腹针疗法干预痔术后尿潴留的临床研究
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摘要
目的:痔是临床常见的疾病之一,其中又以混合痔为多见。外科手术是Ⅲ、Ⅳ度痔的主要治疗手段。由于肛门直肠是具有复杂生理功能的器官,此处的手术对肛门直肠及其邻近组织的牵拉、损伤和缝合切除等易造成术后各种并发症的发生,而尿潴留作为肛门直肠疾病手术后最常见的并发症之一,易引起泌尿系感染甚至引起继发反流性肾病,增加了患者的痛苦,而且延长了患者疾病的康复时间,增加了医疗费用。目前有很多治疗术后尿潴留的方法,但仍存在一定的缺陷。为探求一种安全可靠、副作用少、疗效确切、操作规范化的治疗方法,本课题选择了腹针疗法。
方法:将2007年4月～2008年4月期间符合纳入标准的67名在腰麻下行痔术后出现尿潴留的患者,随机分为试验组(腹针疗法组,N=33)和对照组(体针组,N=34),两组患者在以下各方面均无显著性差异:①患者的性别和年龄②内痔分期及切口数③手术方式和手术耗时④针刺治疗距术毕的时间。两组具有可比性。试验组予以腹针治疗:取穴气海(深刺,D)、关元(深刺,D)、天枢(中刺,M)、中极(浅刺,S)、曲骨(浅刺,S)、归来(浅刺,S),留针15～30min。对照组予以体针治疗(取穴关元、中极、三阴交、足三里为主穴配穴随证加减,留针15～30min)。在治疗后2小时内的疗效按3级评定标准评定。同时记录不良反应。全部数据结果采用SPSS 13.0统计软件进行分析,其中计数资料行x~2检验;计量资料两样本间比较采用两独立样本t检验,等级资料采用Ridit分析。
结果:两组患者在以下各方面均无显著性差异:①治疗后2小时内的排尿次数②治疗后2小时内的总尿量③3级评定无效评定。67例患者中两组共有28例(占41.79%)患者出现尿潴留的时间分布在术后6～7小时,说明患者术后出现尿潴留的时间可能主要分布在6-7小时。两组治疗后首次排尿时间比较,试验组为0:48±0:28、对照组为0:61±0:29,p＜0.05,两组具有显著性差异。两组治疗首次排尿后患者的尿潴留症状(腹胀、尿急感)改善程度对比,试验组优于对照组。3级评定显效率评定具有显著性差异,试验组为66.67%、对照组44.11%,p＜0.05,腹针疗法组效果优于体针组。
结论:腹针疗法在治疗后首次排尿时间及显效评定均优于体针组。虽然其它治疗效果相似,但腹针疗法还具有起效快、副反应小、安全可靠、无痛及操作规范化等优点,不会增加病人的额外痛苦和负担。腹针疗法可能是治疗痔术后尿潴留的又一行之有效的新方法,本研究为临床是否能够广泛使用腹针干预痔术后尿潴留提供依据,扩大了腹针在临床的应用范围,为临床提供了一项新的选择。
Objective:Hemorrhoids is one of the common diseases in clinic,especially the combined hemorrhoids.Surgical intervention is the main treatment for theⅢ、Ⅳdegree hemorrhoids.Anus and rectum are the organs of complicate physiological functions.Complications easily occurred,which are caused by dragging,trauma,suturation and resection to the anus,rectum and the tissues around them.Urinary retention,one of the most common complications after the operations of anus and rectum,It was easy to cause urinary system infection even insecondary refluxing nephropathy,which increased patients' distress,prolonged the restoration time and increased the medical cost.Currently,there are many ways to treat postoperative uroschesis,but there are still some defects.We choose the Abdominal Acupuncture to hunt for a treatment which is secure and easy to manipulate and has certain therapeutic effects and less side effects.
Methods:Sixty seven patients undergoing hemorrhoidectomy with subarachnoid space block anesthesia between April 2007 and April 2008,who were randomly divided into two groups:the experimental group(Abdominal Acupuncture group, 33 patients)and the control group(Body Acupuncture group,34patients). There were no significant differences between the two groups of the following aspects:the age and gender of the patients;the staging of the internal hemorrhoids and the number of the loop ligature of the cut;the way of the operation and the time consuming of operation;the time from the operation ending to the treatment.There were comparability between the two groups.The experimental group was treated with Abdominal Acupuncture:Qihai(deep insertion of needle,D),Guanyuan(deep insertion of needle,D) Tianshu(moderate insertion of needle,M),Zhongji(superficial insertion of needle,S),Qugu(superficial insertion of needle,S),Guilai(superficial insertion of needle,S),retaining needle for 15-30minutes;the control group was treated with body acupuncture(Guanyuan,Zhongji,Sanyinjiao,Zusanli as the main acupoints with the modified acupoints according to the syndromes), retaining needle for 15-30minutes.The therapeutic effects in two hours after the treatment were evaluated by the three degree assessment criteria and the side effects were recorded.All the data was analyzed by SPSS 13.0,enumeration data was tested by x2;comparison of the measurement data between the samples was tested by t in both independent samples;ranked data was analysed by Ridit.
Results:There were no significant differences between the two groups of the following aspects:the urinating times in two hours after the operation,the urine quantity in two hours after the treatment,ineffective assessment of three degree.The first time of urinating in both group was compared. postoperative uroschesis mainly happend in 6-7 hours after the operation in both groups.There was a significant difference(P＜0.05),0:48±0:28 in the experimental group and 0:61±0:29 in the control group.The experimental group was superior to the control group,when the degree of the uroschesis symptoms after the first urinating was compared in both groups.There was a significant difference by the three degree assessment of efficacy(p＜0.05), 66.67%in the experimental group and 44.1%in the control group.The effect of the Abdominal Acupuncture group was superior to that of the Body Acupuncture group.
Conclusions:The first time of urinating and efficacy assessment after operation of the Abdominal Acupuncture is superior to that of the body acupuncture group.Although the other therapeutic effects are similar,there are some advantages of Abdominal Acupuncture,such as quick effects,less side effects,security,indolence,normalization of operation and no other extra pain and burden to the patients.Abdominal Acupuncture is another effect way to treat postoperative uroschesis.This study is supportive to a larger application of the Abdominal Acupuncture and provides a new choice for the clinical application.
方法:将2007年4月～2008年4月期间符合纳入标准的67名在腰麻下行痔术后出现尿潴留的患者,随机分为试验组(腹针疗法组,N=33)和对照组(体针组,N=34),两组患者在以下各方面均无显著性差异:①患者的性别和年龄②内痔分期及切口数③手术方式和手术耗时④针刺治疗距术毕的时间。两组具有可比性。试验组予以腹针治疗:取穴气海(深刺,D)、关元(深刺,D)、天枢(中刺,M)、中极(浅刺,S)、曲骨(浅刺,S)、归来(浅刺,S),留针15～30min。对照组予以体针治疗(取穴关元、中极、三阴交、足三里为主穴配穴随证加减,留针15～30min)。在治疗后2小时内的疗效按3级评定标准评定。同时记录不良反应。全部数据结果采用SPSS 13.0统计软件进行分析,其中计数资料行x~2检验;计量资料两样本间比较采用两独立样本t检验,等级资料采用Ridit分析。
结果:两组患者在以下各方面均无显著性差异:①治疗后2小时内的排尿次数②治疗后2小时内的总尿量③3级评定无效评定。67例患者中两组共有28例(占41.79%)患者出现尿潴留的时间分布在术后6～7小时,说明患者术后出现尿潴留的时间可能主要分布在6-7小时。两组治疗后首次排尿时间比较,试验组为0:48±0:28、对照组为0:61±0:29,p＜0.05,两组具有显著性差异。两组治疗首次排尿后患者的尿潴留症状(腹胀、尿急感)改善程度对比,试验组优于对照组。3级评定显效率评定具有显著性差异,试验组为66.67%、对照组44.11%,p＜0.05,腹针疗法组效果优于体针组。
结论:腹针疗法在治疗后首次排尿时间及显效评定均优于体针组。虽然其它治疗效果相似,但腹针疗法还具有起效快、副反应小、安全可靠、无痛及操作规范化等优点,不会增加病人的额外痛苦和负担。腹针疗法可能是治疗痔术后尿潴留的又一行之有效的新方法,本研究为临床是否能够广泛使用腹针干预痔术后尿潴留提供依据,扩大了腹针在临床的应用范围,为临床提供了一项新的选择。
Objective:Hemorrhoids is one of the common diseases in clinic,especially the combined hemorrhoids.Surgical intervention is the main treatment for theⅢ、Ⅳdegree hemorrhoids.Anus and rectum are the organs of complicate physiological functions.Complications easily occurred,which are caused by dragging,trauma,suturation and resection to the anus,rectum and the tissues around them.Urinary retention,one of the most common complications after the operations of anus and rectum,It was easy to cause urinary system infection even insecondary refluxing nephropathy,which increased patients' distress,prolonged the restoration time and increased the medical cost.Currently,there are many ways to treat postoperative uroschesis,but there are still some defects.We choose the Abdominal Acupuncture to hunt for a treatment which is secure and easy to manipulate and has certain therapeutic effects and less side effects.
Methods:Sixty seven patients undergoing hemorrhoidectomy with subarachnoid space block anesthesia between April 2007 and April 2008,who were randomly divided into two groups:the experimental group(Abdominal Acupuncture group, 33 patients)and the control group(Body Acupuncture group,34patients). There were no significant differences between the two groups of the following aspects:the age and gender of the patients;the staging of the internal hemorrhoids and the number of the loop ligature of the cut;the way of the operation and the time consuming of operation;the time from the operation ending to the treatment.There were comparability between the two groups.The experimental group was treated with Abdominal Acupuncture:Qihai(deep insertion of needle,D),Guanyuan(deep insertion of needle,D) Tianshu(moderate insertion of needle,M),Zhongji(superficial insertion of needle,S),Qugu(superficial insertion of needle,S),Guilai(superficial insertion of needle,S),retaining needle for 15-30minutes;the control group was treated with body acupuncture(Guanyuan,Zhongji,Sanyinjiao,Zusanli as the main acupoints with the modified acupoints according to the syndromes), retaining needle for 15-30minutes.The therapeutic effects in two hours after the treatment were evaluated by the three degree assessment criteria and the side effects were recorded.All the data was analyzed by SPSS 13.0,enumeration data was tested by x2;comparison of the measurement data between the samples was tested by t in both independent samples;ranked data was analysed by Ridit.
Results:There were no significant differences between the two groups of the following aspects:the urinating times in two hours after the operation,the urine quantity in two hours after the treatment,ineffective assessment of three degree.The first time of urinating in both group was compared. postoperative uroschesis mainly happend in 6-7 hours after the operation in both groups.There was a significant difference(P＜0.05),0:48±0:28 in the experimental group and 0:61±0:29 in the control group.The experimental group was superior to the control group,when the degree of the uroschesis symptoms after the first urinating was compared in both groups.There was a significant difference by the three degree assessment of efficacy(p＜0.05), 66.67%in the experimental group and 44.1%in the control group.The effect of the Abdominal Acupuncture group was superior to that of the Body Acupuncture group.
Conclusions:The first time of urinating and efficacy assessment after operation of the Abdominal Acupuncture is superior to that of the body acupuncture group.Although the other therapeutic effects are similar,there are some advantages of Abdominal Acupuncture,such as quick effects,less side effects,security,indolence,normalization of operation and no other extra pain and burden to the patients.Abdominal Acupuncture is another effect way to treat postoperative uroschesis.This study is supportive to a larger application of the Abdominal Acupuncture and provides a new choice for the clinical application.
引文
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[2]Fleischer M,Marini CP,Statmon R,et al.Local anesthesia for anorectal surgical procedures.J Am surg,1994,60:812-815.
[3]Hopping C,Fuguerson JA,Fryl MM,et al.Complications of anorectal surgery:Cocon And rectum(panel discnssion).Dis Cocon Rectum,1996,9:159-167.
[4]Pompens R.Detrusor inhibition from anal region in man.Acta Chir Scand.1996.(suppl):351-354.
[5]张东铭.大肠肛门局部解剖与手术学[M].合肥:安徽科学技术出版社,1999.1.
[6]张元芳.现代泌尿外科理论与实践.复旦大学出版社,2001:191.
[7]《中华人民共和国中医药行业标准·中医病证诊断疗效标准》(1994版).国家中医药管理局,1994,(4).
[8]张伯臾,董建华,周伟瑛.中医内科学.上海科学技术出版社,2003:238.
[9]黄乃健,王玉成,宋光瑞等.中国肛肠病学,山东:山东科学技术出版社,1996,第一版:620-707.
[10]闵志廉.临床泌尿外科学诊断分析与治疗要领.人民军医出版社.2003:48.
[11]石美鑫,张延龄.现代外科学.复旦大学出版社.2002.
[12]葛宏发.临床泌尿外科学疾病诊断与鉴别诊断.人民卫生出版社.2003:135.
[13]高明焕.痔瘘病人术后排尿困难不畅原因及对策.中国乡村医药杂志,2001,9(7):17.
[14]Kitade.Williamson J.Nutsing Times.2005,101(29):53-54.
[15]陈学玲.耳穴贴压肛肠术后尿潴留的护理[J].现代护理,2002,8(11):883.
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