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耳穴疗法预防开胸手术及胸段硬膜外镇痛患者术后尿潴留的随机双盲试验

Auriculotherapy in the prevention of postoperative urinary retention in patients with thoracotomy and thoracic epidural analgesia: A randomized, double-blinded trial.

作者信息

Michel-Cherqui Mireille, Szekely Barbara, Lemoyne François, Feliot Elodie, Gayat Etienne, Fischler Marc

机构信息

Department of Anesthesiology, Hôpital Foch, Suresnes, France and Université Versailles Saint-Quentin en Yvelines.

Department of Anesthesiology and Critical Care Medicine, Hôpital Saint Louis-Lariboisière, AP-HP, Paris, France and Université Hospital, 2 Paris Diderot University, France.

出版信息

Medicine (Baltimore). 2019 Jun;98(23):e15958. doi: 10.1097/MD.0000000000015958.

Abstract

BACKGROUND

Thoracic epidural analgesia is associated with a high rate of postoperative urine retention (POUR). Auriculotherapy can reduce visceral dysfunction and can be helpful in anesthesiology and pain control. The aim of this study was to test the efficacy of preoperative auriculotherapy to decrease the occurrence of POUR.

METHODS

This single-center, double-blinded, 2-arm randomized study was performed between January 2015 and May 2016 in a tertiary care university hospital. Male patients scheduled for an elective lung surgical procedure under combined general anesthesia and thoracic epidural analgesia were included. Auriculotherapy (A group) was performed once the patient was under general anesthesia with 5 semi-permanent needles inserted in both ears at the "Shen Men" "bladder", "pelvic parasympathetic", "anterior hypothalamus", and "frontal lobe" points. Five small round patches of adhesive pads were positioned bilaterally at the same points in the control group (C group). The main outcome measure was the requirement for bladder catheterization during the day and the first night following surgery.

RESULTS

Fifty-three patients were randomized and 25 analyzed in each group. Requirement for bladder catheterization was different between groups: 24 C group patients (96%) and 18 A group patients (72%) (P = .049, Fisher exact test; Odds Ratio = 0.11 [0.01-0.95]. The number of patients needed to treat with auriculotherapy to avoid 1 case of bladder catheterization was 4. No adverse effect was observed due to auriculotherapy.

CONCLUSION

This study demonstrates that auriculotherapy is a safe and useful technique reducing POUR in thoracotomy patients benefiting from thoracic epidural analgesia.

TRIAL REGISTRATION

Clinicaltrials.gov identifier: NCT02290054 (November 13, 2014).

摘要

背景

胸段硬膜外镇痛与术后尿潴留(POUR)的高发生率相关。耳穴疗法可减少内脏功能障碍,对麻醉学和疼痛控制可能有帮助。本研究的目的是测试术前耳穴疗法降低POUR发生率的疗效。

方法

本单中心、双盲、双臂随机研究于2015年1月至2016年5月在一家三级医疗大学医院进行。纳入计划在全身麻醉联合胸段硬膜外镇痛下进行择期肺部手术的男性患者。耳穴疗法组(A组)在患者全身麻醉后进行,将5根半永久性针分别刺入双耳的“神门”“膀胱”“盆腔副交感神经”“下丘脑前部”和“额叶”穴位。对照组(C组)在相同穴位双侧放置5个小圆形贴片。主要观察指标是术后当天和术后第一晚膀胱导尿的需求。

结果

53例患者被随机分组,每组25例接受分析。两组间膀胱导尿的需求不同:C组24例患者(96%),A组18例患者(72%)(P = 0.049,Fisher精确检验;优势比 = 0.11 [0.01 - 0.95])。采用耳穴疗法避免1例膀胱导尿所需治疗的患者数量为4例。未观察到耳穴疗法引起的不良反应。

结论

本研究表明,耳穴疗法是一种安全有效的技术,可降低接受胸段硬膜外镇痛的开胸手术患者的POUR发生率。

试验注册

Clinicaltrials.gov标识符:NCT02290054(2014年11月13日)。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2748/6571246/5d6d9a2b2532/medi-98-e15958-g002.jpg

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