【摘要】：研究背景和目的術(shù)后惡心嘔吐(Postoperative nausea and vomiting,PONV)是患者手術(shù)后常見的不良反應(yīng),不但給病人帶來(lái)巨大痛苦,也會(huì)延長(zhǎng)住院時(shí)間和患者的康復(fù),還有可能造成不可想象的后果。因此如果能盡快讓患者恢復(fù)康復(fù),術(shù)后惡心嘔吐的預(yù)防及治療必不可少。盡管可用藥物眾多,但至今沒(méi)有明確某類藥物最適合于特定患者或特定手術(shù),大量使用同類藥物,不能有效減少PONV發(fā)生,聯(lián)合不同藥物又有可能增加副作用。近年來(lái)非藥物治療受到關(guān)注,中醫(yī)傳統(tǒng)療法與穴位刺激結(jié)合,穴位刺激與內(nèi)臟關(guān)系密切,對(duì)機(jī)能起到調(diào)節(jié)作用。中醫(yī)中內(nèi)關(guān)穴取穴方便易于操作和暴露,本研究旨在通過(guò)觀察子宮全切患者佩戴壓力腕帶是否能預(yù)防和減輕子宮全切術(shù)后惡心嘔吐,進(jìn)而探討中醫(yī)內(nèi)關(guān)穴位刺激對(duì)防治子宮全切患者PONV的可行性,也為后續(xù)相關(guān)推廣和研究提供一定的參考。對(duì)象與方法經(jīng)鄭州大學(xué)第二附屬醫(yī)院倫理委員會(huì)批準(zhǔn),選取鄭州大學(xué)第二附屬醫(yī)院2016年3月至7月在我院接診并收治的子宮肌瘤和/或子宮腺肌病患者82例進(jìn)行研究,篩選條件為:ASA分級(jí)Ⅰ~Ⅱ級(jí),無(wú)高血壓病史,年齡30~65歲,體重50~80kg,選擇將患者按隨機(jī)數(shù)字表法分為研究組A組和對(duì)照組C組各41例。對(duì)照組C組術(shù)后采用鎮(zhèn)痛泵鎮(zhèn)痛,鎮(zhèn)痛泵的配方為舒芬太尼2μg/kg+托烷司瓊4mg+地塞米松10mg;研究組A組在對(duì)照組的基礎(chǔ)上在患者內(nèi)關(guān)穴上貼上壓力腕帶。記錄患者包括年齡、疾病類型、身高、手術(shù)時(shí)間、體重、出血量等相關(guān)內(nèi)容,分別于術(shù)后12h、24h、48h評(píng)定患者的惡心、嘔吐情況,采用SAS和SDS分別于手術(shù)前和手術(shù)后48h評(píng)價(jià)患者抑郁、焦慮及術(shù)后治療不良反應(yīng)發(fā)生情況。本研究數(shù)據(jù)均采用SPSS 22.0進(jìn)行統(tǒng)計(jì)學(xué)處理,計(jì)量資料如:年齡、身高、體重、手術(shù)時(shí)間、出血量書寫格式為均值±標(biāo)準(zhǔn)差,并使用t檢驗(yàn),計(jì)數(shù)資料如:疾病類型、嘔吐及不良反應(yīng)發(fā)生率采用百分比表示,用χ2檢驗(yàn),等級(jí)數(shù)據(jù)如ASA分級(jí)、惡心、焦慮及抑郁程度采用Ridit值計(jì)算,組內(nèi)不同時(shí)間數(shù)據(jù)比較采用單因素方差檢驗(yàn),組間比較采用獨(dú)立樣本t檢驗(yàn),均以P0.05為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果1.兩組患者基本情況差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。2.研究組A組術(shù)后12h惡心發(fā)生例數(shù)及惡心程度分級(jí)低于對(duì)照組C組,差異有統(tǒng)計(jì)學(xué)意義(P0.05);術(shù)后24h惡心發(fā)生例數(shù)及程度分級(jí)低于對(duì)照組C組,差異有統(tǒng)計(jì)學(xué)意義(P0.01);術(shù)后48h惡心發(fā)生例數(shù)及程度分級(jí)低于對(duì)照組C組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。3.研究組A組在12h、24h、48h嘔吐人數(shù)總發(fā)生率低于對(duì)照組C組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。4.兩組術(shù)前抑郁程度和焦慮程度差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);A組術(shù)后48h抑郁程度和焦慮程度均低于C組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。5.術(shù)后不良反應(yīng)發(fā)生率研究組A組低于對(duì)照組C組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論內(nèi)關(guān)穴穴位刺激可安全用于子宮切除患者,能夠降低子宮全切術(shù)后PONV的發(fā)生率及其程度,緩解患者不良情緒,減少術(shù)后不良反應(yīng),效果安全有效,具有臨床推廣價(jià)值。
[Abstract]:BACKGROUND AND OBJECTIVE Postoperative nausea and vomiting (PONV) is a common adverse reaction after surgery. PONV not only brings great pain to patients, but also prolongs hospitalization time and recovery of patients, and may have unimaginable consequences. Therefore, if patients can recover as soon as possible, postoperative nausea and vomiting will occur. Although there are many available drugs, it is not clear that a certain kind of drug is most suitable for a particular patient or surgery. The large number of similar drugs can not effectively reduce the incidence of PONV, and the combination of different drugs may increase side effects. Neiguan acupoint selection is convenient and easy to operate and expose. The purpose of this study is to observe whether wearing pressure wristband can prevent and alleviate nausea and vomiting after hysterectomy, and further explore the effect of Neiguan acupoint stimulation on prevention and treatment of total hysterectomy. Objectives and Methods With the approval of the Ethics Committee of the Second Affiliated Hospital of Zhengzhou University, 82 patients with uterine leiomyoma and/or adenomyosis who were admitted to our hospital from March to July 2016 were selected to study. ASA grade I-II, no history of hypertension, age 30-65 years old, weight 50-80 kg, selected patients according to random number table method for study group A and control group C 41 cases each. Control group C postoperative analgesia pump, analgesia pump formula for sufentanil 2 ug/kg + tropisetron 4 mg + dexamethasone 10 mg; The patients were recorded including age, disease type, height, operation time, weight, bleeding volume and other related contents. Nausea and vomiting were assessed at 12, 24 and 48 hours after operation. Depression, anxiety and adverse reactions were evaluated by SAS and SDS before operation and 48 hours after operation respectively. Data in this study were statistically analyzed by SPSS 22.0. Measurements such as age, height, weight, operation time, bleeding volume were written in a mean (+ standard deviation) format, and t test was used. Data such as disease type, vomiting and adverse reaction rate were expressed by percentage, and_2 test, grade data such as ASA classification, nausea were used. Results 1. There was no significant difference in the basic condition between the two groups (P 0.05). 2. The number of nausea cases and the degree of nausea 12 hours after operation in group A. Grading was lower than the control group C, the difference was statistically significant (P 0.05); postoperative 24 hours of nausea and degree of classification lower than the control group C, the difference was statistically significant (P 0.01); postoperative 48 hours of nausea and degree of classification lower than the control group C, the difference was statistically significant (P 0.05). 3. Study group A in 12 hours, 24 hours, 48 hours of total incidence of vomiting. There was no significant difference in preoperative depression and anxiety between the two groups (P Conclusion Neiguan acupoint stimulation can be safely used in patients with hysterectomy, can reduce the incidence and degree of PONV after total hysterectomy, alleviate patients'bad mood, reduce postoperative adverse reactions, the effect is safe and effective, with clinical popularization value.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R614

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