热疗贴贴敷神阙穴防治吻合器痔上黏膜环切术中牵拉反射的临床观察

目的:探讨吻合器痔上黏膜环切术中应用热疗贴贴敷神阙穴防治术中牵拉反射的临床疗效、贴敷时机、可行性和安全性。方法:采用单中心、随机、平行对照的临床研究方法,将纳入的拟行吻合器痔上黏膜环切术的100例患者按照随机数字法分为4组:术前1h贴敷组、术前0.5h贴敷组、术时贴敷组及不贴敷组,每组25例,各组行标准吻合器痔上黏膜环切术。记录4组患者吻合器痔上黏膜环切术吻合前后平均动脉压、心率、血氧饱和度的变化,统计临床疗效,并观察各组术中和术后24h内疼痛及不良反应发生情况。结果:术前0.5h贴敷组防治牵拉反射的显效率较其它组更为明显(P<0.01),且术前0.5h贴敷组行吻合器痔上黏膜环切术时血压、心率最稳定,术中疼痛程度也低于其它组,且不良反应发生率较低。结论:吻合器痔上黏膜环切术术前0.5h神阙穴贴敷热疗贴是较理想的贴敷时机,可以较安全有效地预防和减轻术中的牵拉反射。

Effect of Preconditioning of Thermopaste Application at Shenque (CV 8) on Stretch Reflex Induced by Procedure for Prolapse and Hemorrhoids in Patients with Hemorrhoids

Objective To observe clinical effect,feasibility and security of preconditioning of thermopaste application at Shenque(CV 8) for relieving stretch reflex induced by procedure for prolapse and hemorrhoids(PPH).Methods A total of 100 cases of mixed hemorrhoids(stage Ⅲ and Ⅳ) patients were randomized into 1.0 h,0.5 h,0 h and control(no application) groups(n=25 in each group) according to a random number table.Thermopaste was applied to Shenque(CV 8) 1.0 h and 0.5 h before PPH or conducted simultaneously with PPH.The mean arterial pressure,heart rate,blood oxygen saturation of patients before and after anastomose operation,and the incidence of adverse reactions within 24 hours after the procedure were monitored and recorded.The patient's pain degree was assessed by using visual analogue scale.Results After the preconditioning,of the 25 patients in the 0.5 h group(0.5 h G),14 experienced marked improvement(in the stretch reflex during PPH),10 had an improvement,and 1 was invalid,respectively.The markedly effective rate and the total effective rate were 56% and 96%,respectively.The therapeutic effects for inhibiting stretch reflect being from the better to the poorer were 0.5 h G>1.0 h G>0 h G>NG.The heart rate and blood pressure from more stable to lesser stable were 0.5 h G>1.0 h G>0 h G>NG.The patients' pain reaction during operation and their adverse effects of nausea,vomiting,abdominal distention and abdominal pain,etc.occurred during operation also presented the same tendency in the 4 groups.Conclusion Thermopaste application to Shenque(CV 8) can effectively prevent and control visceral reflex in patients undergoing PPH,which effect is significantly better when conducted 0.5 hour before the operation.