贞芪扶正颗粒联合针指法在痔上黏膜环切术恶心呕吐中应用

Application of Zhenqi Fuzheng Granules Combined with Acupuncture and Acupressure for Nausea and Vomiting during the Procedure for Prolapse and Hemorrhoids

目的观察比较贞芪扶正颗粒联合针指法在痔上黏膜环切术恶心呕吐中的应用。方法选择ASAⅠ～Ⅱ66例手术患者,随机分为三组:贞芪针指治疗组(ZA组)、恩丹西酮对照组(OH组)和生理盐水空白组(NS组)。三组均采用布比卡因腰麻或腰—硬联合阻滞麻醉,麻醉穿刺完毕后ZA组针刺双侧内关,推揉按压中脘穴及双侧足三里穴;OH组静脉注射恩丹西酮4～8 mg;NS组静脉注射生理盐水5 mL。三组实施术后镇痛(PCIA),术毕口服贞芪扶正颗粒15～30 g。结果 ZA组恶心、呕吐的发生率为4/22,2/22;OH组为3/22,1/22,VAS评分也基本相当,表明两组疗效相同,组间比较差异无统计学意义(P>0.05),与NS组比较,差异有统计学意义(P<0.01)。但对于恶心呕吐程度较重且止呕显效慢者(ZA组持续恶心4例,反复呕吐2例),最好伍用抗呕吐药物。结论在恶心呕吐防治中,贞芪扶正颗粒复合益气针指法适用于轻中度恶心呕吐;恩丹西酮适用于程度较重的持续性恶心呕吐。

Objective To observe the application of zhenqi fuzheng granules combined with acupuncture and acupressure for nausea and vomiting during the procedure for prolapse and hemorrhoids（PPH）.Methods 66 cases of ASA Ⅰ to Ⅱ were selected and divided into three groups,a zhenqi＋acupuncture＋acupressure group（ZA group）,an ondansetron hydrochloride group（OH group）and a normal saline blank group（NS group）.Bupivacain spinal anesthesia or the combined spinal epidural anesthesia（CSEA）was adopted in three groups.After anesthetic puncture,in ZA group,acupuncture was applied to bilateral Neiguan（PC6）and the technique of pushing,kneading and pressing was to Zhongwan（CV12）and bilateral Zusanli（ST36）;in OH group,the intravenous injection with ondansetron hydrochloride was used,4 to 8mg;in NS group,the intravenous injection of normal saline 5mL was provided.The patient controlled intravenous analgesia（PCIA）was adopted after operation in three groups and zhenqi fuzheng granules 15 to 30g were prescribed for oral administration.Results The occurrence rates of nausea and vomiting were 4/22 and 2/22 respectively in ZA group,those were 3/22 and 1/22 respectively in OH group.The VAS scores were basically same between two groups,suggesting the same efficacy in comparison of these two groups.The differences were not significant statistically in group comparison（P〉0.05）.As compared with NS group,the differences were significant statistically（P〈0.01）.But,for the cases with serious nausea and vomiting and slow efficacy of stopping vomiting（4 cases of persistent nausea,2 cases of repeated vomiting in ZA group）,the anti-vomiting medication had better be combined.Conclusions Zhenqi fuzheng granules combined with acupuncture and acupressure for qi benefiting is suitable for the prevention and treatment of mild or moderate nausea and vomiting.Ondansetron hydrochloride is good for quite serious persistent nausea and vomiting.