| Research Background:Subarachnoid block is to inject the local anesthetic into subarachnoid cavity, which will block the spinal nerve root, the dorsal root ganglion as well as the surface of the spinal cord to various degrees and is called Spinal Cord Paralysis in short form. This method can be applied to the most of operations on hypogastrium and the lower limb and can gain satisfactory anesthesia effect. When the local anesthetic is injected into the subarachnoid cavity, it has been proved that it will block cystic micturition reflex, and also block the lower limbs and the cavitas pelvis of the patients in many aspects such as temperature, pain, touch, muscular movement, pressure and proprioceptive sensibility, which will finally result in the urinary retention. Based on the anatomical basis and the physiological change, the urinary retention is caused by the block with dynamic properties, and the normal micturition reflex disappears after the injection of the anesthetic, which is made it has a high incidence rate. Overfilling of bladder could induce changes of circulation. By stimulation of peritoneum, it can provoke BP to increase and even rupture the bladder seriously.At present, the regular method to prevent and treat with the urinary retention is to insert the catheter before operation, however, according to the report by Haley et al. that the urethra infection rate was 3.1% in the patients without urethral catheterization, 1——5% in single urethral catheterization and 9.9% in preserving catheter; and infection rate was related to preservation time of catheter. will increase with the prolonging of retention time of urethral catheterization.Based on the above discussion, the present paper believes that acupuncture is a good way to prevent and reduce urinary retention resulted from lumbar anesthesia.According to the theory of traditional Chinese medicine, the urinary retention belongs to the category of uroschesis. The incidence is related to the urinary obstruction, due to the block in meridians and also closely related to those functions such as the function of triple energizer, lung, spleen, kidney, liver. In the chapter of Reiki Secret Code of Internal Canon of Medicine, it is said that the bladder is the source of body fluid, and the gasification of it reveals the energy. The bladder damp-heat interaction results in adverse gasification, and then the difficulty in urination. The urinary retention, no matter from the operation or the neuro-endocrine factors, results from malfunction in the triple energizer, in the gasification of the bladder and the loss of opening and closing.There are many researches about acupuncture to treat retention of urine. After years of clinical practices, their curative effect has been proved. It has the features such as being simple, economical, safe and non-disturbing in physiological function, and it can also adjust the body's physiological functions.Using electric acupuncture to prevent and reduce the incidence of urinary retention resulted from lumbar anesthesia can avoid those drawbacks caused by the catheter insertion in some operations with less damage and less blood loss.It can reduce the incidence of urinary tract infections, reduce the utilization rate of postoperative antibiotics, remove the fear of the patients brought by the urethral catheterization and improve the quality of operation,accords with the development trend of modern anesthesia.Research purpose:To observe the effect and security of electric acupuncture to interfere in bladder's reconstruction after spinal anesthesia. Research methods:Cases selection:select 61 patients with the suitable standard and randomized them into EA group and control group,31 in EA group and 30 in control group.Electric acupuncture methods:the treatment group starts to acupuncture into the acupoints such as Guanyuan, Guilai and Zhongji when the anesthesia area recedes to the level 10 of the chest. The major acupoints are bilateral Guilai acupoints on both sides, and the matching acupoints are Guanyuan and Zhongi. Patients lie supine and the local routine disinfection is conducted.Locate the Guilai acupoint:one inch above the centre of the groin, one inch on the edge of the pubic bone, and then two inches aside,4 inch acupuncture needle; piercing the needle directly or piercing the needle obliquely inward 1.5-inch.Locate the Zhongji acupoint:the middle of the white line on the bladder above the pubic arch in the hypogastrium,4 inches below the umbilicus; piercing the needle tip obliquely downward 1 inch with an angle of 45 ".Locate the Guanyuan acupoint:the middle line in the hypogastrium,1 inch above the Zhongji acupoint and 3 inches below the umbilicus; piercing the needle directly or obliquely downward 1.5 inches. Connect the HANS electric acupuncture device, with a frequency of 2HZ, continuous wave, current intensity of 2MA, to the acupoints of Guanyuan, Zhongji and Guilai on both sides and keep it for 30 minutes. Comparing method:start to time when the anesthesia area recedes to the level 10(T10) of the chest, but don't give acupuncture intervention and observe the self-voiding time from then.Observation indexes:time and dose of lumbar spinal anesthesia during the operation; records at each time point indexes after the operation:Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean pressure (MBP) and heart rate (HR); the records on urination condition, urination time and urination volume; other factors such as urination cases, stomach sank and gasteremphraxis, obstacles and comfort and acceptability of urination. Research Results:All cases were selected the lower limb operations and achieved spinal anesthesia. To observe the time of recovering urination of bladder(beginning time points were anesthesia area at T10 and 20 minutes after spinal anesthesia respectively): Acupunctured GuanYuan, ZhongJi and bilateral GuiLai points by electric stimulation in EA group; No interferential method in control group. Compared two groups in the time of anesthesia area T10 to urination:P=0.004<0.05, the time of 20 minutes after spinal anesthesia to urination:P=0.002<0.05. Both results have statistical significance. cases T10 to urination 20min after anesthesia to urination Treat group 31227.58±77.92356.29±96.99 Control group 30312.50±90.85428.33±71.37 Above data indicated that urination time in treat group was earlier obviously than control group from both recorded points. So EA can decrease the incidence of urinary retention, avoid of inserting catheter during operation and its uncomfortable feeling or infection. This is a better method to prevent urinary retention resulted by spinal anesthesia.While the drugs will inject into subarachnoid space directly in patients who achieve lower limb-operation by spinal anesthesia, it can lead sympathetic nerve block quickly and a relative cardiac insufficiency, we suggest that mass fluid transfusion treatment after spinal anesthesia is important to prevent hypovolemia. From transfusion volume at the time of T10 and urination after operation, it showed that volume at T10:P=0.446>0.05; at urination:P=0.563>0.05, both of them have no statistical differentiation. Then we observed the urination volume and selected statistic data respectively----divided into≥400ml and<400ml between two groups. According to t test, P=0.569>0.05, no statistic differentiation and X2 test, P=0.002<0.05, has statistic differentiation. cases T10 urination volume volume>400 volume<400 Treat group 311161.29±207.65 1630.65±269.47 339.03±108.49 5 26 Control group30 1126.67±136.29 1673.33±302.78 360.67±179.3816 14 The data above is indicated that no matter treat group or control group, the transfusion volume was related to anesthesia method, especially achieve spinal anesthesia, and therefore, transfusion volume between both of groups has no statistic significance. From the volume of urination, acupuncture relevant points can reduce the recovering time of bladder function and sensitivity, construct urinary reaction quickly underlie the regular urinary capacity, avoid the damage of bladder function from urine retention.Conclusion:Electric acupuncture can promote recovering of bladder function effectively which is after spinal anesthesia, has no side effect, and therefore could be utilized widely in clinical field. |
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