耳穴埋籽防治痔术后尿潴留的临床研究
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摘要
目的：观察耳穴埋籽疗法预防混合痔术后尿潴留的临床疗效及其安全性,为预防和治疗痔术后尿潴留,研究安全有效、简便易行,无创、无副作用的预防痔术后尿潴留的方法提供依据。
方法：选择2010年3月至2011年1月间在江苏省中医院肛肠科收治住院,并符合纳入标准的混合痔患者60例,随机分为A、B、C三组,每组各20例。其中,A、B组是治疗组,分别为术前耳穴埋籽组、术后耳穴埋籽组,C组为空白对照组。三组在术前、术后常规治疗的基础上,术前耳穴埋籽组在术前1小时予耳穴(取穴：交感、神门、皮质下、膀胱、肾、三焦)埋籽,持续按压耳穴每穴3-4秒,分别轮流按压6次,隔30分钟再按一遍,术后每隔1小时予耳穴按压,至排尿通畅为止。术后耳穴埋籽组则在术后即予耳穴埋籽,耳穴按压方法同A组。对照组在术后不予特殊处理(观察)。观察记录导尿率、术后至首次排尿时间、术后至排尿完全通畅时间、首次排尿积分(排尿状况、小腹症状、排尿时间、尿流率),以及治疗期间的不良反应。
结果：(1)在导尿率上,耳穴埋籽组较对照组明显降低(p<0.05),术前耳穴埋籽组较对照组明显降低(p<0.05),而术后耳穴埋籽组与对照组之间、术前与术后耳穴埋籽组之间均无显著性差异(p>0.05)；(2)耳穴埋籽组、术前及术后耳穴埋籽组分别与对照组比较,均能明显缩短术后至首次排尿时间、术后至排尿完全通畅时间(p<0.05),而术前与术后耳穴埋籽组组间比较,无显著性差异(p>0.05)；(3)耳穴埋籽组、术前及术后耳穴埋籽组分别与对照组比较,均能明显改善首次排尿状况、明显减轻首次排尿时小腹胀满症状、明显缩短首次排尿时间、明显增大尿流率值(p<0.05)；且术前耳穴埋籽组在首次排尿时间与尿流率方面明显优于术后耳穴埋籽组(p<0.05)；(4)术前与术后耳穴埋籽组患者均未见由于耳穴埋籽而引起的明显不良反应。
结论：(1)耳穴埋籽能明显降低痔术后导尿率,且术前耳穴埋籽效果更优；(2)耳穴埋籽能有效缩短术后至首次排尿时间、术后至排尿完全通畅时间；(3)耳穴埋籽能有效改善术后首次排尿情况,即能明显改善排尿状况、减轻首次排尿时小腹胀满症状、缩短首次排尿时间、增大尿流率值,且术前耳穴埋籽在首次排尿时间与尿流率上明显优于术后耳穴埋籽。因此,耳穴埋籽是一种安全、有效防治痔术后尿潴留的中医药治疗方法。
Objective:Observe the clinical research of prevention and cure of auricular-point-pressing therapy for urinary retention on hemorrhoids after surgery. Discuss the effective method of prevention and cure to urinary retention on hemorrhoids after surgery, explore a precise curative effect, simple and convenient, cheap, noninvasive and no side effect method.
Methods:Choose the cases of inpatients in Jiangsu province hospital of TCM from March 2010 to January 2011; besides, the sixty hemorrhoids sufferers accord with the taken standards. There are randomized study with three groups and each group consists of 20 cases. Group A and B is the treatment group. Group A is the preoperative group of auricular-point-pressing. Group B is the postoperative group of auricular-point-pressing. Group C is the blank controller. On the preoperative and postoperative basis of the treatment, the preoperative group of auricular-point-pressing oppress the seeds before one hour preoperative. Each point is pressed three or four seconds and executed six times by turns. And do it again every thirty minutes. Press points every hour after operative until the urine more or less than usual. The postoperative group of auricular-point-pressing oppress the seeds after the operative. The methods of press is equal to the preoperative group. The blank controller have no special treatment(observation). Observe the time from the postoperative time to the time of the first urine, the completely unimpeded urinate time, the first urine integral, the rate of the use of neostigmine, the rate of catheterization, urinary flow rate, the change of security and untoward effect. Evaluate the change of symptom of every group and integral of signs.
Results:(l)Compare with the control group, group of auricular-point-pressing and the preoperative group of auricular-point-pressing are obviously discrepancies in catheterization. There haven't obviously discrepancies between the postoperative group of auricular-point-pressing and the control group, between the preoperative group of auricular-point-pressing and the postoperative one. (2) Compare with the control group, the treatment groups clearly shorten the time going to urinate after surgery and the completely unimpeded urinate time. (3)Compare with the control group, the treatment groups obviously discrepancies on the first urine conditions through the statistics analysis.
Conclusion:(1) The auricular-point-pressing therapy can clearly reduce the ratio of catheterization, and the preoperative group of auricular-point-pressing is better than others. (2) The auricular-point-pressing therapy can shorten the time to first urinate after surgery, and the completely unimpeded urinate time. (3) The auricular-point-pressing therapy can effectively improve the first urine status, include the first urinate time, the urinary flow rate and so on. And the treatment group before surgery is better than the group after surgery in the first urinate time and the urinary flow rate. Consequently, we draw a conclusion that the auricular-point-pressing therapy is a kind of safety and effective traditional Chinese medicine treatment to prevent and cure urinary retention on hemorrhoids after surgery.
方法：选择2010年3月至2011年1月间在江苏省中医院肛肠科收治住院,并符合纳入标准的混合痔患者60例,随机分为A、B、C三组,每组各20例。其中,A、B组是治疗组,分别为术前耳穴埋籽组、术后耳穴埋籽组,C组为空白对照组。三组在术前、术后常规治疗的基础上,术前耳穴埋籽组在术前1小时予耳穴(取穴：交感、神门、皮质下、膀胱、肾、三焦)埋籽,持续按压耳穴每穴3-4秒,分别轮流按压6次,隔30分钟再按一遍,术后每隔1小时予耳穴按压,至排尿通畅为止。术后耳穴埋籽组则在术后即予耳穴埋籽,耳穴按压方法同A组。对照组在术后不予特殊处理(观察)。观察记录导尿率、术后至首次排尿时间、术后至排尿完全通畅时间、首次排尿积分(排尿状况、小腹症状、排尿时间、尿流率),以及治疗期间的不良反应。
结果：(1)在导尿率上,耳穴埋籽组较对照组明显降低(p<0.05),术前耳穴埋籽组较对照组明显降低(p<0.05),而术后耳穴埋籽组与对照组之间、术前与术后耳穴埋籽组之间均无显著性差异(p>0.05)；(2)耳穴埋籽组、术前及术后耳穴埋籽组分别与对照组比较,均能明显缩短术后至首次排尿时间、术后至排尿完全通畅时间(p<0.05),而术前与术后耳穴埋籽组组间比较,无显著性差异(p>0.05)；(3)耳穴埋籽组、术前及术后耳穴埋籽组分别与对照组比较,均能明显改善首次排尿状况、明显减轻首次排尿时小腹胀满症状、明显缩短首次排尿时间、明显增大尿流率值(p<0.05)；且术前耳穴埋籽组在首次排尿时间与尿流率方面明显优于术后耳穴埋籽组(p<0.05)；(4)术前与术后耳穴埋籽组患者均未见由于耳穴埋籽而引起的明显不良反应。
结论：(1)耳穴埋籽能明显降低痔术后导尿率,且术前耳穴埋籽效果更优；(2)耳穴埋籽能有效缩短术后至首次排尿时间、术后至排尿完全通畅时间；(3)耳穴埋籽能有效改善术后首次排尿情况,即能明显改善排尿状况、减轻首次排尿时小腹胀满症状、缩短首次排尿时间、增大尿流率值,且术前耳穴埋籽在首次排尿时间与尿流率上明显优于术后耳穴埋籽。因此,耳穴埋籽是一种安全、有效防治痔术后尿潴留的中医药治疗方法。
Objective:Observe the clinical research of prevention and cure of auricular-point-pressing therapy for urinary retention on hemorrhoids after surgery. Discuss the effective method of prevention and cure to urinary retention on hemorrhoids after surgery, explore a precise curative effect, simple and convenient, cheap, noninvasive and no side effect method.
Methods:Choose the cases of inpatients in Jiangsu province hospital of TCM from March 2010 to January 2011; besides, the sixty hemorrhoids sufferers accord with the taken standards. There are randomized study with three groups and each group consists of 20 cases. Group A and B is the treatment group. Group A is the preoperative group of auricular-point-pressing. Group B is the postoperative group of auricular-point-pressing. Group C is the blank controller. On the preoperative and postoperative basis of the treatment, the preoperative group of auricular-point-pressing oppress the seeds before one hour preoperative. Each point is pressed three or four seconds and executed six times by turns. And do it again every thirty minutes. Press points every hour after operative until the urine more or less than usual. The postoperative group of auricular-point-pressing oppress the seeds after the operative. The methods of press is equal to the preoperative group. The blank controller have no special treatment(observation). Observe the time from the postoperative time to the time of the first urine, the completely unimpeded urinate time, the first urine integral, the rate of the use of neostigmine, the rate of catheterization, urinary flow rate, the change of security and untoward effect. Evaluate the change of symptom of every group and integral of signs.
Results:(l)Compare with the control group, group of auricular-point-pressing and the preoperative group of auricular-point-pressing are obviously discrepancies in catheterization. There haven't obviously discrepancies between the postoperative group of auricular-point-pressing and the control group, between the preoperative group of auricular-point-pressing and the postoperative one. (2) Compare with the control group, the treatment groups clearly shorten the time going to urinate after surgery and the completely unimpeded urinate time. (3)Compare with the control group, the treatment groups obviously discrepancies on the first urine conditions through the statistics analysis.
Conclusion:(1) The auricular-point-pressing therapy can clearly reduce the ratio of catheterization, and the preoperative group of auricular-point-pressing is better than others. (2) The auricular-point-pressing therapy can shorten the time to first urinate after surgery, and the completely unimpeded urinate time. (3) The auricular-point-pressing therapy can effectively improve the first urine status, include the first urinate time, the urinary flow rate and so on. And the treatment group before surgery is better than the group after surgery in the first urinate time and the urinary flow rate. Consequently, we draw a conclusion that the auricular-point-pressing therapy is a kind of safety and effective traditional Chinese medicine treatment to prevent and cure urinary retention on hemorrhoids after surgery.
引文
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[2]上海市耳针协作小组.中医杂志,1959,10：34.
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[8]王茵萍.耳胆穴特异性的影像学观察[J].中国针灸,19(7)：421.
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[2]上海市耳针协作小组.中医杂志,1959,10：34.
[3]单秋华.耳穴贴压疗法.山东：山东科学技术出版社,1998,(2)：11.
[4]邢锦秀,刘春霞.关于耳穴的理论研究.吉林中医药,1996,6：39.
[5]Oleson, T. and R. Kroening, A comparison of Chinese and Nogier auricular acupuncture Points. American Journal of Acupuncture[J],1983,11(3):205-223.
[6]黄丽春.耳穴诊断学[M].北京：科学技术文献出版社,2004,223.
[7]王祚邦.针刺耳穴对乙型肝炎患者门静脉血流量的影响[J].中国中西医结合杂志,15(5)：286.
[8]王茵萍.耳胆穴特异性的影像学观察[J].中国针灸,19(7)：421.
[9]张诗兴,姜文方.耳穴定位与神经、血管分布的研究[J].南京中医药大学学报,1998,14(4)：228-229.
[10]刘维洲,许冠荪等.耳廓神经支配与耳针对胃肠电活动影响的观察[J].针刺研究.1990,15(3)：187-190.
[11]孙国杰.针灸学[M].上海：上海科技出版社,1997.158.
[12]贺亚军.针刺治疗肛肠术后急性尿潴留的体会[J].现代护理杂志,2000,6(10)：69.
[13]史伟英.穴位注射治疗痔疮术后尿潴留的临床观察[J].护理学杂志,1999,14(3)：166.
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