电针促进腰麻后膀胱功能恢复疗效观察
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摘要
研究背景：
蛛网膜下腔阻滞系把局麻药注入蛛网膜下腔,使脊神经根、背根神经节及脊髓表面部分产生不同程度的阻滞,简称脊麻。此种方法适用于大部分下腹部和下肢的手术,均可以取得满意的麻醉效果。当把局麻药注入蛛网膜下腔后,有确切的证据可以表明药物会阻断膀胱的排尿反射,阻断病人下肢及盆底的温、痛、触、肌肉运动、压力及本体感觉,也就势必会造成尿潴留。蛛网下腔阻滞后,尿潴留基于解剖学基础及生理学改变则属于动力性梗阻而导致的排尿困难。况且病人麻醉后正常排尿反射消失,因此发生率较高。膀胱的过度充盈可以合并血液动力学变化,由于腹膜的刺激,可引起血压升高及心率增快,严重者可导致膀胱破裂。目前,临床麻醉工作中普遍采用的预防和治疗腰麻后尿潴留的方法是术前常规插导尿管,根据Haley等报道,非导尿患者尿道感染率为3.1%,单次导尿感染率为1%-5%,而保留导尿者感染率为9.9%；且感染率随导尿管保留时间延长而呈增加。
本课题认为针刺麻醉用于预防及减少腰麻所致尿潴留是一种较好的方法。尿潴留属祖国医学“癃闭”范畴.根据中医学理论,癃闭一证,病位多在膀胱,多因膀胱经气受损,气机不畅,下焦决渎无力,导致尿潴留。通过针刺,可以振奋膀胱经气,使下焦气机通畅,水道通调。针刺水道、归来穴,实因其为疏通膀胱、针刺关元、中极等穴,能温补下焦元气,鼓舞膀胱气化功能,达到启闭通尿的作用。
针刺用于治疗尿潴留前人已经做了大量的研究,经历了多年的临床实践,证明其疗效确切。且具有简便、经济、安全、无扰乱生理功能等特点,可以调整机体生理功能。而电针用于预防及减少腰麻所致尿潴留,可以避免在一些损伤小失血少的手术中,插尿管给病人带来的弊端。减少了泌尿系感染的发生,降低了术后抗生素的使用率,消除了病人因导尿而带来的恐惧心理。提高了手术质量,符合现代麻醉学的发展潮流。
研究目的：
观察电针干预促进腰麻后膀胱功能恢复的疗效和安全性。
研究方法：
病例选择：选择符合纳入标准的择期手术病人共61例,针刺麻醉组31例,对照组30例。
电针方法：治疗组待病人麻醉平面消退到胸10水平时开始取针刺关元、归来、中极等穴位.取主穴：双侧归来穴,配穴：关元、中极。患者仰卧位,局部常规消毒。归来穴取穴,腹股沟中央上1寸,耻骨缘上1寸,旁开2寸,4寸毫针,直刺或向内下刺进针1.5寸,中极穴取穴,下腹部耻骨弓上方膀胱部白线中,脐下4寸,针尖呈45。角向下斜刺,进针1寸,关元穴取穴,腹下部正中线上,中极上1寸,脐下3寸,直刺或向下刺1.5寸,关元、中极及双侧归来穴分别接上韩氏电针仪,频率2HZ,连续波,电流强度2MA起,留针30min。
对照方法：待病人麻醉平面消退到胸10水平时开始记时,但不给予针刺干预,观察平面消退到胸10水平时距离自主排尿时间。
观察指标：病人术中使用腰麻药物的时间和剂量；麻醉后各时间点记录患者收缩压(SBP)、舒张压(DBP)、平均压(MBP)和心率(HR)；术前及术后记录患者排尿情况、排尿时间、尿量等；其它：排尿通畅情况、下腹坠涨、排尿不尽感、舒适度及可接受度等。
研究结果：
统计结果显示,在整个研究过程中,均选用实施下肢手术,且给予蛛网膜下腔麻醉的病人作为研究对象。观察白腰麻平面消退到胸10至病人自主排尿的时间及腰麻后20分钟至病人自主排尿的时间,统计结果显示电针组在麻醉平面消退达胸10时给予电针刺激关元、中极、双侧归来穴。对照组不给予任何干预措施。两组间麻醉平面消退到胸10至排尿时间的比较P=0.000<0.05,两组间腰麻后20分至排尿时间的比较P=0.002<0.05。组间比较有显著性差异。例数胸10至排尿时间腰麻后20分至排尿时间电针组31 227.58±77.92 356.29±96.99对照组30 312.50±90.85 428.33±71.37以上数据说明：从两组间距离自主排尿时间来看,电针刺激关元、中极、双侧归来穴,无论是从麻醉平面胸10开始计时,还是从腰麻后20分钟算起,均有明显的缩短病人自主排尿时间的作用。从而极大的降低了尿潴留的发生,为避免术中插尿管后留置尿管给病人带来不适及感染提供了可能。因此电针预防及降低腰麻术后尿潴留的方法疗效确切。
在蛛网膜下腔麻醉下实施下肢或下腹部手术的病人,因为腰麻药直接注入蛛网膜下腔。短时间内造成广泛的交感神经阻滞,循环代偿时间短,病人循环容量会相对不足。因此腰麻后晶体胶体配比输液,是预防容量不足的重要措施。从腰麻后平面消退达胸10时刻的输液量及术后排尿时刻的输液量统计分析看,两组间比较统计结果显示,输液量在麻醉平面消退到胸10时比较P=0.446>0.05,排尿时输液量比较P=0.563>0.05。无统计学差异。观察记录病人术后自主排尿时的尿量,将电针组及对照组尿量在大于等于400毫升者与小于400毫升者分别计数,进行两组间比较后,统计结果显示,两组间腰麻后排尿时尿量比较经完全随机t检验P=0.569>0.05无统计学差异。两组间腰麻后排尿时尿量按400毫升为限,经卡方检验比较P=0.002<0.05有统计学差异。例数胸10时排尿时尿量尿量>400尿量<400电针组31 1161.29±207.65 1630.65±269.47 339.03±108.49 5 26对照组30 1126.67±136.29 1673.33±302.78 360.67±179.38 16 14以上数据说明：无论是电针观察组还是空白对照组,输液量的多少与麻醉方法的实施相关,腰麻是输液的指症,与电针与否无关。因此输液量两组间比较无差异。从尿量来看针刺相关穴位能够缩短膀胱排尿反射恢复的时间和敏感度,在生理尿量的情况下及时建立排尿反射,极大的避免了尿潴留对膀胱功能的损害。研究结论：电针可有效促进腰麻后患者膀胱功能恢复,无不良反应,可临床推广应用。
Research Background:
Subarachnoid block is to inject the local anesthetic into subarachnoid cavity, which will block the spinal nerve root, the dorsal root ganglion as well as the surface of the spinal cord to various degrees and is called Spinal Cord Paralysis in short form. This method can be applied to the most of operations on hypogastrium and the lower limb and can gain satisfactory anesthesia effect. When the local anesthetic is injected into the subarachnoid cavity, it has been proved that it will block cystic micturition reflex, and also block the lower limbs and the cavitas pelvis of the patients in many aspects such as temperature, pain, touch, muscular movement, pressure and proprioceptive sensibility, which will finally result in the urinary retention. Based on the anatomical basis and the physiological change, the urinary retention is caused by the block with dynamic properties, and the normal micturition reflex disappears after the injection of the anesthetic, which is made it has a high incidence rate. Overfilling of bladder could induce changes of circulation. By stimulation of peritoneum, it can provoke BP to increase and even rupture the bladder seriously.
At present, the regular method to prevent and treat with the urinary retention is to insert the catheter before operation, however, according to the report by Haley et al. that the urethra infection rate was 3.1% in the patients without urethral catheterization, 1——5% in single urethral catheterization and 9.9% in preserving catheter; and infection rate was related to preservation time of catheter. will increase with the prolonging of retention time of urethral catheterization.
Based on the above discussion, the present paper believes that acupuncture is a good way to prevent and reduce urinary retention resulted from lumbar anesthesia.According to the theory of traditional Chinese medicine, the urinary retention belongs to the category of uroschesis. The incidence is related to the urinary obstruction, due to the block in meridians and also closely related to those functions such as the function of triple energizer, lung, spleen, kidney, liver. In the chapter of Reiki Secret Code of Internal Canon of Medicine, it is said that the bladder is the source of body fluid, and the gasification of it reveals the energy. The bladder damp-heat interaction results in adverse gasification, and then the difficulty in urination. The urinary retention, no matter from the operation or the neuro-endocrine factors, results from malfunction in the triple energizer, in the gasification of the bladder and the loss of opening and closing.
There are many researches about acupuncture to treat retention of urine. After years of clinical practices, their curative effect has been proved. It has the features such as being simple, economical, safe and non-disturbing in physiological function, and it can also adjust the body's physiological functions.Using electric acupuncture to prevent and reduce the incidence of urinary retention resulted from lumbar anesthesia can avoid those drawbacks caused by the catheter insertion in some operations with less damage and less blood loss.It can reduce the incidence of urinary tract infections, reduce the utilization rate of postoperative antibiotics, remove the fear of the patients brought by the urethral catheterization and improve the quality of operation,accords with the development trend of modern anesthesia.
Research purpose:
To observe the effect and security of electric acupuncture to interfere in bladder's reconstruction after spinal anesthesia. Research methods:
Cases selection:select 61 patients with the suitable standard and randomized them into EA group and control group,31 in EA group and 30 in control group.
Electric acupuncture methods:the treatment group starts to acupuncture into the acupoints such as Guanyuan, Guilai and Zhongji when the anesthesia area recedes to the level 10 of the chest. The major acupoints are bilateral Guilai acupoints on both sides, and the matching acupoints are Guanyuan and Zhongi. Patients lie supine and the local routine disinfection is conducted.
Locate the Guilai acupoint:one inch above the centre of the groin, one inch on the edge of the pubic bone, and then two inches aside,4 inch acupuncture needle; piercing the needle directly or piercing the needle obliquely inward 1.5-inch.Locate the Zhongji acupoint:the middle of the white line on the bladder above the pubic arch in the hypogastrium,4 inches below the umbilicus; piercing the needle tip obliquely downward 1 inch with an angle of 45 ".Locate the Guanyuan acupoint:the middle line in the hypogastrium,1 inch above the Zhongji acupoint and 3 inches below the umbilicus; piercing the needle directly or obliquely downward 1.5 inches. Connect the HANS electric acupuncture device, with a frequency of 2HZ, continuous wave, current intensity of 2MA, to the acupoints of Guanyuan, Zhongji and Guilai on both sides and keep it for 30 minutes.
Comparing method:start to time when the anesthesia area recedes to the level 10(T10) of the chest, but don't give acupuncture intervention and observe the self-voiding time from then.
Observation indexes:time and dose of lumbar spinal anesthesia during the operation; records at each time point indexes after the operation:Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean pressure (MBP) and heart rate (HR); the records on urination condition, urination time and urination volume; other factors such as urination cases, stomach sank and gasteremphraxis, obstacles and comfort and acceptability of urination. Research Results:
All cases were selected the lower limb operations and achieved spinal anesthesia. To observe the time of recovering urination of bladder(beginning time points were anesthesia area at T10 and 20 minutes after spinal anesthesia respectively): Acupunctured GuanYuan, ZhongJi and bilateral GuiLai points by electric stimulation in EA group; No interferential method in control group. Compared two groups in the time of anesthesia area T10 to urination:P=0.004<0.05, the time of 20 minutes after spinal anesthesia to urination:P=0.002<0.05. Both results have statistical significance. cases T10 to urination 20min after anesthesia to urination Treat group 31227.58±77.92356.29±96.99 Control group 30312.50±90.85428.33±71.37 Above data indicated that urination time in treat group was earlier obviously than control group from both recorded points. So EA can decrease the incidence of urinary retention, avoid of inserting catheter during operation and its uncomfortable feeling or infection. This is a better method to prevent urinary retention resulted by spinal anesthesia.
While the drugs will inject into subarachnoid space directly in patients who achieve lower limb-operation by spinal anesthesia, it can lead sympathetic nerve block quickly and a relative cardiac insufficiency, we suggest that mass fluid transfusion treatment after spinal anesthesia is important to prevent hypovolemia. From transfusion volume at the time of T10 and urination after operation, it showed that volume at T10:P=0.446>0.05; at urination:P=0.563>0.05, both of them have no statistical differentiation. Then we observed the urination volume and selected statistic data respectively----divided into≥400ml and<400ml between two groups. According to t test, P=0.569>0.05, no statistic differentiation and X2 test, P=0.002<0.05, has statistic differentiation. cases T10 urination volume volume>400 volume<400 Treat group 311161.29±207.65 1630.65±269.47 339.03±108.49 5 26 Control group30 1126.67±136.29 1673.33±302.78 360.67±179.3816 14 The data above is indicated that no matter treat group or control group, the transfusion volume was related to anesthesia method, especially achieve spinal anesthesia, and therefore, transfusion volume between both of groups has no statistic significance. From the volume of urination, acupuncture relevant points can reduce the recovering time of bladder function and sensitivity, construct urinary reaction quickly underlie the regular urinary capacity, avoid the damage of bladder function from urine retention.
Conclusion:
Electric acupuncture can promote recovering of bladder function effectively which is after spinal anesthesia, has no side effect, and therefore could be utilized widely in clinical field.
蛛网膜下腔阻滞系把局麻药注入蛛网膜下腔,使脊神经根、背根神经节及脊髓表面部分产生不同程度的阻滞,简称脊麻。此种方法适用于大部分下腹部和下肢的手术,均可以取得满意的麻醉效果。当把局麻药注入蛛网膜下腔后,有确切的证据可以表明药物会阻断膀胱的排尿反射,阻断病人下肢及盆底的温、痛、触、肌肉运动、压力及本体感觉,也就势必会造成尿潴留。蛛网下腔阻滞后,尿潴留基于解剖学基础及生理学改变则属于动力性梗阻而导致的排尿困难。况且病人麻醉后正常排尿反射消失,因此发生率较高。膀胱的过度充盈可以合并血液动力学变化,由于腹膜的刺激,可引起血压升高及心率增快,严重者可导致膀胱破裂。目前,临床麻醉工作中普遍采用的预防和治疗腰麻后尿潴留的方法是术前常规插导尿管,根据Haley等报道,非导尿患者尿道感染率为3.1%,单次导尿感染率为1%-5%,而保留导尿者感染率为9.9%；且感染率随导尿管保留时间延长而呈增加。
本课题认为针刺麻醉用于预防及减少腰麻所致尿潴留是一种较好的方法。尿潴留属祖国医学“癃闭”范畴.根据中医学理论,癃闭一证,病位多在膀胱,多因膀胱经气受损,气机不畅,下焦决渎无力,导致尿潴留。通过针刺,可以振奋膀胱经气,使下焦气机通畅,水道通调。针刺水道、归来穴,实因其为疏通膀胱、针刺关元、中极等穴,能温补下焦元气,鼓舞膀胱气化功能,达到启闭通尿的作用。
针刺用于治疗尿潴留前人已经做了大量的研究,经历了多年的临床实践,证明其疗效确切。且具有简便、经济、安全、无扰乱生理功能等特点,可以调整机体生理功能。而电针用于预防及减少腰麻所致尿潴留,可以避免在一些损伤小失血少的手术中,插尿管给病人带来的弊端。减少了泌尿系感染的发生,降低了术后抗生素的使用率,消除了病人因导尿而带来的恐惧心理。提高了手术质量,符合现代麻醉学的发展潮流。
研究目的：
观察电针干预促进腰麻后膀胱功能恢复的疗效和安全性。
研究方法：
病例选择：选择符合纳入标准的择期手术病人共61例,针刺麻醉组31例,对照组30例。
电针方法：治疗组待病人麻醉平面消退到胸10水平时开始取针刺关元、归来、中极等穴位.取主穴：双侧归来穴,配穴：关元、中极。患者仰卧位,局部常规消毒。归来穴取穴,腹股沟中央上1寸,耻骨缘上1寸,旁开2寸,4寸毫针,直刺或向内下刺进针1.5寸,中极穴取穴,下腹部耻骨弓上方膀胱部白线中,脐下4寸,针尖呈45。角向下斜刺,进针1寸,关元穴取穴,腹下部正中线上,中极上1寸,脐下3寸,直刺或向下刺1.5寸,关元、中极及双侧归来穴分别接上韩氏电针仪,频率2HZ,连续波,电流强度2MA起,留针30min。
对照方法：待病人麻醉平面消退到胸10水平时开始记时,但不给予针刺干预,观察平面消退到胸10水平时距离自主排尿时间。
观察指标：病人术中使用腰麻药物的时间和剂量；麻醉后各时间点记录患者收缩压(SBP)、舒张压(DBP)、平均压(MBP)和心率(HR)；术前及术后记录患者排尿情况、排尿时间、尿量等；其它：排尿通畅情况、下腹坠涨、排尿不尽感、舒适度及可接受度等。
研究结果：
统计结果显示,在整个研究过程中,均选用实施下肢手术,且给予蛛网膜下腔麻醉的病人作为研究对象。观察白腰麻平面消退到胸10至病人自主排尿的时间及腰麻后20分钟至病人自主排尿的时间,统计结果显示电针组在麻醉平面消退达胸10时给予电针刺激关元、中极、双侧归来穴。对照组不给予任何干预措施。两组间麻醉平面消退到胸10至排尿时间的比较P=0.000<0.05,两组间腰麻后20分至排尿时间的比较P=0.002<0.05。组间比较有显著性差异。例数胸10至排尿时间腰麻后20分至排尿时间电针组31 227.58±77.92 356.29±96.99对照组30 312.50±90.85 428.33±71.37以上数据说明：从两组间距离自主排尿时间来看,电针刺激关元、中极、双侧归来穴,无论是从麻醉平面胸10开始计时,还是从腰麻后20分钟算起,均有明显的缩短病人自主排尿时间的作用。从而极大的降低了尿潴留的发生,为避免术中插尿管后留置尿管给病人带来不适及感染提供了可能。因此电针预防及降低腰麻术后尿潴留的方法疗效确切。
在蛛网膜下腔麻醉下实施下肢或下腹部手术的病人,因为腰麻药直接注入蛛网膜下腔。短时间内造成广泛的交感神经阻滞,循环代偿时间短,病人循环容量会相对不足。因此腰麻后晶体胶体配比输液,是预防容量不足的重要措施。从腰麻后平面消退达胸10时刻的输液量及术后排尿时刻的输液量统计分析看,两组间比较统计结果显示,输液量在麻醉平面消退到胸10时比较P=0.446>0.05,排尿时输液量比较P=0.563>0.05。无统计学差异。观察记录病人术后自主排尿时的尿量,将电针组及对照组尿量在大于等于400毫升者与小于400毫升者分别计数,进行两组间比较后,统计结果显示,两组间腰麻后排尿时尿量比较经完全随机t检验P=0.569>0.05无统计学差异。两组间腰麻后排尿时尿量按400毫升为限,经卡方检验比较P=0.002<0.05有统计学差异。例数胸10时排尿时尿量尿量>400尿量<400电针组31 1161.29±207.65 1630.65±269.47 339.03±108.49 5 26对照组30 1126.67±136.29 1673.33±302.78 360.67±179.38 16 14以上数据说明：无论是电针观察组还是空白对照组,输液量的多少与麻醉方法的实施相关,腰麻是输液的指症,与电针与否无关。因此输液量两组间比较无差异。从尿量来看针刺相关穴位能够缩短膀胱排尿反射恢复的时间和敏感度,在生理尿量的情况下及时建立排尿反射,极大的避免了尿潴留对膀胱功能的损害。研究结论：电针可有效促进腰麻后患者膀胱功能恢复,无不良反应,可临床推广应用。
Research Background:
Subarachnoid block is to inject the local anesthetic into subarachnoid cavity, which will block the spinal nerve root, the dorsal root ganglion as well as the surface of the spinal cord to various degrees and is called Spinal Cord Paralysis in short form. This method can be applied to the most of operations on hypogastrium and the lower limb and can gain satisfactory anesthesia effect. When the local anesthetic is injected into the subarachnoid cavity, it has been proved that it will block cystic micturition reflex, and also block the lower limbs and the cavitas pelvis of the patients in many aspects such as temperature, pain, touch, muscular movement, pressure and proprioceptive sensibility, which will finally result in the urinary retention. Based on the anatomical basis and the physiological change, the urinary retention is caused by the block with dynamic properties, and the normal micturition reflex disappears after the injection of the anesthetic, which is made it has a high incidence rate. Overfilling of bladder could induce changes of circulation. By stimulation of peritoneum, it can provoke BP to increase and even rupture the bladder seriously.
At present, the regular method to prevent and treat with the urinary retention is to insert the catheter before operation, however, according to the report by Haley et al. that the urethra infection rate was 3.1% in the patients without urethral catheterization, 1——5% in single urethral catheterization and 9.9% in preserving catheter; and infection rate was related to preservation time of catheter. will increase with the prolonging of retention time of urethral catheterization.
Based on the above discussion, the present paper believes that acupuncture is a good way to prevent and reduce urinary retention resulted from lumbar anesthesia.According to the theory of traditional Chinese medicine, the urinary retention belongs to the category of uroschesis. The incidence is related to the urinary obstruction, due to the block in meridians and also closely related to those functions such as the function of triple energizer, lung, spleen, kidney, liver. In the chapter of Reiki Secret Code of Internal Canon of Medicine, it is said that the bladder is the source of body fluid, and the gasification of it reveals the energy. The bladder damp-heat interaction results in adverse gasification, and then the difficulty in urination. The urinary retention, no matter from the operation or the neuro-endocrine factors, results from malfunction in the triple energizer, in the gasification of the bladder and the loss of opening and closing.
There are many researches about acupuncture to treat retention of urine. After years of clinical practices, their curative effect has been proved. It has the features such as being simple, economical, safe and non-disturbing in physiological function, and it can also adjust the body's physiological functions.Using electric acupuncture to prevent and reduce the incidence of urinary retention resulted from lumbar anesthesia can avoid those drawbacks caused by the catheter insertion in some operations with less damage and less blood loss.It can reduce the incidence of urinary tract infections, reduce the utilization rate of postoperative antibiotics, remove the fear of the patients brought by the urethral catheterization and improve the quality of operation,accords with the development trend of modern anesthesia.
Research purpose:
To observe the effect and security of electric acupuncture to interfere in bladder's reconstruction after spinal anesthesia. Research methods:
Cases selection:select 61 patients with the suitable standard and randomized them into EA group and control group,31 in EA group and 30 in control group.
Electric acupuncture methods:the treatment group starts to acupuncture into the acupoints such as Guanyuan, Guilai and Zhongji when the anesthesia area recedes to the level 10 of the chest. The major acupoints are bilateral Guilai acupoints on both sides, and the matching acupoints are Guanyuan and Zhongi. Patients lie supine and the local routine disinfection is conducted.
Locate the Guilai acupoint:one inch above the centre of the groin, one inch on the edge of the pubic bone, and then two inches aside,4 inch acupuncture needle; piercing the needle directly or piercing the needle obliquely inward 1.5-inch.Locate the Zhongji acupoint:the middle of the white line on the bladder above the pubic arch in the hypogastrium,4 inches below the umbilicus; piercing the needle tip obliquely downward 1 inch with an angle of 45 ".Locate the Guanyuan acupoint:the middle line in the hypogastrium,1 inch above the Zhongji acupoint and 3 inches below the umbilicus; piercing the needle directly or obliquely downward 1.5 inches. Connect the HANS electric acupuncture device, with a frequency of 2HZ, continuous wave, current intensity of 2MA, to the acupoints of Guanyuan, Zhongji and Guilai on both sides and keep it for 30 minutes.
Comparing method:start to time when the anesthesia area recedes to the level 10(T10) of the chest, but don't give acupuncture intervention and observe the self-voiding time from then.
Observation indexes:time and dose of lumbar spinal anesthesia during the operation; records at each time point indexes after the operation:Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean pressure (MBP) and heart rate (HR); the records on urination condition, urination time and urination volume; other factors such as urination cases, stomach sank and gasteremphraxis, obstacles and comfort and acceptability of urination. Research Results:
All cases were selected the lower limb operations and achieved spinal anesthesia. To observe the time of recovering urination of bladder(beginning time points were anesthesia area at T10 and 20 minutes after spinal anesthesia respectively): Acupunctured GuanYuan, ZhongJi and bilateral GuiLai points by electric stimulation in EA group; No interferential method in control group. Compared two groups in the time of anesthesia area T10 to urination:P=0.004<0.05, the time of 20 minutes after spinal anesthesia to urination:P=0.002<0.05. Both results have statistical significance. cases T10 to urination 20min after anesthesia to urination Treat group 31227.58±77.92356.29±96.99 Control group 30312.50±90.85428.33±71.37 Above data indicated that urination time in treat group was earlier obviously than control group from both recorded points. So EA can decrease the incidence of urinary retention, avoid of inserting catheter during operation and its uncomfortable feeling or infection. This is a better method to prevent urinary retention resulted by spinal anesthesia.
While the drugs will inject into subarachnoid space directly in patients who achieve lower limb-operation by spinal anesthesia, it can lead sympathetic nerve block quickly and a relative cardiac insufficiency, we suggest that mass fluid transfusion treatment after spinal anesthesia is important to prevent hypovolemia. From transfusion volume at the time of T10 and urination after operation, it showed that volume at T10:P=0.446>0.05; at urination:P=0.563>0.05, both of them have no statistical differentiation. Then we observed the urination volume and selected statistic data respectively----divided into≥400ml and<400ml between two groups. According to t test, P=0.569>0.05, no statistic differentiation and X2 test, P=0.002<0.05, has statistic differentiation. cases T10 urination volume volume>400 volume<400 Treat group 311161.29±207.65 1630.65±269.47 339.03±108.49 5 26 Control group30 1126.67±136.29 1673.33±302.78 360.67±179.3816 14 The data above is indicated that no matter treat group or control group, the transfusion volume was related to anesthesia method, especially achieve spinal anesthesia, and therefore, transfusion volume between both of groups has no statistic significance. From the volume of urination, acupuncture relevant points can reduce the recovering time of bladder function and sensitivity, construct urinary reaction quickly underlie the regular urinary capacity, avoid the damage of bladder function from urine retention.
Conclusion:
Electric acupuncture can promote recovering of bladder function effectively which is after spinal anesthesia, has no side effect, and therefore could be utilized widely in clinical field.
引文
1、刘永红.骨科术后患者尿潴留原因分析及护理[J].中国实用神经疾病杂志,2009,12(14)：73-74
2、刘猷枋,张亚强.中西医结合泌尿外科学[M].第1版.北京：人民军医出版社,2007：46
3、庄心良,曾因明,陈伯銮.现代麻醉学[M].第3版.北京：人民卫生出版社,2003：260
4、刘俊杰,赵俊.现代麻醉学[M].第2版.北京：人民卫生出版社,1997：628
5、张东铭.大肠肛门局部解剖与手术学[M].第4版.合肥：安徽科学技术出版社,2002：282
6、李培.宫颈癌根治术后尿潴留的护理体会[J].中国实用医药,2007,2(19)：24
7、吴绪峰,漆林涛,卢玉兰等.降低宫颈癌术后并发症的几项新技术[J].医学新杂志,1998,8(4)：18
8、肖晓华,徐明芳,李瑞春.电针为主治疗顽固性产后尿潴留的疗效观察[J].针灸临床杂志,2010,26(2)：26—27
9、高桂霞,张新华等.混合痔术后尿潴留的原因分析和护理措施[J].中外医疗,2010,(2)：77
10、于莹.术后病人尿潴留的原因及预防护理[J].护理研究,2005,19(7)：1317-1319
11、吕丽华,张富爱.肛肠手术后尿潴留的观察及护理[J].护理研究,2004,18(8B)：1502
12、刘永红.骨科术后患者尿潴留原因分析及护理[J].中国实用神经疾病杂志,2009,12(14)：73-74
13、刘炼炼,刘榆.骨科患者术后尿潴留原因分析[J].西南军医,2006,8(5)：118-191
14、曹桂华.肛门直肠手术后尿潴留的预防与护理[J].全科护理,2010,8(2)：423-424
15、陈庆霞.开塞露灌肠治疗肛肠病术后尿潴留56例[J].中国肛肠病杂,2001,21(11)：14
16、于莹,侯春颖,郭清阳.术后病人尿潴留的原因及预防护理[J].护理研究, 2005,19(7)：1317-1319
17、胡美玉.留置尿管病人尿路感染的原因分析及预防措施[J].中华护理杂志,2003,38(8)：645-647.
18、俞学红,任旭东,杜燕.导尿与尿路感染的分析[J].护士进修杂志,1996,11(6)：12
19、黄球香.气囊导尿管留置导尿相关问题的分析及预防[J].实用护理杂志,2002,8(3)：4-5
20、蔡柔妹.气囊导尿留置过程中存在的问题与护理对策[J].现代护理,2002,8(6)：421-422
21、王淑朋,李晓玲,齐然.腰麻或硬膜外麻醉患者术后导尿管留置时间的探讨[J].医药世界,11(4)：36
22、陈晚英.针刺三阴交穴治疗骨科手术后尿潴留的体会[J].河南中医,2003,23 (9)：6.
23、郭玉花.针刺照海穴治疗尿潴留[J].江西中医药,2003,23(9)：6.
24、马秀萍.针刺太渊穴为主治疗产后尿潴留58例[J].中国针灸,2005,25(7)：489.
25、针刺加穴位注射治疗尿潴留48例[J].湖北中医杂志,2003,25(6)：53.
26、王颖.针刺治疗产后尿潴留56例[J].辽宁中医杂志,2005,32(6)：570.
27、公方宏,鲁艳丽.针刺治疗产后尿潴留120例[J].国医论坛,2002,17(4)：34.
28、刘瑞华.针刺治疗产后尿潴留49例[J].辽宁中医杂志,2004,31(2)：167.
29、张瑜,雷国华.针刺配合艾灸治疗剖宫产术后尿潴留38例[J]陕西中医,2005,26(5)：451.
30、王振英,王爱法.针灸治疗肛肠病术后尿潴留86例[J].中医外治杂志,2005,14(2)：42.
31、陈瑞.针刺治疗中风后急性尿潴留42例[J].中国中医急症,2005,14(8)：784.
32、吴滨,何竟,冉兴无,等.针药结合治疗糖尿病神经原性膀胱病变20例[J]. 四川中医,2002,20(5)：72.
33、陈仲新.上下配穴法针刺预防产后尿潴留[J].中国针灸,2004,24(3)：172.
34、杨恩华,刘晓安.电针百会、三阴交为主治疗产后尿潴留110例[J].中国医药指南,2005,3(2)：72.
35、陈树扬,黄建莲,纪泽虹,等.腹针疗法缓解产后尿潴留的效果观察[J].护理学杂志(外科版),2005,20(12)：49.
36、纪艳华,刘水香,王霆.针灸治疗尿潴留42例临床观察[J].针灸临床杂志,2003,19(3)：47.
37、温瑞书,张明泉,刘忙柱.手针疗法治疗尿潴留[J].新中医,2003,35(3)：10.
38、杭春平.耳针治疗痔瘘术后尿潴留的耳针、体什治疗对比观察[J].安徽中医临床杂志,2004,35(2)：53.
39、肖晓华,徐明芳,李瑞春.电针为主治疗顽固性产后尿潴留的疗效观察[J].针灸临床杂志,2010,26(2)：26-27
40、何乐中.电针配合艾灸治疗产后尿潴留28例[J].浙江中医杂志,2009,5(44)：358
41.温跃明.电针治疗肛肠病术后急性尿潴留93例[J].新中医1998,4(30)：28
42.赵月玲.关元穴注射治疗术后癃闭36例.辽宁中医杂2004,4(31)：340
43.黄兰,杨云春,杨雪.针灸解除椎管内麻醉术后尿潴留的疗效观察.西部医学2006,5(18)：636
44.孙书香.指压关元穴治疗尿潴留.牡丹江医学院学报.1993.14(2)：115
45、王启才.针灸治疗学[M].第2版.北京：中国中医药出版社,2007：1282005,26(5)：451
46、邓春雷.针刺对延髓排尿中枢和膀胱机能的影响[J].上海针灸杂志,1988,(2)：20-22
[1]陈晚英。针刺三阴交穴治疗骨科手术后尿潴留的体会.河南中医,2003;23(9)：6
[2]郭玉花。针刺照海穴治疗尿潴留[J].江西中医药,2003,23(9)：6.
[3]李敏.李莲.谢远见.针刺治疗尿潴留疗效观察。内蒙古中医药2006.29(7)：2
[4]针刺治疗尿潴留选穴组方概况.高淑红,陆明霞。中国针灸2006年9月第26卷第9期
[5]庄心良,曾因明,陈伯銮主编。现代麻醉学.第3版.北京：北京人民卫生出版
社,2003.1080[6]姚泰主编.人体生理学.第三版2001.1980
2、刘猷枋,张亚强.中西医结合泌尿外科学[M].第1版.北京：人民军医出版社,2007：46
3、庄心良,曾因明,陈伯銮.现代麻醉学[M].第3版.北京：人民卫生出版社,2003：260
4、刘俊杰,赵俊.现代麻醉学[M].第2版.北京：人民卫生出版社,1997：628
5、张东铭.大肠肛门局部解剖与手术学[M].第4版.合肥：安徽科学技术出版社,2002：282
6、李培.宫颈癌根治术后尿潴留的护理体会[J].中国实用医药,2007,2(19)：24
7、吴绪峰,漆林涛,卢玉兰等.降低宫颈癌术后并发症的几项新技术[J].医学新杂志,1998,8(4)：18
8、肖晓华,徐明芳,李瑞春.电针为主治疗顽固性产后尿潴留的疗效观察[J].针灸临床杂志,2010,26(2)：26—27
9、高桂霞,张新华等.混合痔术后尿潴留的原因分析和护理措施[J].中外医疗,2010,(2)：77
10、于莹.术后病人尿潴留的原因及预防护理[J].护理研究,2005,19(7)：1317-1319
11、吕丽华,张富爱.肛肠手术后尿潴留的观察及护理[J].护理研究,2004,18(8B)：1502
12、刘永红.骨科术后患者尿潴留原因分析及护理[J].中国实用神经疾病杂志,2009,12(14)：73-74
13、刘炼炼,刘榆.骨科患者术后尿潴留原因分析[J].西南军医,2006,8(5)：118-191
14、曹桂华.肛门直肠手术后尿潴留的预防与护理[J].全科护理,2010,8(2)：423-424
15、陈庆霞.开塞露灌肠治疗肛肠病术后尿潴留56例[J].中国肛肠病杂,2001,21(11)：14
16、于莹,侯春颖,郭清阳.术后病人尿潴留的原因及预防护理[J].护理研究, 2005,19(7)：1317-1319
17、胡美玉.留置尿管病人尿路感染的原因分析及预防措施[J].中华护理杂志,2003,38(8)：645-647.
18、俞学红,任旭东,杜燕.导尿与尿路感染的分析[J].护士进修杂志,1996,11(6)：12
19、黄球香.气囊导尿管留置导尿相关问题的分析及预防[J].实用护理杂志,2002,8(3)：4-5
20、蔡柔妹.气囊导尿留置过程中存在的问题与护理对策[J].现代护理,2002,8(6)：421-422
21、王淑朋,李晓玲,齐然.腰麻或硬膜外麻醉患者术后导尿管留置时间的探讨[J].医药世界,11(4)：36
22、陈晚英.针刺三阴交穴治疗骨科手术后尿潴留的体会[J].河南中医,2003,23 (9)：6.
23、郭玉花.针刺照海穴治疗尿潴留[J].江西中医药,2003,23(9)：6.
24、马秀萍.针刺太渊穴为主治疗产后尿潴留58例[J].中国针灸,2005,25(7)：489.
25、针刺加穴位注射治疗尿潴留48例[J].湖北中医杂志,2003,25(6)：53.
26、王颖.针刺治疗产后尿潴留56例[J].辽宁中医杂志,2005,32(6)：570.
27、公方宏,鲁艳丽.针刺治疗产后尿潴留120例[J].国医论坛,2002,17(4)：34.
28、刘瑞华.针刺治疗产后尿潴留49例[J].辽宁中医杂志,2004,31(2)：167.
29、张瑜,雷国华.针刺配合艾灸治疗剖宫产术后尿潴留38例[J]陕西中医,2005,26(5)：451.
30、王振英,王爱法.针灸治疗肛肠病术后尿潴留86例[J].中医外治杂志,2005,14(2)：42.
31、陈瑞.针刺治疗中风后急性尿潴留42例[J].中国中医急症,2005,14(8)：784.
32、吴滨,何竟,冉兴无,等.针药结合治疗糖尿病神经原性膀胱病变20例[J]. 四川中医,2002,20(5)：72.
33、陈仲新.上下配穴法针刺预防产后尿潴留[J].中国针灸,2004,24(3)：172.
34、杨恩华,刘晓安.电针百会、三阴交为主治疗产后尿潴留110例[J].中国医药指南,2005,3(2)：72.
35、陈树扬,黄建莲,纪泽虹,等.腹针疗法缓解产后尿潴留的效果观察[J].护理学杂志(外科版),2005,20(12)：49.
36、纪艳华,刘水香,王霆.针灸治疗尿潴留42例临床观察[J].针灸临床杂志,2003,19(3)：47.
37、温瑞书,张明泉,刘忙柱.手针疗法治疗尿潴留[J].新中医,2003,35(3)：10.
38、杭春平.耳针治疗痔瘘术后尿潴留的耳针、体什治疗对比观察[J].安徽中医临床杂志,2004,35(2)：53.
39、肖晓华,徐明芳,李瑞春.电针为主治疗顽固性产后尿潴留的疗效观察[J].针灸临床杂志,2010,26(2)：26-27
40、何乐中.电针配合艾灸治疗产后尿潴留28例[J].浙江中医杂志,2009,5(44)：358
41.温跃明.电针治疗肛肠病术后急性尿潴留93例[J].新中医1998,4(30)：28
42.赵月玲.关元穴注射治疗术后癃闭36例.辽宁中医杂2004,4(31)：340
43.黄兰,杨云春,杨雪.针灸解除椎管内麻醉术后尿潴留的疗效观察.西部医学2006,5(18)：636
44.孙书香.指压关元穴治疗尿潴留.牡丹江医学院学报.1993.14(2)：115
45、王启才.针灸治疗学[M].第2版.北京：中国中医药出版社,2007：1282005,26(5)：451
46、邓春雷.针刺对延髓排尿中枢和膀胱机能的影响[J].上海针灸杂志,1988,(2)：20-22
[1]陈晚英。针刺三阴交穴治疗骨科手术后尿潴留的体会.河南中医,2003;23(9)：6
[2]郭玉花。针刺照海穴治疗尿潴留[J].江西中医药,2003,23(9)：6.
[3]李敏.李莲.谢远见.针刺治疗尿潴留疗效观察。内蒙古中医药2006.29(7)：2
[4]针刺治疗尿潴留选穴组方概况.高淑红,陆明霞。中国针灸2006年9月第26卷第9期
[5]庄心良,曾因明,陈伯銮主编。现代麻醉学.第3版.北京：北京人民卫生出版
社,2003.1080[6]姚泰主编.人体生理学.第三版2001.1980