耳穴压贴法联合三阶梯止痛法治疗中重度癌痛的疗效分析研究

背景　大量中重度癌痛患者在西药的镇痛药物治疗过程中常出现难以耐受的不良反应,中医耳穴压贴法的联合治疗效果值得探究。目的　观察耳穴压贴法联合三阶梯止痛法治疗中重度癌痛的临床疗效。方法　选择2017—2018年上海市浦东新区迎博社区卫生服务中心舒缓疗护病房收治的癌症晚期并伴有中重度癌痛患者60例,采用随机数字表法将其分为对照组和治疗组,各30例。对照组采用三阶梯止痛法,治疗组采用三阶梯止痛法联合耳穴压贴法治疗。1周后观察两组疼痛程度、镇痛药物〔盐酸羟考酮控释片（奥施康定）〕使用剂量和恶心呕吐、便秘的发生情况及抑郁状态。采用数字评分法（NRS）评估疼痛程度,采用汉密尔顿抑郁量表（HAMD）评估抑郁状态。结果　两组NRS疼痛评分减轻程度比较,差异无统计学意义（Z=0.106,P=0.916）。滴定1周后,治疗组使用的奥施康定药物剂量为40（20,60）mg/24 h,低于对照组的40（40,60）mg/24 h（Z=2.067,P=0.039）。治疗组恶心、呕吐严重程度轻于对照组（Z=2.395,P=0.017）。治疗组便秘发生率为16.7%（5/30）,低于对照组的43.3%（13/30）（χ2=5.079,P=0.024）。治疗1周后,治疗组HAMD评分低于对照组（P<0.05）。结论　耳穴压贴法联合三阶梯止痛法治疗中重度癌痛可以有效减少镇痛药物使用剂量,缓解消化系统不良反应,并改善患者抑郁状态,具有一定的临床推广应用价值。     

Effect of P-6 acupressure on prevention of nausea and vomiting after epidural morphine for post-Cesarean section pain relief

Background: Nausea and vomiting are important side effects following administration of epidural morphine for post-Cesarean section pain relief. Stimulation of the P-6 (Neiguan) acupoint is a traditional Chinese acupuncture modality used for antiemetic purpose; it has been found to be effective. The aim of this study was to evaluate the antiemetic effect of P-6 acupressure in parturients given epidural morphine for post-Cesarean section pain relief.
Method: In a randomized, double-blind and controlled trial, sixty parturients receiving epidural morphine for post-Cesarean section pain relief were investigated. Parturients were allocated to receive the acupressure bands or placebo bands on the P-6 acupoint bilaterally before the administration of spinal anesthesia and were observed over a 48-hour study period.
Results: The incidence of nausea and vomiting was significantly decreased from 43% and 27% in the control group, to 3% and 0% in the acupressure group, respectively ( P <0.05).
Conclusion: The results demonstrate that prophylactic use of acupressure bands bilaterally on the P-6 acupoint can significantly reduce incidence of nausea and vomiting after epidural morphine for post-Cesarean section pain relief.     

Effects of acupressure therapy for patients having prolonged mechanical ventilation support

AIMS: This paper reports an investigation of the effects of acupressure therapy on dyspnoea, anxiety and physiological indicators of heart rate and respiratory rate in patients with chronic obstructive pulmonary disease having mechanical ventilation support. BACKGROUND: Patients with chronic obstructive pulmonary disease who are using mechanical ventilation often experience dyspnoea and anxiety, which affects successful ventilator use. METHODS: The study had an experimental blocking design, using sex, age and length of ventilator use as a blocking factor. Qualified patients in two intermediate respiratory intensive care units were randomly assigned to an acupressure group and a comparison group. A total of 52 patients with chronic obstructive pulmonary disease in northern Taiwan participated. Those in the experimental group received daily acupressure therapy and massage treatment for 10 days. Patients in the comparison group received massage treatment and handholding. The primary outcome measures were the visual analogue scales for dyspnoea and anxiety, and physiological indicators of heart rate and respiratory rate. Data were collected every day from baseline (day 1), during the treatment (days 2-10) and follow-up (days 11-17). Data were analysed using generalized estimation equations. The study was carried out in 2003. RESULTS: Patients with chronic obstructive pulmonary disease who were using prolonged mechanical ventilatory support experienced high levels of dyspnoea and anxiety. Dyspnoea (P = 0.009), anxiety (P = 0.011) and physiological indicators (P < 0.0001) in the acupressure group improved statistically significantly over time when compared with those of the comparison group. CONCLUSIONS: This results support the suggestion that acupressure therapy could decrease sympathetic stimulation and improve perceived symptoms of dyspnoea and anxiety in patients with chronic obstructive pulmonary disease who are using prolonged mechanical ventilation.     

穴位按压腕带缓解术后恶心呕吐随机对照试验的Meta分析

目的评价穴位按压腕带作用于内关穴缓解成人术后恶心呕吐的效果。方法检索MEDLINE、CNKI等数据库,纳入所有相关的随机对照试验(RCT),采用RevMan5.0分析数据。结果共纳入9个RCT。相对于安慰剂对照组,试验组即穴位按压腕带作用于内关穴可以有效减少术后呕吐的发生率(RR=0.50,95%CI:0.37~0.66,P<0.01)。而对于术后恶心的发生率,试验组和安慰剂对照组的差异无统计学意义(RR=0.85,95%CI:0.72~1.00,P>0.05)。结论术后护理中应用穴位按压腕带作用于内关穴可以有效缓解术后呕吐,而缓解术后恶心作用不显著,需要今后的研究者进行更加可靠的RCT试验进一步研究和探讨。护理人员可以引进穴位按压腕带进行有效性和适用性的研究。     

网站研发与测试:在线学习痛经的自我管理

研发与测试一交互式名为"痛经健康促进信息网"网站.本交互式网站应用因特网结合文字、动态与静态影像、动画、图片、照片、相关网站连结,强调学习者与网站的交互式自我学习与自我管理.本网站建置在IBM WebSphere 5.O网络服务器上,以IBM DB2为数据库,美工与图片编辑与制作选用Ulead公司的PhotoImpact 6.0软件,动画档案则以Macromedia公司的Flash 5.0软件编辑而成.本网站参考国内外相关文献,经由专家指导修改编整后建置而成.38位高中女生参与网站在线学习的成效试验.研究结果显示,网站结合耳穴贴压后,试验者能有效的减低其痛经程度,痛经者的疼痛感觉、疼痛强度以及经期不适症状得到改善.大多数的试验者给予本网站很高的肯定评价,显示本网站有助于青少女自我学习以缓解痛经,并能提升青少女自我管理行为与健康促进能力.     

针刺配合指压法对妇科腹腔镜手术后恶心呕吐症的干预研究

目的:观察比较针刺内关配合腧穴、指揉按压法在妇科腹腔镜手术后恶心呕吐症中的干预研究。方法:选择ASAⅠ-Ⅱ116例妇科腹腔镜手术患者,随机分为五组:针刺指揉组(AF,n=23)、恩丹西酮组(OH,n=23)、甲氧氯普胺组(MP,n=23)、氟哌利多组(DR,n=23)和生理盐水组(NS,n=24)。实施全凭静脉麻醉及术后镇痛(patient controlled intravenous analgesia,PCIA)。常规连续监测收缩压(SBP)、舒张压(DBP)、心率(HR)、血氧饱和度(SpO2)外,采用A-Line麻醉-镇静深度监测仪监测听觉诱发电位指数(AAI)值,指导麻醉药物的使用。结果:针刺指揉组、恩丹西酮组、甲氧氯普胺组与氟哌利多组VAS评分相当,与生理盐水组比较P<0.01,各试验组之间比较P>0.05,表明针刺指揉组、恩丹西酮组、甲氧氯普胺组和氟哌利多组疗效相同。结论:针刺配合指揉按压法在防治妇科腹腔镜恶心呕吐中适用于轻、中度恶心呕吐。     

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。     

基于前哨症状的耳穴贴压预防胃癌化疗患者症状群的效果

目的 对胃癌化疗患者进行预防性症状管理,降低症状群发生率及相关症状严重程度。方法 将肿瘤科收治的胃癌化疗患者120例按随机序列分为试验Ⅰ组40例、试验Ⅱ组40例、对照组40例。三组均在常规护理的基础上行耳穴贴压,试验Ⅰ组选取症状群相关穴位行耳穴贴压,试验Ⅱ组选取疼痛相关穴位行耳穴贴压,对照组选取假穴位贴压,连续干预1周。比较三组干预前后疼痛-疲乏-睡眠障碍症状群发生率、症状严重程度的差异。结果 干预后,试验Ⅰ组症状群发生率显著低于对照组(P<0.0125),试验Ⅰ组、试验Ⅱ组疼痛程度显著低于对照组,试验Ⅰ组疲乏得分、睡眠得分显著低于试验Ⅱ组与对照组(均P<0.05)。结论 基于前哨症状行耳穴贴压预见性干预胃癌化疗患者,可显著降低疼痛-疲乏-睡眠障碍症状群发生率,减轻患者症状困扰程度。     

玫瑰解郁汤联合穴位埋线及耳穴贴压治疗血液透析患者抑郁症临床研究

目的:观察玫瑰解郁汤联合穴位埋线及耳穴贴压疗法治疗血液透析患者抑郁症的临床疗效。方法:选取患有抑郁症的血液透析患者66例,随机分为观察组和对照组,每组各33例。观察组采用玫瑰解郁汤联合穴位埋线、耳穴贴压治疗,对照组单纯采用玫瑰解郁汤治疗。观察治疗后两组患者汉密尔顿抑郁量表(Hamilton depression scale,HAMD)评分及抑郁自评量表(self-rating depression scale,SDS)评分,评价临床疗效。结果:治疗后两组患者HAMD评分及SDS评分均较治疗前降低,观察组优于对照组,两组比较,差异有统计学意义(P0.05);观察组有效率84.9%,对照组有效率57.6%,两组比较,差异有统计学意义(P0.05);两组治疗期间均未出现明显不良反应。结论:玫瑰解郁汤联合穴位埋线、耳穴贴压疗法治疗血液透析患者抑郁症效果明显,无明显不良反应。