therapy to adjust analgesic and anti-infective mechanism of the body.
Results:1. Three groups of patients according to age, body mass index(BMI), ASA grade, diseases types, pregnancy history, surgical ways, and the principles of TCM classification,there are not statistically significant difference(p>0.05).2.Three groups of patients'auricular point positive comparison:The positive rate were 93.5%,96.8%,93.3% in sequence, and the total positive rate is 94.6%. Point area of the uterus and pelvic cavity are filling with the visual blood vessel,which occupy a large proportion of positive type.3. Three groups of patients pre-operation estimating SAS scores show no significant statistical difference(p> 0.05).While the ear group post-operation estimating SAS scores compared with the comfort group and control group scores, there are significant statistical difference (p<0.05); yet the comfort group and control group scores are not statistically significant difference (p> 0.05).4. Being recorded in stable state, induction period of anesthesia, beginning of operation, the separation of tumor, end of operation, the first day after operation,all six different time points of heart rate, pulse oxygen saturation among the three groups showed no significant statistical difference(p> 0.05). However, the blood pressure of the ear group at the time point of beginning of operation, the separation of tumor, end of operation, compared with the comfort group and control group there are significant statistical difference (p<0.05); but at the same time point the respiratory rate and Ramesay score among the three groups showed no significant statistical difference(p> 0.05).5. Each group of symptoms pre-operation were not significantly different (p>0.05). Abdominal pain and distension, loss of appetite, nausea and vomiting, insomnia, skin pruritus, all above of symptoms compared the comfort group with the control group pre and post-operation. And post-operation comparisons among the three groups revealed symptoms such as abdominal pain and distension, loss of appetite, nausea and vomiting, insomnia, there are significant statistical difference (p<0.05).6. Calculate the time of all patients excreting flatus and stool post-operation. The ear group compared with the comfort group and control group, there are significant statistical difference (p<0.05); while the comfort group and control group comparisons are not statistically significant difference(p> 0.05).7. Each group of the operation time were not significantly different (p>0.05). But on the amount of epidural drug and the number of cases plus fentanyl-droperidol mixture, the ear group compared with the comfort group and control group, there are significant statistical difference (p＜0.05); while the comfort group and control group comparisons are not statistically significant difference(p> 0.05).8. Each group of the hemanalysis indicator test were not significantly different (p>0.05). But by analysis of blood leukocyte, the total number of single-granulocyte of the ear group compared with the comfort group and control group, there are significant statistical difference (p<0.05); while the comfort group and control group comparisons are not statistically significant difference(p> 0.05).9. Each group of the amount ofβ-endorphin test in blood serum pre-operation, there are significant statistical difference (p<0.05). But each group of the amount ofβ-endorphin test in blood serum post-operatione, and each group of the amount of C-reactive protein test in blood serum pre and post-operation, there are not statistically significant difference(p> 0.05).
Conclusion:This research reveals it's positive that the auricular points magnet therapy effects the adjustment of body function in gynecological peri-operation. Pre-operation through the auricular points magnet therapy patients could relief the tension, fear and other negative emotions, improve sleep quality, reduce anxiety, adjust the emotional state of mind and disorders of the body function. So the body moves towards the direction of the normal physiological state of transformation, and it reduces incidence of narcotic drugs side-effect, symptoms such as abdominal pain and distension, loss of appetite, nausea and vomiting, insomnia. During the operation the operator can adjust, stabilize blood pressure at any time, and not only in varying degrees reduce the symptoms of stomach discomfort, nausea or others caused by visceral traction reaction, but find no inhibition of the respiratory and circulatory systems as life-threatened bad reactions, which help the operation smooth. Post-operation calculate the time of all patients excreting flatus and stool, we find that the ear group'time was significantly shortened, which indicate the auricular points magnet therapy can improve the recovery of digestive system function of the body.
In the field of anesthesia, the group used the auricular points magnet therapy require 15%-20% less epidural drug than the comfort group and control group need, and the number of cases plus fentanyl-droperidol mixture is similar condition, only 16.1%. At present acupuncture combined with epidural anesthesia is mainly supporting analgesic, to cut the amount of narcotic drugs, to reduce incidence of narcotic drugs side-effect and postoperative complications. In addition, the study also observed auricular points magnet therapy can stimulate the level of serumβ-endorphin increased before surgery;control the total number of single-granulocyte to increased to stabilize the body's immune system. But all above of the specific mechanism needs further study.
方法：1、分组方法：将符合纳入标准的病人92例,采用完全随机设计法分为三组：①耳穴贴压组(耳穴组),31例；②安慰对照组(对照组),31例；③空白对照组(空白组),30例。
2、实验步骤：(1)各组操作方法：全部病例均需进行耳廓视诊,并记录阳性反应的类型、部位。①耳穴组：术前一日利用耳穴探测器,选取双侧神门、皮质下、内分泌、耳中、肺、脾和子宫、盆腔等耳穴,常规消毒后敷压磁贴。以拇指、食指对压耳穴,以局部发红、发热,病人可耐受为限。术中操作者每隔30分钟按压1次,每次以60-90次／分的频率按压耳穴,每穴30秒,用力均匀。叮嘱患者或其家属手术前后自行按压耳穴,按压3-5次后,则不痛不压,痛时再压,3天后去除耳穴贴。②对照组：在所选耳穴区敷贴同样外观、数量的无磁珠胶布,不予任何刺激。③空白组：不予任何干预措施。(2)所有患者麻醉前30分钟肌肉注射阿托品0.5毫克和苯巴比妥钠100毫克,术中静脉输注5%乳酸钠林格注射液或羟乙基淀粉130／0.4氯化钠注射液(万汶),输液速度统一为8ml·kg-1·h-1,并根据失血量按晶体：胶体为2：1补充液体。(3)所有患者进入手术室后,连接多功能监测仪(Marquette EA-GLE 3000)常规监测,开放外周静脉。右侧卧位下行两点法腰-硬联合麻醉穿刺,麻醉平面控制在T6以下。以术中保持病人安静、无痛和手术能顺利进行为前提。记录术中麻醉药的用量。(4)术中保持患者意识清醒,并常规鼻导管吸氧,必要时面罩辅助给氧。(5)术毕时利用耳穴探测器,在耳穴组患者的耳穴区内探查大、小肠及胃、脑点并加敷磁贴。
3、观察指标：(1)分别于手术前一天、术后第三天时采用SAS自评量表记录患者神志情绪评分,以评价耳穴贴压对机体神志情绪状况的调整作用。(2)记录麻醉前、麻醉诱导时、手术开始切皮时、分离肿物时、术毕时、术后第一天各个时期的心率(HR)、血压(BP)、脉搏氧饱和度(SPO2)、呼吸频率(RR)、Ramesay评分,以评价耳穴贴压对机体功能的调整作用。(3)观察并记录各种不良反应,以及术后并发症的发生情况,以评价耳穴贴压对机体的调整作用。(4)记录患者术后排气及排便时间,以评价耳穴贴压对机体胃肠功能恢复的调整作用。(5)分别于贴压耳穴前、术后第三天抽取外周静脉血,检测外周血白细胞构成比、生化等相关指标,以探明耳穴贴压对于氧化应激反应的相关作用机制。(6)分别于术前准备期、术毕时抽取外周静脉血,应用酶联免疫法检测外周静脉血β-内啡肽和C-反应蛋白等相关指标,以探明耳穴贴压镇痛抗炎的相关作用机制。
结果：1、三组病人按照年龄、体质指数、ASA分级、疾病构成、孕产史构成、手术方式构成、中医证型等方面进行对比,其组间比较差异均无统计学意义(p>0.05),具有可比性。2、三组病例耳穴阳性反应的比较：三组的阳性率依次为93.5%、96.8%、93.3%,总阳性率达到94.6%,其中子宫和盆腔穴处血管充盈的阳性反应类型占较大的比例。说明耳穴阳性反应具有一定的辅助诊断意义。3、三组病例术前SAS评分的组间比较差异无显著性统计学意义(p>0.05),但术后耳穴组的SAS评分分别与对照组、空白组的分数相比较,差异存在统计学意义(p<0.05)；而对照组与空白组的SAS评分相比较,差异无显著性统计学意义(p>0.05)。4、三组病例各时间点的心率、脉搏氧饱和度、呼吸频率、Ramesay评分自身及组间比较差异无统计学意义(p>0.05),说明各组的心率、脉搏氧饱和度、呼吸频率、Ramesay评分在各时间点虽有变化,但无显著的影响。而在术始切皮时、分离肿物时、术毕时各时间点的三组血压的组内比较,以及耳穴组与对照组、空白组的组间比较,差异存在统计学意义(p<0.05),说明耳穴刺激对患者术中的血压有良好的稳定、调整作用。5、术前各组症状程度差异无显著性统计学意义(p>0.05),对照组、空白组在手术前后比较在腹胀痛、神疲乏力、纳呆、恶心呕吐、失眠、皮肤瘙痒等症状方面差异均存在统计学意义(p<0.05)；手术后耳穴组在腹胀痛、神疲乏力、纳呆、恶心呕吐、失眠方面,分别与对照组、空白组比较,差异均存在统计学意义(p<0.05)。说明耳穴刺激可降低患者使用麻醉药物后的不良反应发生率。6、耳穴组的排气、排便时间分别与对照组、空白组相比较,差异均存在统计学意义(p<0.05)：而对照组与空白组相比较,差异无显著性统计学意义(p>0.05)。7、三组病例的手术时间组间比较差异无显著性统计学意义(p>0.05)。但耳穴组的硬膜外用药量、加用芬氟合剂的例数分别与对照组、空白组相比较,差异均存在统计学意义(p<0.05)；而对照组与空白组相比较,差异无显著性统计学意义(p>0.05)。8、三组病例术前血分析组间比较差异无显著性统计学意义(p>0.05),但术后耳穴组的单核粒细胞总数分别与对照组、空白组相比较,差异存在统计学意义(p<0.05)；而对照组与空白组的单核粒细胞总数相比较,差异无显著性统计学意义(p>0.05)。9、三组病例术前血清β-内啡肽的组间比较差异存在统计学意义(p<0.05)。三组病例术后血清β-内啡肽的组间比较、C-反应蛋白的组间及手术前后比较差异无显著性统计学意义(p>0.05)。说明耳穴刺激可使血清β-内啡肽水平升高而起到镇痛的作用。
结论：本研究表明,耳穴磁疗在妇科开腹手术的围手术期中对机体功能的调整作用是肯定的。手术前期通过耳穴刺激可以缓解患者的紧张、恐惧等负面情绪,调整体内失调、紊乱的代谢过程或功能状态,使机体朝着正常生理状态方向发展转化,并降低术后腹胀痛、神疲乏力、纳呆、恶心呕吐、失眠等麻醉药物不良反应的发生率。手术中期可以即时调整、稳定患者的血压,不同程度地减轻病人手术中因内脏牵拉引起的胃部不适、恶心等症状,利于手术的顺利进行。手术后期患者的排气、排便时间明显缩短,说明耳穴贴压可改善术后胃肠功能恢复的情况。但其具体作用机理有待进一步探讨。
在麻醉方面,手术中期耳穴组的硬膜外用药量比对照组、空白组的药量少15%-20%,需加用芬氟合剂的例数也较对照组、空白组少,仅占16.1%。目前针药复合麻醉主要还在于辅助镇痛,减少麻醉药用量,减少术后不良反应、并发症的发生。此外,本研究还观察到耳穴刺激可使血清β-内啡肽水平在术前升高；抑制单核粒细胞总数的增加,从而稳定了机体的免疫系统功能。
Objectives:1. Observe the effect of combined auricular points magnet therapy for auxiliary analgesia in gynecological peri-operation.2. Observe the effect of combined auricular points magnet therapy for the adjustment of body function in gynecological peri-operation.3. Explore the mechanism of auricular points magnet therapy.4. Based on the above, summed up a set of simple, effective auricular point therapy method for the gynecological peri-operation.
Method:1. Group Methods:The patients who met the inclusion criteria,92 cases of completely random design with three groups:①auricular point pressing group (ear group),31;②comfort control group (comfort group),31;③control group (control group),30.
2. Experimental Steps:(1) Auricular point sticking:all patients are required to ear visual examination, and the operator record the positive type, location.①Ear group:the day before the operation the operator uses the auricular-point detector and selectes bilateral Shenmen, subcortex, endocrine, diaphragm, lung, spleen and uterus, pelvic cavity, disinfecting the skin and sticking magnets on the points. The thumb and index finger on the ear pressure, to local redness, heat, patients can tolerate is limited. During the surgery the operator press once every 30 minutes, each time with 60-90 times/min in the frequency of pressing ear,30 seconds per point, pressure well-distributed. Told patients or their families to press their own ears before and after surgery, after pressing 3-5 times, no pain no pressure, when the patient feels pain again, she could press the auricular-point. After three days they could remove the magnets on the points themselves.②Control group:in the same ear area selected sticking the same appearance, number of plaster, no magnetic beads, no stimulation.③Control group:no any intervention. (2)30 minutes before anesthesia all patients are intramuscular injected atropine 0.5 mg and Luminal 100 mg. During the surgery the intravenous infusion rate required consistent with 8ml·kg-1·h-1. According to blood loss the intravenous infusion alternate Ringer's injection and 5% hydroxyethyl starch 130/0.4 and sodium chloride injection, using of the ratio of 2:1. (3) When all patients enter the operation room, they should be linked with the multifunction monitor (marquette EA-GLE 3000), injected the intravenous liquid. Put them right lateral body position, and use combined spinal and epidural anesthesia(CSEA), controlling the plane of anesthesia under T6. It is all-important to keep the patient quiet, painless and smooth operation. Record the amount of narcotic drugs. (4) Keep all patients remaining conscious and supply conventional nasal catheter oxygen, if necessary plus the oxygen mask. (5) When the Ear group's operation are over, the operator would use the auricular-point detector, explore for large, small intestine and stomach, brain point and add magnets on their ears.
3. Outcome Measures:(1)In the day before operation and the third day after operation, the operator estimates all patients with Self-Rating Anxiety Scale (SAS). The score were recorded to evaluate the effect of auricular points magnet therapy to the emotional state of mind and adjustment of the function. (2) Record in stable state, induction period of anesthesia, beginning of operation, the separation of tumor, end of operation, the first day after operation, the heart rate (HR), blood pressure (BP), pulse oxygen saturation (SPO2), respiratory rate (RR), Ramesay score of each period to evaluate the auricular points magnet therapy effect on the body to adjust the cardiopulmonary function. (3)Observe and record the dizziness, nausea and vomiting, lack strength, insomnia, skin pruritus, hypotension (systolic blood pressure〈90mmHg, or diastolic blood pressure<60mmHg) and other bad side effects, and the incidence of postoperative complications to evaluate the auricular points magnet therapy on the role of the body to adjust. (4)Record the time of all patients excreting flatus and stool, to evaluate the auricular points magnet therapy on the body to adjust the recovery of digestive system function. (5)In the day before operation and the third day after operation, collect all the patients'venule blood samples, and test hemanalysis and biochemical indicator.By the analysis of blood leukocyte, it's proved that the auricular points magnet therapy could stabilize immune system of the body. (6)At the beginning and end of operation, collect all the patients'venule blood samples, and test the amount ofβ-endorphin and C-reactive protein in blood serum, to evaluate the auricular points magnet therapy to adjust analgesic and anti-infective mechanism of the body.
Results:1. Three groups of patients according to age, body mass index(BMI), ASA grade, diseases types, pregnancy history, surgical ways, and the principles of TCM classification,there are not statistically significant difference(p>0.05).2.Three groups of patients'auricular point positive comparison:The positive rate were 93.5%,96.8%,93.3% in sequence, and the total positive rate is 94.6%. Point area of the uterus and pelvic cavity are filling with the visual blood vessel,which occupy a large proportion of positive type.3. Three groups of patients pre-operation estimating SAS scores show no significant statistical difference(p> 0.05).While the ear group post-operation estimating SAS scores compared with the comfort group and control group scores, there are significant statistical difference (p<0.05); yet the comfort group and control group scores are not statistically significant difference (p> 0.05).4. Being recorded in stable state, induction period of anesthesia, beginning of operation, the separation of tumor, end of operation, the first day after operation,all six different time points of heart rate, pulse oxygen saturation among the three groups showed no significant statistical difference(p> 0.05). However, the blood pressure of the ear group at the time point of beginning of operation, the separation of tumor, end of operation, compared with the comfort group and control group there are significant statistical difference (p<0.05); but at the same time point the respiratory rate and Ramesay score among the three groups showed no significant statistical difference(p> 0.05).5. Each group of symptoms pre-operation were not significantly different (p>0.05). Abdominal pain and distension, loss of appetite, nausea and vomiting, insomnia, skin pruritus, all above of symptoms compared the comfort group with the control group pre and post-operation. And post-operation comparisons among the three groups revealed symptoms such as abdominal pain and distension, loss of appetite, nausea and vomiting, insomnia, there are significant statistical difference (p<0.05).6. Calculate the time of all patients excreting flatus and stool post-operation. The ear group compared with the comfort group and control group, there are significant statistical difference (p<0.05); while the comfort group and control group comparisons are not statistically significant difference(p> 0.05).7. Each group of the operation time were not significantly different (p>0.05). But on the amount of epidural drug and the number of cases plus fentanyl-droperidol mixture, the ear group compared with the comfort group and control group, there are significant statistical difference (p＜0.05); while the comfort group and control group comparisons are not statistically significant difference(p> 0.05).8. Each group of the hemanalysis indicator test were not significantly different (p>0.05). But by analysis of blood leukocyte, the total number of single-granulocyte of the ear group compared with the comfort group and control group, there are significant statistical difference (p<0.05); while the comfort group and control group comparisons are not statistically significant difference(p> 0.05).9. Each group of the amount ofβ-endorphin test in blood serum pre-operation, there are significant statistical difference (p<0.05). But each group of the amount ofβ-endorphin test in blood serum post-operatione, and each group of the amount of C-reactive protein test in blood serum pre and post-operation, there are not statistically significant difference(p> 0.05).
Conclusion:This research reveals it's positive that the auricular points magnet therapy effects the adjustment of body function in gynecological peri-operation. Pre-operation through the auricular points magnet therapy patients could relief the tension, fear and other negative emotions, improve sleep quality, reduce anxiety, adjust the emotional state of mind and disorders of the body function. So the body moves towards the direction of the normal physiological state of transformation, and it reduces incidence of narcotic drugs side-effect, symptoms such as abdominal pain and distension, loss of appetite, nausea and vomiting, insomnia. During the operation the operator can adjust, stabilize blood pressure at any time, and not only in varying degrees reduce the symptoms of stomach discomfort, nausea or others caused by visceral traction reaction, but find no inhibition of the respiratory and circulatory systems as life-threatened bad reactions, which help the operation smooth. Post-operation calculate the time of all patients excreting flatus and stool, we find that the ear group'time was significantly shortened, which indicate the auricular points magnet therapy can improve the recovery of digestive system function of the body.
In the field of anesthesia, the group used the auricular points magnet therapy require 15%-20% less epidural drug than the comfort group and control group need, and the number of cases plus fentanyl-droperidol mixture is similar condition, only 16.1%. At present acupuncture combined with epidural anesthesia is mainly supporting analgesic, to cut the amount of narcotic drugs, to reduce incidence of narcotic drugs side-effect and postoperative complications. In addition, the study also observed auricular points magnet therapy can stimulate the level of serumβ-endorphin increased before surgery;control the total number of single-granulocyte to increased to stabilize the body's immune system. But all above of the specific mechanism needs further study.
引文
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