| Objectives:1. Observe the effect of combined auricular points magnet therapy for auxiliary analgesia in gynecological peri-operation.2. Observe the effect of combined auricular points magnet therapy for the adjustment of body function in gynecological peri-operation.3. Explore the mechanism of auricular points magnet therapy.4. Based on the above, summed up a set of simple, effective auricular point therapy method for the gynecological peri-operation.Method:1. Group Methods:The patients who met the inclusion criteria,92 cases of completely random design with three groups:①auricular point pressing group (ear group),31;②comfort control group (comfort group),31;③control group (control group),30.2. Experimental Steps:(1) Auricular point sticking:all patients are required to ear visual examination, and the operator record the positive type, location.①Ear group:the day before the operation the operator uses the auricular-point detector and selectes bilateral Shenmen, subcortex, endocrine, diaphragm, lung, spleen and uterus, pelvic cavity, disinfecting the skin and sticking magnets on the points. The thumb and index finger on the ear pressure, to local redness, heat, patients can tolerate is limited. During the surgery the operator press once every 30 minutes, each time with 60-90 times/min in the frequency of pressing ear,30 seconds per point, pressure well-distributed. Told patients or their families to press their own ears before and after surgery, after pressing 3-5 times, no pain no pressure, when the patient feels pain again, she could press the auricular-point. After three days they could remove the magnets on the points themselves.②Control group:in the same ear area selected sticking the same appearance, number of plaster, no magnetic beads, no stimulation.③Control group:no any intervention. (2)30 minutes before anesthesia all patients are intramuscular injected atropine 0.5 mg and Luminal 100 mg. During the surgery the intravenous infusion rate required consistent with 8ml·kg-1·h-1. According to blood loss the intravenous infusion alternate Ringer's injection and 5% hydroxyethyl starch 130/0.4 and sodium chloride injection, using of the ratio of 2:1. (3) When all patients enter the operation room, they should be linked with the multifunction monitor (marquette EA-GLE 3000), injected the intravenous liquid. Put them right lateral body position, and use combined spinal and epidural anesthesia(CSEA), controlling the plane of anesthesia under T6. It is all-important to keep the patient quiet, painless and smooth operation. Record the amount of narcotic drugs. (4) Keep all patients remaining conscious and supply conventional nasal catheter oxygen, if necessary plus the oxygen mask. (5) When the Ear group's operation are over, the operator would use the auricular-point detector, explore for large, small intestine and stomach, brain point and add magnets on their ears.3. Outcome Measures:(1)In the day before operation and the third day after operation, the operator estimates all patients with Self-Rating Anxiety Scale (SAS). The score were recorded to evaluate the effect of auricular points magnet therapy to the emotional state of mind and adjustment of the function. (2) Record in stable state, induction period of anesthesia, beginning of operation, the separation of tumor, end of operation, the first day after operation, the heart rate (HR), blood pressure (BP), pulse oxygen saturation (SPO2), respiratory rate (RR), Ramesay score of each period to evaluate the auricular points magnet therapy effect on the body to adjust the cardiopulmonary function. (3)Observe and record the dizziness, nausea and vomiting, lack strength, insomnia, skin pruritus, hypotension (systolic blood pressure〈90mmHg, or diastolic blood pressure<60mmHg) and other bad side effects, and the incidence of postoperative complications to evaluate the auricular points magnet therapy on the role of the body to adjust. (4)Record the time of all patients excreting flatus and stool, to evaluate the auricular points magnet therapy on the body to adjust the recovery of digestive system function. (5)In the day before operation and the third day after operation, collect all the patients'venule blood samples, and test hemanalysis and biochemical indicator.By the analysis of blood leukocyte, it's proved that the auricular points magnet therapy could stabilize immune system of the body. (6)At the beginning and end of operation, collect all the patients'venule blood samples, and test the amount ofβ-endorphin and C-reactive protein in blood serum, to evaluate the auricular points magnet therapy to adjust analgesic and anti-infective mechanism of the body.Results:1. Three groups of patients according to age, body mass index(BMI), ASA grade, diseases types, pregnancy history, surgical ways, and the principles of TCM classification,there are not statistically significant difference(p>0.05).2.Three groups of patients'auricular point positive comparison:The positive rate were 93.5%,96.8%,93.3% in sequence, and the total positive rate is 94.6%. Point area of the uterus and pelvic cavity are filling with the visual blood vessel,which occupy a large proportion of positive type.3. Three groups of patients pre-operation estimating SAS scores show no significant statistical difference(p> 0.05).While the ear group post-operation estimating SAS scores compared with the comfort group and control group scores, there are significant statistical difference (p<0.05); yet the comfort group and control group scores are not statistically significant difference (p> 0.05).4. Being recorded in stable state, induction period of anesthesia, beginning of operation, the separation of tumor, end of operation, the first day after operation,all six different time points of heart rate, pulse oxygen saturation among the three groups showed no significant statistical difference(p> 0.05). However, the blood pressure of the ear group at the time point of beginning of operation, the separation of tumor, end of operation, compared with the comfort group and control group there are significant statistical difference (p<0.05); but at the same time point the respiratory rate and Ramesay score among the three groups showed no significant statistical difference(p> 0.05).5. Each group of symptoms pre-operation were not significantly different (p>0.05). Abdominal pain and distension, loss of appetite, nausea and vomiting, insomnia, skin pruritus, all above of symptoms compared the comfort group with the control group pre and post-operation. And post-operation comparisons among the three groups revealed symptoms such as abdominal pain and distension, loss of appetite, nausea and vomiting, insomnia, there are significant statistical difference (p<0.05).6. Calculate the time of all patients excreting flatus and stool post-operation. The ear group compared with the comfort group and control group, there are significant statistical difference (p<0.05); while the comfort group and control group comparisons are not statistically significant difference(p> 0.05).7. Each group of the operation time were not significantly different (p>0.05). But on the amount of epidural drug and the number of cases plus fentanyl-droperidol mixture, the ear group compared with the comfort group and control group, there are significant statistical difference (p＜0.05); while the comfort group and control group comparisons are not statistically significant difference(p> 0.05).8. Each group of the hemanalysis indicator test were not significantly different (p>0.05). But by analysis of blood leukocyte, the total number of single-granulocyte of the ear group compared with the comfort group and control group, there are significant statistical difference (p<0.05); while the comfort group and control group comparisons are not statistically significant difference(p> 0.05).9. Each group of the amount ofβ-endorphin test in blood serum pre-operation, there are significant statistical difference (p<0.05). But each group of the amount ofβ-endorphin test in blood serum post-operatione, and each group of the amount of C-reactive protein test in blood serum pre and post-operation, there are not statistically significant difference(p> 0.05).Conclusion:This research reveals it's positive that the auricular points magnet therapy effects the adjustment of body function in gynecological peri-operation. Pre-operation through the auricular points magnet therapy patients could relief the tension, fear and other negative emotions, improve sleep quality, reduce anxiety, adjust the emotional state of mind and disorders of the body function. So the body moves towards the direction of the normal physiological state of transformation, and it reduces incidence of narcotic drugs side-effect, symptoms such as abdominal pain and distension, loss of appetite, nausea and vomiting, insomnia. During the operation the operator can adjust, stabilize blood pressure at any time, and not only in varying degrees reduce the symptoms of stomach discomfort, nausea or others caused by visceral traction reaction, but find no inhibition of the respiratory and circulatory systems as life-threatened bad reactions, which help the operation smooth. Post-operation calculate the time of all patients excreting flatus and stool, we find that the ear group'time was significantly shortened, which indicate the auricular points magnet therapy can improve the recovery of digestive system function of the body.In the field of anesthesia, the group used the auricular points magnet therapy require 15%-20% less epidural drug than the comfort group and control group need, and the number of cases plus fentanyl-droperidol mixture is similar condition, only 16.1%. At present acupuncture combined with epidural anesthesia is mainly supporting analgesic, to cut the amount of narcotic drugs, to reduce incidence of narcotic drugs side-effect and postoperative complications. In addition, the study also observed auricular points magnet therapy can stimulate the level of serumβ-endorphin increased before surgery;control the total number of single-granulocyte to increased to stabilize the body's immune system. But all above of the specific mechanism needs further study. |
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