本文選題：耳穴按壓 + 預(yù)防產(chǎn)后尿潴留��； 參考：《廣州中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：研究背景產(chǎn)后尿潴留是指在陰道分娩后6 h內(nèi)不能排出尿液或剖宮產(chǎn)術(shù)后拔除導(dǎo)尿管后不能自主排尿仍需再次插入導(dǎo)尿管的稱為產(chǎn)后尿潴留[1]。目前一般認(rèn)為是產(chǎn)后6～8 h出現(xiàn)排尿困難,一般表現(xiàn)為尿液排出不暢點滴而下,或完全閉塞不通,伴有小腹脹急疼痛等不適;或產(chǎn)后多日小便不能排盡,彩超或留置導(dǎo)尿測膀胱殘留尿膀胱殘留尿多于100mL。產(chǎn)后尿潴留是產(chǎn)后常見的一種并發(fā)癥,發(fā)生率約14%。產(chǎn)后尿潴留是繼發(fā)產(chǎn)后泌尿系統(tǒng)感染,及產(chǎn)后大出血的重要因素;對產(chǎn)婦產(chǎn)后的的身心健康以及產(chǎn)后的康復(fù)情況產(chǎn)生諸多困擾。臨床目前的處理分為級而來,對于病情稍輕,以熱敷及聽流水聲及局部按摩等輔助治療,鼓勵產(chǎn)婦多做局部肌肉收縮運(yùn)動,促進(jìn)排尿;病情不緩解則采用肌肉注射新斯的明;癥狀進(jìn)一步加重則采用導(dǎo)尿管導(dǎo)尿。對于一般治療臨床首選肌肉注射新斯的明,但療效一般;而留置導(dǎo)尿管則增加產(chǎn)婦泌尿系感染機(jī)率,同時也沒有改變產(chǎn)婦自我排尿的功能,沒有解決根本問題;產(chǎn)后尿潴留發(fā)生,目前的治療措施較局限。國內(nèi)近幾年研究及相關(guān)文獻(xiàn)報道[2]聯(lián)合傳統(tǒng)中醫(yī)的思路及治療方法能提高產(chǎn)后尿潴留和產(chǎn)后疾病的治愈率,并且縮短治療時間,因而可以認(rèn)為采用中醫(yī)的辨證思維,并以此為指導(dǎo),應(yīng)用中醫(yī)傳統(tǒng)療法及西醫(yī)藥物能提高疾病康復(fù)水平,這為產(chǎn)后康復(fù)提供一個人思路。在傳統(tǒng)中醫(yī)理論中提倡未病先防,預(yù)防重于治療的觀點,產(chǎn)婦在分娩過程中耗氣耗血,分娩后的產(chǎn)婦在氣血虛弱情況下,出現(xiàn)產(chǎn)后疾病的概率增加,而如何積極預(yù)防這些產(chǎn)后疾病的發(fā)生,西醫(yī)目前能采用的措施較少。產(chǎn)婦為特殊人群,常規(guī)中藥藥物及針刺艾灸等療法有一定的局限性,因此在傳統(tǒng)療法中尋找一種可簡便操作而且有療效的預(yù)防產(chǎn)后疾病的辦法具有很好的臨床意義。相較傳統(tǒng)療法,耳穴較其他的治療手段方便易操作,容易被產(chǎn)婦接受,耳穴按壓在以往文獻(xiàn)報道[3]中,產(chǎn)科的諸多疾病中運(yùn)用較多,但是對產(chǎn)后尿潴留提及不多,同時一般多用于治療疾病,對于疾病預(yù)防提及很少。而對于產(chǎn)后尿潴留,結(jié)合耳穴的特點,在不影響產(chǎn)婦正常分娩情況下,盡早進(jìn)行耳穴按壓能提高預(yù)防效果;故而考慮可以在第三產(chǎn)程時采用耳穴按壓預(yù)防產(chǎn)后尿潴留。傳統(tǒng)醫(yī)學(xué)認(rèn)為尿潴留的發(fā)生主要是與膀胱失施、三焦的氣化不足有關(guān),同時人體的肺、脾、腎三臟失調(diào)有關(guān);而產(chǎn)婦情況較為特殊,如何預(yù)防產(chǎn)后尿潴留需更全面及整體考慮;根據(jù)已有的文獻(xiàn)研究[4]中的耳穴按壓治療產(chǎn)后尿潴留只選取腎、膀胱等與泌尿系相關(guān)的耳穴,未體現(xiàn)出中醫(yī)整體思路,加之產(chǎn)后一般多虛多瘀,故尿潴留的發(fā)病還與血脈不通、中氣不足大氣陷下等有關(guān),故在預(yù)防產(chǎn)后疾病中,選穴則應(yīng)整體考慮。本課題采用中醫(yī)治未病思路,結(jié)合中醫(yī)整體觀,采用傳統(tǒng)耳穴按壓,探討產(chǎn)后尿潴留的預(yù)防,擬為預(yù)防產(chǎn)后其他疾病提供新的思路。研究目的研究遵循臨床科研設(shè)計和方法,運(yùn)用臨床隨機(jī)對照試驗,本研究通過隨機(jī)對照實驗,于第三產(chǎn)程中應(yīng)用中醫(yī)辨證整體觀采用耳穴按壓,觀察第一、二、三產(chǎn)程時間、新生兒體重、會陰是否側(cè)切、產(chǎn)后2 h出血量、產(chǎn)后6 h、24 h排尿是否順暢、產(chǎn)后6 h及24 hB超殘余尿量,探討第三產(chǎn)程中運(yùn)用耳穴按壓是否能更好減少產(chǎn)后尿潴留的發(fā)生率。以此為據(jù),通過第三產(chǎn)程使用耳穴按壓預(yù)防產(chǎn)后疾病,減少產(chǎn)褥感染及預(yù)防產(chǎn)后大出血,提高產(chǎn)婦產(chǎn)后康復(fù)水平提供基礎(chǔ)。研究方法本研究應(yīng)用隨機(jī)對照臨床試驗,將符合納入標(biāo)準(zhǔn)的研究對象120例,隨機(jī)分為對照組(無任何干預(yù)治療組)、治療組一(耳穴腎+膀胱+三焦按壓)、治療組二(耳穴腎+膀胱+三焦+心+脾+肺按壓)各40例,觀察第一、二、三產(chǎn)程時間、新生兒體重、會陰是否側(cè)切、產(chǎn)后2h出血量、產(chǎn)后6h、24h排尿是否順暢、產(chǎn)后6h及24hB超殘余尿量。建立數(shù)據(jù)庫,統(tǒng)計分析數(shù)據(jù),判定第三產(chǎn)程耳穴按壓預(yù)防產(chǎn)后尿潴留的療效,并三組進(jìn)行對比。研究結(jié)果1、三組病例中在第一產(chǎn)程時間、第二產(chǎn)程時間、新生兒體重、會陰是否側(cè)切的比較,統(tǒng)計結(jié)果無顯著性差異(P0.05);2、三組病例在第三產(chǎn)程時間、產(chǎn)后兩小時出血量比較,二組治療組分別較對照組,第三產(chǎn)程時間、產(chǎn)后兩小時出血量統(tǒng)計有顯著性差異(P0.05),兩組治療組相互比較,第三產(chǎn)程時間、產(chǎn)后兩小時出血量組間統(tǒng)計結(jié)果無顯著性差異(P0.05);3、三組病例在產(chǎn)后6 h、24 h排尿是否順暢、B超產(chǎn)后6 h殘余尿量及24 h殘余尿量比較中,三組在產(chǎn)后6 h、24 h排尿是否順暢、B超產(chǎn)后6 h殘余尿量及24 h殘余尿量差異統(tǒng)計有顯著性差異(P0.05),兩組治療組兩兩比較,產(chǎn)后6 h排尿是否順暢及產(chǎn)后6hB超殘余尿量統(tǒng)計有顯著性差異(P0.05),產(chǎn)后24hB超殘余尿量及產(chǎn)后24h排尿是否順暢統(tǒng)計結(jié)果無顯著性差異(P0.05)。結(jié)論耳穴按壓能促進(jìn)產(chǎn)后排尿,對產(chǎn)后尿潴留、產(chǎn)后出血有預(yù)防作用,并能減少第三產(chǎn)程時間;辨證選用穴位能提高預(yù)防效果;但對已發(fā)生的產(chǎn)后尿潴留,耳穴按壓作用欠佳。
[Abstract]:Research background postpartum urine retention is the 6 h after vaginal delivery can not discharge urine or cesarean section after the extraction of urethral catheter can not be extracted after the urethral catheterization still need to insert urethral catheter again called postpartum urinary retention [1]. is generally considered to be postpartum urination difficulties, generally showing the urine excretion of unobstructed drops, or complete occlusion Discomfort, accompanied by abdominal distention and pain, etc., or multi day postpartum urine can not be exhausted, color Doppler ultrasound or indwelling catheterization for residual urinary bladder residual urine more than 100mL. postpartum urinary retention is a common postpartum complication, the incidence of 14%. postpartum urinary retention is secondary postpartum urinary system infection, and postpartum hemorrhage important factors; to parturients The physical and mental health of the postpartum and the postpartum recovery have a lot of trouble. The treatment of the clinic is divided into grade, which is slightly lighter, with the aid of hot compress and hearing water sound and local massage, encourage the parturient to do the local muscle contraction and promote urination. Step aggravation is the use of urinary catheter catheterization. For general treatment, the first choice of intramuscular injection of neostigmine, but the curative effect is general, but the indwelling catheter increases the probability of maternal urinary infection, at the same time it does not change the function of parturients' self urination, does not solve the fundamental problem; postpartum retention occurs, the current treatment measures are limited. In recent years, the domestic treatment measures are limited. The thought and treatment of traditional Chinese medicine ([2]) combined with traditional Chinese medicine can improve the cure rate of postpartum urine retention and postpartum diseases, and shorten the treatment time. Therefore, it can be considered that the dialectical thinking of traditional Chinese medicine can be used as a guide, and traditional Chinese medicine and Western medicine can be used to improve the recovery level of the disease, which is the postpartum health. In the traditional theory of traditional Chinese medicine, we advocate the prevention of disease first, the prevention of heavy than treatment, maternal consumption of blood in the process of childbirth, the incidence of postpartum diseases after childbirth is increased, and how to prevent these postpartum diseases actively, the measures that western medicine can adopt are less. As a special group, traditional Chinese medicine and acupuncture and moxibustion have some limitations. Therefore, it is of great clinical significance to find a simple and effective way to prevent postpartum diseases in traditional therapy. Compared with traditional therapy, the ear acupoint is easier to operate than other treatment methods, and it is easily accepted by the parturient. Acupoint press in the previous literature report [3], many obstetric diseases are used more, but the postpartum urine retention is not mentioned much, at the same time, it is usually used to treat diseases, and the prevention of disease is seldom mentioned. In order to prevent the effect, it is considered that the auricular acupoint pressure can be used to prevent the retention of postpartum urine in the third course of labor. Traditional medicine believes that the occurrence of urinary retention is mainly related to the inadequacy of bladder application, the insufficiency of the gasification of the triple coke, and the three dirty disorders of the lung, spleen and kidney of the human body; and the maternal situation is more special, and how to prevent postpartum retention needs a more comprehensive and overall examination. According to the existing literature, the study on the treatment of postpartum urine retention in [4] is only the selection of kidney, bladder and other auricular points related to urinary system, which does not reflect the whole idea of traditional Chinese medicine, and the general deficiency and blood stasis after postpartum, so the incidence of urinary retention is also related to the inability of blood vessels and the lack of air depression, so the selection of points should be in the prevention of postpartum diseases. Overall consideration. This subject uses traditional Chinese medicine to cure the disease, combined with the overall view of traditional Chinese medicine, and adopts the traditional auricular acupoint press to discuss the prevention of postpartum urinary retention. The purpose of this study is to provide new ideas for the prevention of other postpartum diseases. In the third course of labor, the application of TCM syndrome differentiation on the basis of auricular acupoint press, observation of first, second, three period of labor, newborn weight, perineum side cut, postpartum 2 h hemorrhage, 6 h after postpartum, 24 h urination, 6 h and 24 hB after postpartum urine residual urine, explore the possibility of using auricular point pressing to reduce postpartum urinary retention in the third production process According to this, the basis of using auricular acupoint pressing to prevent postpartum diseases, reducing puerperium infection and preventing postpartum hemorrhage, and raising the level of postpartum recovery of puerpera were provided by the third process. A randomized controlled clinical trial was used in this study, and 120 cases were randomly divided into the control group (without any intervention treatment group). The treatment group (auricular kidney + bladder + triple coke Press), the treatment group two (auricular kidney + bladder + triple coke + heart + spleen + lung Press) each, observe first, second, three process time, newborn weight, perineum side cut, postpartum 2H bleeding, postpartum 6h, 24h urination is smooth, postpartum 6h and 24hB ultra residual urine volume. Establish a database, statistical analysis data, determination The effect of third process ear acupoint pressing on prevention of postpartum urinary retention was compared. The results were compared between the three groups. The results of the study were 1. In the three cases, there was no significant difference in the first labor time, the second labor time, the weight of the newborn and the lateral perineum (P0.05); 2, the three groups were in third labor time and two hours after postpartum hemorrhage, two Group treatment group compared with the control group, third period of labor time, two hours after postpartum hemorrhage statistics have significant difference (P0.05), two groups of treatment groups, third labor time, two hours after postpartum hemorrhage group statistical results of no significant difference (P0.05); 3, three groups of cases in the postpartum 6 h, 24 h urination is smooth, B-mode postpartum 6 h residual urine volume and 6 h postpartum and the residual urine volume and 24 h residual urine volume, three groups in postpartum 6 h, 24 h urination is smooth, postpartum 6 h residual urine volume and 24 h residual urine volume difference statistically significant difference (P0.05), two groups of treatment group 22 comparison, postpartum 6 h micturition is smooth and postpartum 6hB ultra residual urine statistics have significant difference (P0.05), postpartum 24hB ultra residual urine volume and postpartum 2 The results of 4H urination have no significant difference (P0.05). Conclusion auricular acupoint pressing can promote postpartum urination, have preventive effect on postpartum urine retention, postpartum hemorrhage, and reduce third period of labor; differentiation of points can improve the effect of prevention, but the effect of postpartum retention of postpartum urine is not good.
【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R714.64

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