穴位埋线对妇科开腹手术后硬膜外吗啡镇痛引起瘙痒的影响(1)
[摘要] 目的 观察穴位埋线对妇科开腹手术术后硬膜外注入吗啡镇痛所引起的皮肤瘙痒及镇痛效果的影响。方法 便利选择2019年1—8月行妇科开腹手术治疗的患者90例，ASA分级Ⅰ～Ⅱ级，采用随机数字表法分为对照组、穴位组和假穴位组，每组30例。所有患者关闭腹膜时硬膜外腔內注入含吗啡2 mg的生理盐水溶液5 mL。记录3组患者术后4 h、8 h、12 h、24 h和48 h的疼痛VAS评分和瘙痒评分以及48 h内镇痛药物追加的患者例数和患者术后恶心呕吐、呼吸抑制、尿潴留等不良反应的发生情况。结果 与穴位组相比，对照组和假穴位组在术后12 h、24 h和48 h的VAS评分明显较高，术后4 h、8 h和12 h的瘙痒评分明显较高(P<0.05)。术后恶心呕吐对照组11例、假穴位组10例明显多于穴位组2例(P<0.05)。结论 穴位埋线预处理双侧曲池、血海、足三里、三阴交穴能够减轻妇科开腹手术硬膜外吗啡术后镇痛引起的皮肤瘙痒，降低恶心呕吐的发生，增强吗啡的镇痛效果。
[关键词] 穴位埋线;妇科开腹手术;吗啡;术后镇痛;瘙痒
[中图分类号] R245.9 [文献标识码] A [文章编号] 1674-0742(2020)06(b)-0009-04
[Abstract] Objective To observe the effect of catgut embedding at the acupoint on the skin itching and analgesic effect caused by epidural morphine injection after gynecological laparotomy. Methods From January to August 2019， 90 patients underwent gynecological laparotomy were convenient selected. They were classified into ASA grades Ⅰ～Ⅱ. They were divided into control group， acupoint group and pseudo-acupoint group by random number table method， 30 cases in each group. When all patients closed the peritoneum， 5 mL of physiological saline solution containing 2 mg of morphine was injected into the epidural space. Record the pain VAS scores and pruritus scores at 4 h， 8 h， 12 h， 24 h and 48 h after operation， and the number of patients with analgesic drugs added within 48 h and the occurrence of adverse reaction such as nausea and vomiting， respiratory depression， and urinary retention. Results Compared with the acupoint group， the VAS scores of the control group and the sham point group were higher at 12 h， 24 h and 48 h after operation， and the pruritus scores were higher significantly at 4 h， 8 h and 12 h after operation (P<0.05). Postoperative nausea and vomiting were found in 11 cases in the control group and 10 cases in the acupoint group than in the acupoint group 2 cases(P<0.05). Conclusion Catgut embedding at the acupoints for pretreatment of bilateral Quchi， Xuehai， Zusanli and Sanyinjiao points can alleviate the skin itching caused by postoperative analgesia after epidural morphine in gynecological laparotomy， reduce the incidence of nausea and vomiting， and enhance the analgesia of morphine effect.
[Key words] Embedding at acupuncture points; Gynecological laparotomy; Morphine; Postoperative analgesia; Itching
吗啡是临床上用于术后镇痛的经典药物，其脂溶性差，椎管内给药后脑脊液浓度高，起效缓慢镇痛时间长，用药量少，是单次椎管内给药的最佳药物，但应用吗啡常常出现皮肤瘙痒等不良反应，严重的瘙痒可影响患者术后恢复及术后镇痛效果而限制吗啡的应用。目前针对椎管内应用吗啡引起的瘙痒尚无明确的治疗方法。针刺能够减轻吗啡引起的瘙痒、缓解症状[1]，穴位埋线是针刺技术的延伸和发展，现已广泛应用于临床各科室[2]，在妇科疾病中已有报道[3-5]。目前有关穴位埋线防治吗啡硬膜外镇痛所致瘙痒的相关研究较少，该研究便利选取该院2019年1—8月择期行妇科开腹手术治疗的患者90例，通过穴位埋线预处理双侧曲池、血海、足三里和三阴交穴对能否防治妇科开腹手术后硬膜外吗啡镇痛所引起的皮肤瘙痒并增强其镇痛效果进行观察，旨在寻求一种对硬膜外吗啡术后镇痛引起皮肤瘙痒的防治方法，以弥补该镇痛方法的不足，使之更趋完善，现报道如下。, 百拇医药(李丹 陈琦 栾国会 康宇 董玲 于洪艳)
[关键词] 穴位埋线;妇科开腹手术;吗啡;术后镇痛;瘙痒
[中图分类号] R245.9 [文献标识码] A [文章编号] 1674-0742(2020)06(b)-0009-04
[Abstract] Objective To observe the effect of catgut embedding at the acupoint on the skin itching and analgesic effect caused by epidural morphine injection after gynecological laparotomy. Methods From January to August 2019， 90 patients underwent gynecological laparotomy were convenient selected. They were classified into ASA grades Ⅰ～Ⅱ. They were divided into control group， acupoint group and pseudo-acupoint group by random number table method， 30 cases in each group. When all patients closed the peritoneum， 5 mL of physiological saline solution containing 2 mg of morphine was injected into the epidural space. Record the pain VAS scores and pruritus scores at 4 h， 8 h， 12 h， 24 h and 48 h after operation， and the number of patients with analgesic drugs added within 48 h and the occurrence of adverse reaction such as nausea and vomiting， respiratory depression， and urinary retention. Results Compared with the acupoint group， the VAS scores of the control group and the sham point group were higher at 12 h， 24 h and 48 h after operation， and the pruritus scores were higher significantly at 4 h， 8 h and 12 h after operation (P<0.05). Postoperative nausea and vomiting were found in 11 cases in the control group and 10 cases in the acupoint group than in the acupoint group 2 cases(P<0.05). Conclusion Catgut embedding at the acupoints for pretreatment of bilateral Quchi， Xuehai， Zusanli and Sanyinjiao points can alleviate the skin itching caused by postoperative analgesia after epidural morphine in gynecological laparotomy， reduce the incidence of nausea and vomiting， and enhance the analgesia of morphine effect.
[Key words] Embedding at acupuncture points; Gynecological laparotomy; Morphine; Postoperative analgesia; Itching
吗啡是临床上用于术后镇痛的经典药物，其脂溶性差，椎管内给药后脑脊液浓度高，起效缓慢镇痛时间长，用药量少，是单次椎管内给药的最佳药物，但应用吗啡常常出现皮肤瘙痒等不良反应，严重的瘙痒可影响患者术后恢复及术后镇痛效果而限制吗啡的应用。目前针对椎管内应用吗啡引起的瘙痒尚无明确的治疗方法。针刺能够减轻吗啡引起的瘙痒、缓解症状[1]，穴位埋线是针刺技术的延伸和发展，现已广泛应用于临床各科室[2]，在妇科疾病中已有报道[3-5]。目前有关穴位埋线防治吗啡硬膜外镇痛所致瘙痒的相关研究较少，该研究便利选取该院2019年1—8月择期行妇科开腹手术治疗的患者90例，通过穴位埋线预处理双侧曲池、血海、足三里和三阴交穴对能否防治妇科开腹手术后硬膜外吗啡镇痛所引起的皮肤瘙痒并增强其镇痛效果进行观察，旨在寻求一种对硬膜外吗啡术后镇痛引起皮肤瘙痒的防治方法，以弥补该镇痛方法的不足，使之更趋完善，现报道如下。, 百拇医药(李丹 陈琦 栾国会 康宇 董玲 于洪艳)