隔药艾灸护理干预对宫腔侵入性操作后患者即时止疼效果的临床研究

doi:10.3760/cma.j.issn.1007-1245.2023.23.040

摘要/Abstract

摘要：

目的　探讨隔药艾灸护理干预对宫腔侵入性操作后即时止疼效果，为隔药艾灸在术后止疼方面的推广提供临床依据。方法　本研究为随机对照试验。选取2020年1月至2022年6月在烟台市烟台山医院进行宫腔侵入性操作后疼痛评分达重度疼痛的女性不孕症患者95例，年龄（32.40±4.32）岁，随机分组划分为对照组（31例）、发热贴组（32例）、隔药艾灸组（32例）。对照组术后接受常规疼痛护理，发热贴组在疼痛护理基础上给予下腹部一次性发热贴贴敷，隔药艾灸组在疼痛护理基础上给予穴位贴敷+隔药艾灸干预。对比3组各时间节点的疼痛数字评分法（NRS）评分、疼痛消失时间、疼痛控制有效率、舒适度状况［简化舒适状况量表（GCQ）］，评价止疼效果。采用单因素方差分析、χ²检验、线性回归分析。结果　⑴NRS评分：隔药艾灸组在干预后5、10 min的平均NRS评分与对照组间差异分别为1.54分（95%CI：0.89～2.19；P<0.001）、2.91分（95%CI：2.18～3.63；P<0.001）；与发热贴组间差异为1.41分（95%CI：0.76～2.05；P<0.001）、2.00分（95%CI：1.28～2.72；P<0.001）；组间平均差异达到较大效应量；发热贴组NRS评分较对照组有所降低，但只有干预后10 min平均NRS评分组间差异为0.91分（95%CI：0.18～1.63；P<0.05）。⑵疼痛消失时间：对照组、发热贴组、隔药艾灸组疼痛消失时间分别为（38.23±15.41）min、（26.09±13.48）min、（15.50±7.99）min，隔药艾灸组疼痛消失时间均短于其他两组，差异均有统计学意义（均P<0.001）。⑶疼痛控制有效率：干预后5 min，隔药艾灸组NRS降低分值均高于对照组与发热贴组，达到较大效应量，差异均有统计学意义（均P<0.001）；发热贴组与对照组间差异无统计学意义（P>0.05）；隔药艾灸组疼痛控制有效率均高于对照组和发热贴组，差异均有统计学意义（均P<0.001）。⑷疼痛控制满意度：隔药艾灸组均高于发热贴组和对照组（均P<0.001）。⑸GCQ评分：隔药艾灸组在生理、心理、社会文化维度评分及总舒适度均高于对照组和发热贴组，差异有统计学意义（均P<0.001）；线性回归分析显示，干预后10 min NRS评分会对GCQ评分产生显著的负向影响（r=-0.735，P<0.001）。结论　对宫腔侵入性操作后疼痛患者实施隔药艾灸可以有效缓解疼痛，减少疼痛不适时间，提高舒适度，且隔药艾灸的即时止疼效果优于发热贴，推荐应用于宫腔操作检查后止疼。

关键词:

隔药艾灸, 宫腔侵入性操作, 即时, 止疼, 护理干预

Abstract:

Objective　To discuss the immediate pain-relieving effect of medication-separated moxibustion nursing intervention after intrauterine invasive operation, and provide a clinical basis for the promotion of medication-separated moxibustion in pain-relieving after surgery. Methods　It was a randomized controlled trial. A total of 95 female infertility patients aged (32.40±4.32) years and scoring to severe pain after intrauterine invasive operation in Yantai Yantaishan Hospital from January 2020 to June 2022 were selected, and were randomly divided into a control group (31 cases), a heat patch group (32 cases), and a medication-separated moxibustion group (32 cases). The control group received routine pain nursing care after surgery, the heat patch group received one-time heat patch application on the lower abdomen based on pain nursing, and the medication-separated moxibustion group received acupoint application and medication-separated moxibustion care based on pain nursing. The Numeric Rating Scale (NRS) scores at each time point, pain disappearance time, pain control efficiency, and comfort level [General Comfort Questionnaire (GCQ)] of the three groups were compared, and the pain relief effect was evaluated. One-way analysis of variance, χ² test, and linear regression analysis were used. Results　(1) NRS score: the differences of average NRS score between the moxibustion group and the control group at 5 and 10 min after intervention were 1.54 points (95%CI: 0.89-2.19; P<0.001) and 2.91 points (95%CI: 2.18-3.63; P<0.001); the differences between the moxibustion group and the heat patch group were 1.41 points (95%CI: 0.76-2.05; P<0.001) and 2.00 points (95%CI: 1.28-2.72; P<0.001); the average difference between groups reached a large effect size; the NRS score of the heat patch group was lower than that of the control group, but only the difference of average NRS score at 10 min after intervention was 0.91 points (95%CI: 0.18-1.63; P<0.05). (2) Pain disappearance time: the pain disappearance time of the control group, the heat patch group, and the moxibustion group were (38.23±15.41) min, (26.09±13.48) min, and (15.50±7.99) min, respectively. The pain disappearance time of the moxibustion group was shorter than those in the other two groups, with statistically significant differences (both P<0.001). (3) Pain control efficiency: the NRS reduction degree in the moxibustion group was higher than those in the control group and the heat patch group 5 min after intervention, reaching a large effect size, with statistically significant differences (all P<0.001); there was no statistically significant difference between the heat patch group and the control group (P>0.05). The pain control efficiency in the moxibustion group was higher than those in the control group and the heat patch group, with statistically significant differences (both P<0.001). (4) Satisfaction with pain control: that in the moxibustion group was higher than those in the heat patch group and the control group (both P<0.001). (5) GCQ score: the scores of physiological, psychological, and social and cultural dimensions and the total comfort of the moxibustion group were higher than those of the control group and the heat patch group, with statistically significant differences (all P<0.001). Linear regression analysis showed that NRS score had a significant negative effect on GCQ score 10 min after intervention (r=-0.735, P<0.001). Conclusions　Doing medication-separated moxibustion to patients with severe pain after intrauterine invasive operation can effectively relieve the pain, reduce the pain discomfort time, and improve the comfort. The pain-relieving effect of medication-separated moxibustion is better is that of heat patch, which is recommended to relieve the pain after uterine operation examination.

Key words:

Medication-separated moxibustion, Intrauterine invasive operation, Immediately, Pain-relieving, Nursing intervention

张爱玉.

隔药艾灸护理干预对宫腔侵入性操作后患者即时止疼效果的临床研究 [J]. 国际医药卫生导报, 2023, 29(23): 3501-3506.

Zhang Aiyu.

Clinical study on immediate pain-relieving effect of medication-separated moxibustion nursing intervention after intrauterine invasive operation [J]. International Medicine and Health Guidance News, 2023, 29(23): 3501-3506.

参考文献

[1] 中国妇幼保健协会放射介入专业委员会. 输卵管造影技术规范中国专家共识(2022年版)[J]. 中国实用妇科与产科杂志,2022,38(2):165-169. DOI: 10.19538/j.fk2022020110.
[2] Emanuel MH. New developments in hysteroscopy[J]. Best Pract Res Clin Obstet Gynaecol, 2013, 27(3): 421-429. DOI: 10.1016/j.bpobgyn.2012.11.005.
[3] 孙宇婷,冯力民. 2020年美国妇产科医师学会«宫腔镜在宫内疾病诊治中的应用»解读[J]. 中国妇产科临床杂志,2020,21(6):670-672. DOI: 10.13390/j.issn.1672-1861.2020. 06.041.
[4] 王浩,于代友. 数字化子宫输卵管造影相关疼痛的研究进展[J]. 生殖医学杂志,2018,27(3):286-290. DOI: 10.3969/j.issn.1004-3845.2018.03.019.
[5] Buzzaccarini G, Alonso Pacheco L, Vitagliano A, et al. Pain management during office hysteroscopy: an evidence-based approach[J]. Medicina (Kaunas), 2022, 58(8): 1132. DOI: 10.3390/medicina58081132.
[6] 刘金莲,赵佳,杜晓果,等. 不孕症患者行门诊不麻醉宫腔镜检查疼痛影响因素分析[J]. 国际生殖健康/计划生育杂志,2018,37(1):41-44. DOI: 10.3969/j.issn.1674-1889.2018. 01.009.
[7] 杨永琴,魏本君,赵粉琴,等. 基于敦煌«灸经图»理论浅谈艾灸在妇科宫寒疾病中的应用[J]. 中华中医药杂志,2020,35(1):330-332.
[8] 马凤君,李姝婧,潘亚辉,等. 基于TLR2靶点探讨脐灸对寒凝血瘀型痛经大鼠穴区启动-神经-内分泌-靶器官的调控作用[J]. 中华中医药杂志,2020,35(9):4342-4347.
[9] 宋学军,樊碧发,万有,等. 国际疼痛学会新版疼痛定义修订简析[J]. 中国疼痛医学杂志,2020,26(9):641-644. DOI: 10.3969/j.issn.1006-9852.2020.09.001.
[10] Aubrun F, Nouette-Gaulain K, Fletcher D, et al. Revision of expert panel's guidelines on postoperative pain management[J]. Anaesth Crit Care Pain Med, 2019, 38(4): 405-411. DOI: 10.1016/j.accpm.2019.02.011.
[11] 张俊峰,蔡莹莹,郑可欣,等. 术后急性疼痛患者自控镇痛管理相关指南的系统评价[J]. 中华护理杂志,2021,56(12):1868-1875. DOI: 10.3761/j.issn.0254-1769.2021.12.018.
[12] 朱丽霞,高凤莉,罗虹辉,等. 舒适状况量表的信效度测试研究[J]. 中国实用护理杂志,2006,22(13):57-59. DOI: 10.3760/cma.j.issn.1672-7088.2006.13.034.
[13] 张晓春,陈凤,陈莉. 中医特色疗法在急性痛症中的应用研究[J]. 国际医药卫生导报,2022,28(24):3485-3490. DOI: 10.3760/cma.j.issn.1007-1245.2022.24.017.
[14] 付嘉诚. 艾灸联合三阶梯止痛法治疗轻中度癌性疼痛的临床观察[D].辽宁中医药大学,2022.DOI: 10.27213/d.cnki.glnzc.2021.000135.
[15] 尹海燕,罗钦,侯帅,等. 艾灸镇痛下丘脑疼痛相关信号分子的PCR Array筛选研究[J]. 成都中医药大学学报,2020,43(3):8-13. DOI: 10.13593/j.cnki.51-1501/r.2020.03.008.
[16] 兰晓燕,张元,朱龙波,等. 艾叶化学成分、药理作用及质量研究进展[J]. 中国中药杂志,2020,45(17):4017-4030. DOI: 10.19540/j.cnki.cjcmm.20200714.201.
[17] 张承舜,吕鹏,唐勇,等. 艾灸光效应研究进展及展望[J]. 成都中医药大学学报,2016,39(3):1-4. DOI: 10.13593/j.cnki.51-1501/r.2016.03.001.
[18] 杨华元,胡追成. 艾灸的生物物理特性[J]. 中国针灸,2009,29(11):897-899.
[19] 兰蕾,常小荣,石佳,等. 艾灸的作用机理研究进展[J]. 中华中医药学刊,2011,29(12): 2616-2620. DOI: 10.13193/j.archtcm.2011.12.18.lanl.021.
[20] 于琴,赵以琳,周娟,等. 苍山贴脐温宫法对肾虚血瘀型患者冻融胚胎移植结局及子宫内膜容受性影响[J]. 辽宁中医药大学学报,2022,24(7):82-86. DOI: 10.13194/j.issn.1673- 842x.2022.07.019.
[21] 赵亚楠,吴文忠,刘成勇,等. 基于"内外同治之理"探讨穴位贴敷疗法的中医理论体系[J]. 针灸临床杂志,2019,35(7):5-8. DOI: 10.3969/j.issn.1005-0779.2019.07.003.
[22] 解广东,白克运. 吴尚先«理瀹骈文»脐疗法探析[J]. 针灸临床杂志,2017,33(8):63-66. DOI: 10.3969/j.issn.1005- 0779.2017.08.018.
[23] 张贤,陈静,易景娜,等. 基于就医体验的郑州市三级综合医院住院患者满意度状况及其影响因素[J]. 医学与社会,2021,34(6):18-21,30. DOI: 10.13723/j.yxysh.2021. 06.004.
[24] 张凤芝,谢俊房. 宫腔镜检查患者疼痛管理的研究进展[J]. 中国内镜杂志,2017,23(9):84-88. DOI: 10.3969/j.issn.1007-1989.2017.09.016.
[25] 唐贞贞,王曼曼,栗彦伟. 疼痛与心理护理共同应用于晚期肿瘤癌痛患者的效果研究[J]. 国际医药卫生导报,2022,28(2):185-189. DOI:10.3760/cma.j.issn.1007-1245.2022. 02.009.
[26] de Carvalho Schettini JA, Ramos de Amorim MM, Ribeiro Costa AA, et al. Pain evaluation in outpatients undergoing diagnostic anesthesia-free hysteroscopy in a teaching hospital: a cohort study[J]. J Minim Invasive Gynecol, 2007, 14(6):729-35. DOI: 10.1016/j.jmig.2007.05.009.
[27] 王中钰,双爽,韩丽,等. 现代艾灸治疗仪器的研发现状[J]. 中华中医药杂志,2023,38(2): 705-709.