目的:观察耳穴压豆联合子午流注穴位贴敷对腰椎间盘突出症术后患者胃肠道功能、心理情绪和疼痛的影响。方法:收集2020年1月~2022年2月在我院门诊或住院腰椎间盘突出症术后患者60例,按照就诊顺序编号,采用随机数字表按照随机原则,随机分为2组各30例。对照组给予常规护理,包括环境护理、生活起居护理、时间护理、饮食护理、功能锻炼及心理护理等,同时给予耳穴压豆,于皮质下腰骶部取交感、神门穴,于患者术后2 h内给予耳穴压豆按压3~5 min/次,5次/d。观察组在对照组基础上给予子午流注穴位贴敷。依据子午流注法,取穴时辰为大肠经最旺盛的卯时(05:00~07:00);选取胃经的天枢及足三里穴,取穴时辰为胃经最旺盛的辰时(07:00~09:00)。选茴香枳术汤为敷贴药物,准确取穴后进行穴位敷贴,贴敷2 h/次,1次/d。2组均连续干预2周观察患者胃肠功能情况、心理情绪评分和疼痛评分情况。结果:与对照组比较,观察组腹胀时间、排气时间和排便时间均明显缩短。干预后,2组SAS、SDS评分均下降(P < 0.05);且观察组SAS、SDS评分下降明显低于对照组。干预后,2组VAS评分均下降(P < 0.05);且观察组VAS评分下降明显低于对照组。结论:耳穴压豆联合子午流注穴位贴敷能改善腰椎间盘突出症术后患者胃肠道功能、降低心理负面情绪和疼痛程度,值得临床推广借鉴。 Objective: To observe the effect of auricular acupoint pressing bean combined with Ziwuliuzhu ac-upoint application on gastrointestinal function, psychological emotion and pain in patients with lumbar disc protrusion after surgery. Methods: A total of 60 outpatients or inpatients with lumbar disc protrusion after surgery in our hospital from January 2020 to February 2022 were collected and randomly divided into 2 groups with 30 cases in each group according to the random number table according to the random principle. The control group was given routine nursing, including en-vironmental nursing, daily life nursing, time nursing, diet nursing, functional exercise and psycho-logical nursing, etc. At the same time, the patients were given auricular acupoint pressing beans, and sympathetic and Shenmen acupoints were taken from the lower back and sacral part of the cortex. The patients were given auricular acupoint pressing beans 3~5 min/ time, 5 times/day within 2 hours after operation. On the basis of the control group, the observation group was given Ziwuliuzhu acupoint application. Tianshu and Zusanli points of the stomach meridian were selected, and the time of acupoint selection was the most vigorous hour of the stomach meridian (07:00~ 09:00). Fennel Zhishu decoction was selected as the application drug, and acupoint application was carried out after accurate acupoint selection, 2 h/time, once/day. The gastrointestinal function, psychological and emotional scores and pain scores of patients in both groups were observed for 2 weeks. Results: Compared with the control group, the abdominal distension time, exhaust time and defecation time were significantly shortened in the observation group. After intervention, the scores of SAS and SDS in the two groups were decreased (P < 0.05). The decline of SAS and SDS in the observation group was significantly lower than that in the control group. After intervention, the VAS scores of the two groups were decreased (P < 0.05). The decrease of VAS score in observation group was significantly lower than that in control group. Conclusion: Auricular acupoint pressure combined with Ziwuliuzhu acupoint application can improve gastrointestinal function, reduce psy-chological negative emotions and pain degree of patients after lumbar disc protrusion, which is worthy of clinical promotion and reference.
目的:观察耳穴压豆联合子午流注穴位贴敷对腰椎间盘突出症术后患者胃肠道功能、心理情绪和疼痛的影响。方法:收集2020年1月~2022年2月在我院门诊或住院腰椎间盘突出症术后患者60例,按照就诊顺序编号,采用随机数字表按照随机原则,随机分为2组各30例。对照组给予常规护理,包括环境护理、生活起居护理、时间护理、饮食护理、功能锻炼及心理护理等,同时给予耳穴压豆,于皮质下腰骶部取交感、神门穴,于患者术后2 h内给予耳穴压豆按压3~5 min/次,5次/d。观察组在对照组基础上给予子午流注穴位贴敷。依据子午流注法,取穴时辰为大肠经最旺盛的卯时(05:00~07:00);选取胃经的天枢及足三里穴,取穴时辰为胃经最旺盛的辰时(07:00~09:00)。选茴香枳术汤为敷贴药物,准确取穴后进行穴位敷贴,贴敷2 h/次,1次/d。2组均连续干预2周观察患者胃肠功能情况、心理情绪评分和疼痛评分情况。结果:与对照组比较,观察组腹胀时间、排气时间和排便时间均明显缩短。干预后,2组SAS、SDS评分均下降(P < 0.05);且观察组SAS、SDS评分下降明显低于对照组。干预后,2组VAS评分均下降(P < 0.05);且观察组VAS评分下降明显低于对照组。结论:耳穴压豆联合子午流注穴位贴敷能改善腰椎间盘突出症术后患者胃肠道功能、降低心理负面情绪和疼痛程度,值得临床推广借鉴。
耳穴压豆,子午流注,穴位贴敷,腰椎间盘突出症,胃肠道,心理情绪
Shujun Fu, Xing Chen
Yiwu Central Hospital of Zhejiang Province, Yiwu Zhejiang
Received: Oct. 1st, 2022; accepted: Oct. 27th, 2022; published: Nov. 3rd, 2022
Objective: To observe the effect of auricular acupoint pressing bean combined with Ziwuliuzhu acupoint application on gastrointestinal function, psychological emotion and pain in patients with lumbar disc protrusion after surgery. Methods: A total of 60 outpatients or inpatients with lumbar disc protrusion after surgery in our hospital from January 2020 to February 2022 were collected and randomly divided into 2 groups with 30 cases in each group according to the random number table according to the random principle. The control group was given routine nursing, including environmental nursing, daily life nursing, time nursing, diet nursing, functional exercise and psychological nursing, etc. At the same time, the patients were given auricular acupoint pressing beans, and sympathetic and Shenmen acupoints were taken from the lower back and sacral part of the cortex. The patients were given auricular acupoint pressing beans 3~5 min/ time, 5 times/day within 2 hours after operation. On the basis of the control group, the observation group was given Ziwuliuzhu acupoint application. Tianshu and Zusanli points of the stomach meridian were selected, and the time of acupoint selection was the most vigorous hour of the stomach meridian (07:00~ 09:00). Fennel Zhishu decoction was selected as the application drug, and acupoint application was carried out after accurate acupoint selection, 2 h/time, once/day. The gastrointestinal function, psychological and emotional scores and pain scores of patients in both groups were observed for 2 weeks. Results: Compared with the control group, the abdominal distension time, exhaust time and defecation time were significantly shortened in the observation group. After intervention, the scores of SAS and SDS in the two groups were decreased (P < 0.05). The decline of SAS and SDS in the observation group was significantly lower than that in the control group. After intervention, the VAS scores of the two groups were decreased (P < 0.05). The decrease of VAS score in observation group was significantly lower than that in control group. Conclusion: Auricular acupoint pressure combined with Ziwuliuzhu acupoint application can improve gastrointestinal function, reduce psychological negative emotions and pain degree of patients after lumbar disc protrusion, which is worthy of clinical promotion and reference.
Keywords:Auricular Acupoint Pressing Bean, Meridional Flow, Acupoint Application, Lumbar Intervertebral Disc Protrusion, Gastrointestinal Tract, Psychological Emotions
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腰椎间盘突出症是临床较为常见的一种多发病及常见病,好发于中老年人,以腰痛、下肢放射痛、行走困难等为临床症状,严重者会出现肌肉瘫痪、神经麻痹等症状,严重危及人类健康。选择手术治疗是目前最有效的治疗腰椎间盘突出症的方法之一 [
收集2020年1月~2022年2月在我院门诊或住院腰椎间盘突出症术后患者60例,按照就诊顺序编号,采用随机数字表按照随机原则,随机分为2组各30例。对照组中男20例,女10例;平均年龄(56.83 ± 6.45)岁;平均病程(2.65 ± 0.83)年;手术病变部位:L3~4有8例,L4~5有12例,L5~S1有10例。观察组中男16例,女14例;平均年龄(57.26 ± 6.13)岁;平均病程(2.59 ± 0.91)年;手术病变部位:L3~4有10例,L4~5有12例,L5~S1有8例。2组性别、年龄、病程等一般资料比较,差异均无统计学意义(P > 0.05),具有可比性。诊断均符合《实用骨病学》中标准。
① 均为腰椎间盘突出症术后患者;② 生命体征平稳,意识清楚;③ 年龄30~68岁;④ 具有一定的阅读理解能力,客观地完成问卷调查;⑤ 患者或家属签署知情同意书,自愿参与研究;⑥ 经过医院伦理委员会同意者。
① 有严重认知障碍者;② 有视、听言语障碍者;③ 存在骨关节、肌肉等运动系统疾病者;④ 患者有严重的心脏病、新近发生的心肌梗塞、近期心绞痛发作未能良好控制的;⑤ 有腰椎间盘突出症,但未行手术者;⑥ 术后出现其他并发症;⑦ 既往有消化系统疾病,如胃溃疡、胃癌等疾病者;⑧ 有精神系统疾病者;⑨ 同时参加其他试验或者是接受其他治疗者。
给予常规护理,包括环境护理、生活起居护理、时间护理、饮食护理、功能锻炼及心理护理等,同时给予耳穴压豆,具体如下:① 穴位选取:于皮质下腰骶部取交感、神门穴;② 具体操作:于患者术后2 h内给予耳穴压豆,先用操作棒探敏感区,以患者有胀痛感为度,然后将耳廓常规消毒后,用王不留行籽贴压在所选穴位上,边贴边按压,直至患者出现明显酸胀感为度,并嘱患者适度按压3~5 min/次,5次/d。
在对照组基础上给予子午流注穴位贴敷。具体如下:1) 穴位选取和取穴时辰:依据子午流注法,取穴时辰为大肠经最旺盛的卯时(05:00~07:00);选取胃经的天枢及足三里穴,取穴时辰为胃经最旺盛的辰时(07:00~09:00)。2) 敷贴药物:选茴香枳术汤为敷贴药物,即取白术30 g、枳壳30 g、小茴香30 g、苍术15 g、香附15 g、桂枝15 g混合,将药物研磨成粉状,过200目筛,避光干燥保存。3) 穴位敷贴操作:取上述药物粉末5 g加蜂蜜1 mL混合成糊状,将药糊装入内径为2 cm的医用穴位敷贴中,护士准确取穴后,医用酒精清洁穴位,之后进行穴位敷贴,贴敷2 h/次,1次/d。2组均连续干预2周。
均于干预前,干预2周时观察患者胃肠功能情况、心理情绪评分和疼痛评分情况。① 胃肠功能情况 [
使用SPSS23.0软件进行统计分析,计量资料用均数 ± 标准差表示;计数资料用构成比(%)表示。P < 0.05为差异有统计学意义。
与对照组比较,观察组腹胀时间、排气时间和排便时间均明显缩短(P < 0.05,表1)。
分组 | 腹胀时间(h) | 排气时间(h) | 排便时间(h) |
---|---|---|---|
对照组 | 35.74 ± 6.38 | 42.76 ± 7.14 | 38.54 ± 4.27 |
观察组 | 21.56 ± 5.02a | 23.91 ± 6.25a | 20.31 ± 3.86a |
表1. 2组患者胃肠功能情况比较(n = 30)
与对照组比较,aP < 0.05。
干预后,2组SAS、SDS评分均下降(P < 0.05);且观察组SAS、SDS评分下降明显低于对照组(P < 0.05,表2)。
分组 | SAS | SDS | ||
---|---|---|---|---|
干预前 | 干预后 | 干预前 | 干预后 | |
对照组 | 61.45 ± 7.56 | 45.39 ± 6.12a | 57.68 ± 7.13 | 46.85 ± 6.26a |
观察组 | 62.38 ± 7.13 | 34.86 ± 5.57ac | 57.59 ± 7.09 | 36.37 ± 5.76ac |
表2. 2组患者焦虑、抑郁量表评分比较(n = 30,分)
与干预前比较,aP < 0.05,与对照组干预后比较,cP < 0.05。
干预后,2组VAS评分均下降(P < 0.05);且观察组VAS评分下降明显低于对照组(P < 0.05,表3)。
分组 | 干预前 | 干预2周 |
---|---|---|
对照组 | 7.76 ± 2.48 | 3.79 ± 1.35a |
观察组 | 7.82 ± 2.63 | 2.04 ± 1.04a c |
表3. 2组患者干预前后VAS评分比较(n = 30,分)
与干预前比较,aP < 0.05,与对照组干预2周比较,cP < 0.05。
腰椎间盘突出症患者术后是由骨断筋伤、气滞血瘀所致,“不通则痛”,耳穴压豆治疗为中医特色疗法,是通过行气活血、活血祛瘀而起到止痛作用的 [
本研究结果表明,与对照组比较,观察组腹胀时间、排气时间和排便时间均明显缩短。干预后,2组SAS、SDS评分均下降(P < 0.05);且观察组SAS、SDS评分下降明显低于对照组。干预后,2组VAS评分均下降(P < 0.05);且观察组VAS评分下降明显低于对照组。本研究的局限性:样本量较少,且为单中心研究,在同一地域进行研究。所以,耳穴压豆联合子午流注穴位贴敷能改善腰椎间盘突出症术后患者胃肠道功能、降低心理负面情绪和疼痛程度,同时具有安全有效、操作方便、不良反应少、可以反复多次治疗的优点,值得临床推广借鉴。
浙江省义乌市科技局课题(NO.19-3-09)。
傅淑君,陈 星. 耳穴压豆联合子午流注穴位贴敷对腰椎间盘突出症术后患者胃肠道功能、心理情绪和疼痛的影响Effect of Auricular Acupoint Pressure Combined with Ziwuliuzhu Acupoint Application on Gastrointestinal Function, Psychological Emotion and Pain in Patients with Lumbar Disc Protrusion after Surgery[J]. 临床医学进展, 2022, 12(11): 9784-9788. https://doi.org/10.12677/ACM.2022.12111411