耳穴压丸治疗功能性便秘的临床观察

[目的]观察耳穴压丸治疗功能性便秘的疗效。[方法]将功能性便秘病人80例随机分成两组,治疗组40例,采用王不留行耳穴贴压大肠、三焦、皮质下、交感、直肠下段为主穴、便秘点,配以肝、脾、肺、胃、内分泌等穴位治疗;对照组40例,只进行常规护理健康指导,不进行任何治疗干预。[结果]治疗组治愈率95%,对照组55%,两组间疗效差异有统计学意义(P<0.01)。[结论]耳穴压丸法治疗功能性便秘的疗效确切。     

耳穴压丸治疗功能性便秘的临床观察

[目的]观察耳穴压丸治疗功能性便秘的疗效。[方法]将功能性便秘病人80例随机分成两组,治疗组40例,采用王不留行耳穴贴压大肠、三焦、皮质下、交感、直肠下段为主穴、便秘点,配以肝、脾、肺、胃、内分泌等穴位治疗;对照组40例,只进行常规护理健康指导,不进行任何治疗干预。[结果]治疗组治愈率95%,对照组55%,两组间疗效差异有统计学意义(P<0.01)。[结论]耳穴压丸法治疗功能性便秘的疗效确切。     

基于数据挖掘的耳穴疗法治疗便秘的选穴规律分析

目的通过数据挖掘分析耳穴疗法治疗便秘的选穴规律。方法检索建库以来至2020年9月30日中国期刊全文数据库(CNKI)、维普中文科技期刊数据库(VIP)、万方学术期刊全文数据库(Wanfang)、中国生物医学文献数据库(SinoMed)、PubMed数据库收录的耳穴治疗便秘的临床试验研究文献,采用Microsoft Excel 2016建立数据库,应用SPSS 23.0软件对高频耳穴、耳穴组合、耳穴常用科室进行频数统计,运用SPSS Modeler 18.0软件对相关耳穴进行关联规则分析,通过R 4.0.3软件进行耳穴集合可视化分析及耳穴网络分析。结果本研究共纳入562篇文献,包含61个耳穴,其中累计应用频次较高的耳穴为大肠(95.56%)、直肠(75.63%)、脾(66.90%)、三焦(60.67%)、肺(53.56%);耳穴治疗便秘患者的科室以肛肠科、脑病科、骨伤科多见;耳穴配伍以大肠和三焦最为常见;常见的耳穴组合为大肠、直肠、交感。结论耳穴疗法治疗便秘以中医辨证原则为指导,取穴以大肠为基础,并根据不同基础疾病灵活配伍随症选穴。基于数据挖掘探析耳穴疗法治疗便秘的选穴、配伍规律具有可行性,可为临床研究提供参考。     

耳穴贴压缓解化疗致恶心、呕吐的文献分析

[目的]了解和分析我国中医护理技术耳穴贴压缓解肿瘤化疗所致恶心、呕吐干预性研究的现状及存在的问题,为今后的研究和临床工作提供依据和方向。[方法]以"恶心、呕吐""胃肠道反应""化疗""耳穴"为主题词,从中国期刊全文数据库(CNKI)、万方数据库、维普数据库及中国生物医学数据库(CBM)检索相关文献,采用EndNote X3软件查重,采用Excel软件进行统计分析。[结果]共检索出52篇有效文献;研究证实耳穴贴压能有效缓解化疗所致恶心、呕吐情况,但大部分文献未对恶心、呕吐进行分类,分别观察干预效果;耳穴贴压在选穴、按压频率、开始时间、疗程等方面缺乏统一标准;文献质量一般,未达到循证要求。[结论]耳穴贴压能有效缓解化疗所致恶心、呕吐已得到证实,但在文献质量及耳穴贴压标准化研究方面,可从严格的实验设计、客观的评价指标、标准实施方案等方面进行更深入研究。     

耳穴贴压治疗气虚血瘀型中风患者便秘的疗效观察

目的:观察耳穴贴压对气虚血瘀型中风患者便秘的疗效。方法:选择气虚血瘀型中风后出现便秘的患者120例,随机分为观察组60例和对照组60例,观察组实行耳穴贴压王不留行籽,主穴:大肠、小肠、直肠、三焦,配穴:内分泌、肺、脾、肾。并同时予健康指导。对照组仅对患者进行健康指导。干预60d后,比较2组临床疗效,便秘症候改善程度。结果:观察组和对照组有效率分别为98.3%和75%,2组间疗效有统计学意义(P0.05)。结论:耳穴贴压对气虚血瘀型中风患者便秘的疗效良好,无不良反应。     

癌症病人阿片类药物相关性便秘最佳循证实践方案的制订和应用

[目的]制定癌症病人阿片类药物相关性便秘管理的最佳循证实践方案,并应用于临床。[方法]检索相关领域的临床实践指南、系统评价等循证资源,获取最佳证据并进行分析,形成"癌症病人阿片类药物相关性便秘管理的最佳实践方案",将该方案应用于入住放疗科的癌症病人中检验其效果。[结果]跟踪随访8周后,观察组便秘发生率为26. 53%,显著高于对照组(54. 90%),观察组肠功能指数评分显著低于对照组,生活质量评分[(77. 77±11. 13)分]显著高于对照组[(62. 07±10. 52)分],差异均有统计学意义(P0. 05)。[结论]基于循证的最佳实践方案可改善癌症病人阿片类药物相关性便秘的症状,提升病人的生活质量,为此类病人的临床管理提供依据及参考。     

循经按摩配合耳穴贴压治疗阿片类药物所致脾肾亏虚型便秘的疗效观察

目的 探讨循经络按摩配合耳穴贴压治疗阿片类药物所致便秘的应用效果。方法 2012年1月～2014年1月在我院肿瘤康复科接受阿片类药物镇痛治疗的肿瘤中重度癌痛便秘患者，选取90例辨证为脾肾亏虚型的患者为研究对象，采用抽签法，随机分为两组，治疗组46例、对照组44例。治疗组采用循经络按摩配合耳穴贴压治疗，对照组口服通便灵胶囊治疗。两组患者均参照中药新药治疗便秘的临床研究指导原则的疗效评价标准进行疗效评价，统计两组患者便秘治疗的有效率，并行统计学分析，观察时间为4周。结果 便秘改善总有效率治疗组为95．7％，对照组为86．4％，两组比较差异有统计学意义（P＜0．05）。结论 循经络按摩配合耳穴贴压治疗阿片类药物所致便秘，远期疗效优于口服药通便治疗。     

辨证耳穴贴压对改善慢性肾病患者便秘的作用

目的观察辨证选穴用药的耳穴贴压方法对改善慢性肾病患者便秘的作用。方法选择2007年1月-2008年10月在我院住院的慢性肾病且有便秘症状患者120例,根据证型分为虚证60例,实证60例;组内随机分为试验组与对照组各30例。在常规治疗的基础上,实证试验组选取“大肠、小肠、直肠、肺、三焦、胃”等耳穴以六神丸压贴;虚证试验组选取“大肠、小肠、直肠、脾、肾、内分泌”等耳穴,以磁珠压贴;对照组不采用耳穴贴压,在需要时以灌肠或泻药通便。观察患者治疗前后的排便次数、排便难易程度及腹胀、纳减等主要症状,以及肾功能指标的变化。结果两组试验组和对照组患者疗程后便秘症状比较差异有统计学意义（P〈0．01）;纳减改善也优于对照组（P〈0．05）。实证试验组与对照组患者疗程后血尿素氮（BUN）和虚证试验组与对照组患者血尿酸（SUA）比较差异有统计学意义（P〈0．05）;其他实验室肾功能指标比较差异均无统计学意义（P〉0．05）。结论辨证用药选取相应耳穴贴压,可明显改善慢性肾病患者的便秘症状,改善纳食情况;耳穴贴压技术简便易行,对改善慢性肾病患者的便秘症状具有积极的作用。     

中医技术耳穴贴压对脑卒中病人便秘疗效的Meta分析

[目的]评价耳穴贴压治疗脑卒中便秘的疗效。[方法]计算机检索PubMed、EMbase、CBMdisc、万方数据库、维普网、中国知网全文数据库(CNKI)、中国生物医学文献数据库(CBM)中关于耳穴贴压治疗脑卒中便秘的随机对照临床试验。采用Cochrane手册5.1.0推荐的偏倚风险评估对纳入的文献进行质量评价,用RevMan5.3软件进行Meta分析,对不能合并的文献采用描述性分析。[结果]共纳入7个随机对照试验,实验组290例,对照组289例,6个研究报告了临床有效率,5个研究报告了痊愈率,Meta分析结果显示,耳穴贴压组临床有效率优于常规护理组(Z=6.93,P0.01),耳穴贴压组痊愈率优于常规护理组(Z=4.22,P0.01)。[结论]护理常用中医技术耳穴贴压治疗脑卒中便秘的疗效优于常规护理,且耳穴贴压有可能减少西药副作用的产生。     

基于数据挖掘技术探讨耳穴疗法干预疲劳的选穴规律

目的:基于数据挖掘技术，探索耳穴疗法干预疲劳的常用选穴，分析不同疲劳类型耳穴疗法干预规律。方法:检索中国知网期刊全文数据库、万方数据库、中文科技期刊数据库、中国生物医学文献服务系统、PubMed、EMbase、CINAHL数据库，检索时限为建库至2022年10月23日。对耳穴疗法的频次和规律进行总结，并分析耳穴选穴方案之间的关联性。结果:共纳入文献37篇，提取耳穴处方44项，涉及耳穴18种，应用频次排名前10位的耳穴依次是脾、肝、肾、皮质下、神门、心、交感、内分泌、肺、胃；耳穴贴压是主要疗法，耳穴总刺激量多分布在8～30 d，单日刺激频数多集中在1～<3次，单次刺激时长多集中在3～6 min；关联规则分析有13条强关联配伍。结论:耳穴疗法干预疲劳的常用选穴为脾、肝、肾、皮质下等，主要疗法为耳穴贴压，通过数据挖掘技术可发现耳穴疗法干预疲劳的规律，加深对耳穴疗法缓解疲乏的认识，为优化临床应用提供理论指导。     

Antagonistes opioïdes et constipation

Constipation is a common adverse effect associated with opioid therapy; it is mediated primarily by stimulation of opioid receptor in the gastrointestinal tract. In patients with pain, uncontrolled constipation can add to their discomfort and may serve as a barrier to effective pain management, limiting therapy, or prompting discontinuation. Prolonged-release of naloxone and methylnaltrexone are effective, respectively, for preventing and treating the symptoms of constipation in patients treated with opioids. Early studies confirm that they are effective without entering the central nervous system and affecting analgesia. With a better understanding of the prevalence and pathophysiology of opioid-induced constipation, a new approach to reducing and treating constipation is also possible and will likely improve the quality of life of patients with pain.     

Development of a protocol to prevent opioid-induced constipation in patients with cancer: a research utilization project

Opioids are the major class of analgesics used in the management of moderate to severe cancer pain, and constipation is a common side effect of opioid administration. While monitoring for quality-assurance, nurses found that 95% of patients interviewed on a 28-bed oncology unit of a Midwestern hospital reported constipation as the major side effect of their opioid regimen for pain control. Through the efforts of a nursing research utilization committee, a protocol to prevent opioid-induced constipation in patients with cancer was developed and implemented.     

Methylnaltrexon

Chronic pain patients using opioids frequently suffer from constipation which compromises well-being. Such an opioid-induced gastro-intestinal complication can occur regularly in patients in palliative care as well as in analgesic sedated intensive care patients or during prolonged perioperative pain therapy. Discomfort and distress in the affected patients can be so severely pronounced that they would rather suffer from the pain than from the side effect of constipation. Conventional therapy can be insufficient in providing satisfactory relief of constipation, mostly because this opioid-induced bowel hypomotility can be laxative-resistant. Moreover, constipation does not decrease during the course of therapy as do other side effects. It is well known that opioid-induced constipation is mediated via activation of µ-opioid receptors in the gastrointestinal tract. Selective peripheral µ-receptor antagonists (such as methylnaltrexone, Relistor®) can effectively treat opioid-induced constipation. An interference with central analgesia does not occur as the molecules cannot pass the blood-brain barrier due to their charged states. A reduction of opioid therapy or the development of withdrawal symptoms can be avoided. Studies have shown that methylnaltrexone is not only safe and efficient for chronically constipated palliative care patients but offers promising therapeutic options for further patient collectives.     

Opioid antagonists in the treatment of opioid-induced constipation and pruritus

OBJECTIVE: To describe the role of opioid antagonists in the treatment of opioid-induced constipation and pruritus. DATA SOURCES: A MEDLINE search was performed (1966-February 2000) for narcotics and opioid antagonists. Results were limited to English-language and clinical trials. Background information was obtained from pharmacology and pharmacotherapy references and review articles. Hand searching of selected bibliographies yielded several references. STUDY SELECTION AND DATA EXTRACTION: Studies were reviewed that examined the use of naloxone, naltrexone, and methylnaltrexone for opioid-related constipation and pruritus. Selected citations included various clinical trials and case series. DATA SYNTHESIS: Opioid agents are used for cancer and nonmalignant pain. Peripheral opioid receptor stimulation due to endogenous (i.e., endorphins) or exogenous (i.e., morphine) stimulants may result in negative adverse effects, including constipation and pruritus. Adjuvant agents, such as laxatives and antihistamines, are often used to treat these adverse effects, but are themselves associated with adverse effects and are sometimes ineffective. Opioid antagonists have demonstrated reversal of peripheral opioid receptor stimulation. Clinical trials show adequate maintenance of pain control, as well as decreases in opioid-induced constipation and pruritus. CONCLUSIONS: Opioid antagonists offer a therapeutic alternative to conventional adjuvant agents, with the risk of loss of analgesia at higher doses. Methylnaltrexone offers the advantage of peripheral action only, therefore not reversing analgesia. Results are promising; however, larger clinical trials are necessary before opioid antagonists become the standard of care for opioid-induced constipation and pruritus.     

Opioid-induced constipation in intensive care patients: relief in sight?

Constipation is the most common gastrointestinal complication associated with opioid therapy in chronic pain patients, and also frequently occurs in sedated intensive care unit patients. Conventional therapy may not provide sufficient relief from constipation, which can be severe enough to limit opioid use or the dose. In a recent study on terminally ill patients suffering from laxative-resistant opioid-induced constipation, Thomas and colleagues demonstrated subcutaneous methylnaltrexone to rapidly induce defecation. This appealing result might also have favourable prospects for intensive care patients, as their outcome is often codetermined by recovery of bowel functioning.     

Subcutaneous methylnaltrexone for the treatment of opioid-induced constipation in patients with advanced illness: a double-blind, randomized, parallel group, dose-ranging study

Methylnaltrexone, a peripherally-acting quaternary opioid antagonist, is an investigational treatment for opioid-induced constipation in patients with advanced illness. This randomized, parallel-group, repeated dose, dose-ranging trial included a double-blind phase for one week followed by an open-label phase for a maximum of three weeks. Opioid-treated patients with advanced illness who met criteria for opioid-induced constipation despite laxative therapy were potentially eligible. Double-blind treatment occurred on Days 1, 3, and 5; open-label therapy could be administered as often as every other day. The initial dose range of 1 mg, 5 mg, or 12.5 mg was extended by adding a 20 mg group during the study while still maintaining the double blind; the initial open-label dose of 5 mg could be titrated. The primary outcome was a laxation response within four hours after the first dose. Thirty-three patients received at least one dose of methylnaltrexone. Only one of 10 patients (10%) who received the 1 mg dose experienced laxation within four hours of dosing. The median time to laxation was >48 hours for the 1 mg dose group, compared to 1.26 hours for all patients receiving ≥5 mg (P = 0.0003). There was no apparent dose–response above 5 mg. Most adverse events were related to the gastrointestinal system, were mild, and did not lead to discontinuation. In conclusion, methylnaltrexone relieved opioid-induced constipation at doses ≥5 mg in patients with advanced illness, and did not reduce analgesia or cause opioid withdrawal symptoms.     

对王不留行耳穴压丸防治骨科患者便秘作用的探讨

目的减轻患者痛苦,提高患者的舒适度,预防由于便秘导致的各种并发症,减轻患者对药物的依赖心理及其他不良反应。方法采用王不留行耳穴压丸法进行对照研究,将1999年1～3月的骨科便秘患者（除截瘫外）随机分为耳穴压丸治疗组和常规治疗组（n＝50）;将1999年4～9月收治的骨科卧床患者（除截瘫外）随机分为便秘耳穴压丸预防组和对照组（n＝100）。耳穴压丸治疗组和常规治疗组的对象均为便秘3～10d患者（除截瘫外）。结果耳穴压丸治疗组有效率为96％,常规治疗组有效率为62％,差异有显著性（P＜0．01）;便秘预防组有效率为100％,对照组的便秘发生率为62％,差异有显著性（P＜0.001）。结论耳穴压丸对于预防和治疗骨科患者便秘有显著效果。     

耳穴贴压配合中医护理对糖尿病肾病血液透析患者高血压的影响

目的:探讨耳穴贴压配合中医护理对糖尿病肾病(DN)血液透析患者高血压的影响。方法:将DN患者85例随机分成对照组42例和治疗组43例,对照组给予常规治疗及口服降压药,治疗组在此基础上加用耳穴贴压配合中医护理疗法。结果:治疗组有效率为79.1%,对照组为57.1%,两组结果比较差异有统计学意义(P<0.05);治疗组头晕恶心、心律失常、心力衰竭发生率明显低于对照组(P<0.05)。结论:耳穴贴压配合中医护理能有效降低糖尿病肾病血液透析患者的高血压,减少并发症,提高患者生活质量。     

耳穴疗法对精神分裂症患者预防便秘效果的研究

目的 了解耳穴疗法对精神分裂症患者便秘的预防效果.方法 以200例使用抗精神病药物的精神分裂症患者为研究对象,随机分为干预组和对照组各100例,干预组采用常规治疗加耳穴疗法,对照组采用常规治疗,观察2组患者便秘的发生率.结果 干预组经干预后便秘发生率为11.34%,对照组便秘发生率为36.73%,2组患者差异显著.而且耳穴疗法对不同药物所致便秘疗效不同,尤其对氯氮平、氯丙嗪、喹硫平所致便秘疗效较好,2组比较差异显著. 结论 耳穴疗法预防抗精神病药物所致便秘疗效好,痛苦与不良反应少,操作简单、安全,同时能有效改善患者的服药依从性,对临床使用抗精神病药物,促进精神病患者的康复起到积极的作用.