揿针埋于不同穴位对腰硬联合麻醉下行剖宫产产妇不良反应的改善效果对比分析

Comparative analysis of the effect of pressing needles buried in different acupoints on the adverse reactions of patients undergoing cesarean section under combined spinal-epidural anesthesia

目的探讨揿针埋于穴位对腰硬联合麻醉行剖宫产产妇麻醉相关不良反应的影响。方法前瞻性选取2018年12月至2019年6月邯郸市妇幼保健院接受腰硬联合麻醉下剖宫产分娩的产妇400例进行研究,依据随机数字表法表分为A、B、C、D 4组各100例,A组产妇入室即静脉注射托烷司琼4 mg,B组产妇入室将揿针埋于内关穴、合谷穴,C组产妇入室将揿针埋于内关穴、人中穴,D组产妇入室即给等量0.9%氯化钠溶液。比较4组产妇的舒芬太尼用量、药物追加次数、麻醉平面、补液速率;比较4组产妇手术过程中麻醉相关不良反应发生率及术后4、8、12、24 h的恶心呕吐干呕症状量表(INVR)评分。结果 A组、B组、C组、D组产妇的舒芬太尼用量、药物追加次数、麻醉平面、补液速率比较,差异均无统计学意义(P> 0.05)。A组、B组、C组、D组产妇的心动过缓、牵拉反应发生率比较,差异均无统计学意义(P> 0.05);A、B、C组产妇恶心、呕吐发生率低于D组,差异有统计学意义(P <0.05),A组、B组、C组产妇的恶心、呕吐发生率差异无统计学意义(P> 0.05)。术后4、8、12、24 h时刻,A、B、C组产妇的INVR评分均低于D组,差异有统计学意义(P <0.05),A组和C组产妇在8、12、24 h的INVR评分低于B组,差异有统计学意义(P <0.05)。结论将揿针埋于内关穴、合谷穴与将揿针埋于内关穴、人中穴对预防腰硬联合麻醉剖宫产产妇恶心、呕吐不良反应有明显的效果,后者优于前者。

Objective To explore the effect of pressing needles buried in acupoints on anesthesia-related adverse reactions of patients undergoing cesarean section with combined spinal-epidural anesthesia.Methods From December 2018 to June 2019,400 parturients from Handan Maternal and Child Health Hospital who underwent cesarean delivery under combined spinal-epidural anesthesia were selected prospectively.They were divided into A,B,C and D four groups according to the random number table,each group 100 cases.Patients in group A were received intravenous injection of tropisetron 4 mg when they entered the room,patients in group B were buried the needles at Neiguan and Hegu points when they entered the room and,patients in group C were buried the needles at Neiguan and Renzhong when they entered the room,patients in group D were given the same amount of 0.9%sodium chloride solution when entering the room.The dosage of sufentanil,the number of additional drugs,the level of anesthesia,and the rate of rehydration in the 4 groups of women were compared;the incidence of anesthesia-related adverse reactions during the operation of the 4 groups of women and the index of nausea,vomiting,and retching(INVR)scores at 4,8,12,and 24 h after the operation were compared.Results There was no statistically significant difference in the amount of sufentanil,the number of drug additions,the level of anesthesia,and the rate of rehydration among the parturients of group A,group B,group C and group D(P>0.05);There was no statistically significant difference in the incidence of bradycardia and traction reaction among women in group A,group B,group C and group D(P>0.05).The incidence of nausea and vomiting in groups A,B,and C were lower than that of in group D(P<0.05).There was no significant difference in the incidence of nausea and vomiting in group A,B,and C(P>0.05);At 4,8,12,and 24 h after operation,the INVR scores of the parturients in group A,group B,and group C were higher than those of group D,and the differences were statistically significant(P<0.05).The INVR scores of group A and C at 8,12 and 24 h were lower than those of group B,and the difference was statistically significant(P<0.05).Conclusion Buried press needles at Neiguan and Hegu points and press needles at Neiguan and Renzhong points have obvious effects in preventing nausea and vomiting of parturients during caesarean section with combined spinal-epidural anesthesia.The former is better than the latter.