【作者】 徐静艳；

【导师】 徐斌；

【作者基本信息】 南京中医药大学 ， 针灸推拿学， 2008， 硕士

【摘要】 本文从理论、临床两个方面对电针介入多次实施体外受精-胚胎移植(in vitrofertilization and embryo transfer,IVF-ET)患者取卵过程的镇痛问题进行了研究,并对电针介入后的术后不良反应的变化进行了观察和分析。理论研究:综述了针剌镇痛的起源、发展、作用范围和特点,着重论述了针刺镇痛中使用最多的电针镇痛,以及电针镇痛疗效的影响因素,并从人工辅助生殖的角度论述采用电针镇痛的必要性、可行性及有效性,以及与传统麻醉或镇痛药物的比较优势。理论研究表明:电针介入IVF-ET具有科学依据和临床必要性及可行性。临床研究:采用数字随机分组的方法,将120例多次IVF-ET治疗患者分为针药组和药物组,术前测试患者的基础痛阈和耐痛阈、焦虑评分,观察患者术中疼痛程度并予以评级评分,让患者在术后立即以视觉模拟评分法(visual analogue scales,VAS)评价疗效,并回忆最近一次取卵时的感受,以VAS评价疗效。观察患者术后1小时和术后2-5小时的术后不良反应情况。通过对最后纳入的111例病例的分析,结果提示:(1)从患者角度观察,针药组本次手术VAS值为20.55±2.67,上次手术VAS值为23.46±3.05;药物组本次手术VAS值为23.37±3.24,上次手术VAS值为24.10±3.34。针药组两次VAS值差异有显著性意义(p＜0.05);药物组两次VAS值差异无显著性意义(p＞0.05);针药组和药物组本次手术VAS值差异无显著性意义(p＞0.05),表明电针介入IVF-ET取卵过程,能有效地减轻术中疼痛。(2)在术后不良反应方面,术后1小时,针药组59例有28例发生腹痛,腹痛率为47.46%;药物组52例有37例发生腹痛,腹痛率为71.15%,两组差异有显著性意义(p＜0.05)。说明电针介入IVF-ET取卵过程,能有效地减少患者术后腹痛。在术后恶心、呕吐方面,两组出现此症状的患者均较少,对出现该症状的患者针刺双内关穴,经治疗,患者均述症状缓解,提示针刺能有效地缓解患者术后恶心、呕吐的症状。结论:针刺麻醉具有疗效确切、生理干扰少的优势,更符合IVF-ET要求在最符合自然状态下实施的要求。电针介入IVF-ET患者取卵过程,能有效地减轻患者取卵时的疼痛,并减少术后腹痛的发生。更多还原

【Abstract】 This paper from two aspects of theory and clinic discusses efficacy of analgesia for electro-acupuncture interventional therapy on patients with multiple oocyte aspiration process of in vitro fertilization and embryo transfer treating,and observes and analyzes the post-operative response.Theoretical research:introducing a summary of the origin、development、action sphere and the keynote of acupuncture analgesia,emphasis on electro-acupuncture analgesia and its effect factors,discussing the necessity、feasibility、and efficacy of electro-acupuncture analgesia with the view of artificial supplementary reproduction,and also the advantages of electro-acupuncture analgesia compared with traditional anesthesia or analgesia way. Theoretical research indicated:electro-acupuncture getting involved in in-vitro fertilization and embryo transfer(IVF-ET) has scientific base and clinical necessity.Clinical research:putting the 120 patients with multiple oocyte aspiration process into electro-acupuncture combined with medication group and medication group with the way of digital random grouping,testing the patients basic pain threshold and the max pain threshold、anxieties score before the operation,observing the pain of the operation and giving the grade and score of the pain,making the patients to give a valve of VAS,and recall the felling of latter operation,and also give a valve of VAS to judge the effect of analgesia.Observing the post-operative response of 1hour and 2-5 hour after the operation of the 111patients,the result suggested:1.observed from the view of patients,the VAS of electro-acupuncture combined with medication group is 20.55±2.67,the VAS of latter operation is 23.46±3.05,the VAS of medication group is 23.37±3.24,the VAS of latter operation is 24.10±3.34.The difference of the twice VAS of the electro-acupuncture combined with medication group has statistics meaning,p＜0.05.The difference of the twice VAS of the medication group doesn’t have statistics meaning,p＞0.05.The difference between the two group of this operation doesn’t have statistics meaning,p＞0.05.The result suggests that electro-acupuncture analgesia can release the pain of the operation.2.On the postoperative adverse reaction,there are 28 patients have abdominal pain in the total 59 patients of the electro-acupuncture combined with medication group,the rate of abdominal pain is 47.46%;there are 37 patients have abdominal pain in the total 52 patients of the medication group,the rate of abdominal pain is 71.15%.The difference of abdominal pain between the two group has statistics meaning,p＜0.05.The result suggests that electro-acupuncture interventional therapy can reduce postoperative adverse reaction.On the aspect of postoperative nausea and vomiting aspects,there are a few patients have those symptoms of both the two groups.For the patient with the symptoms of nausea and vomiting aspects,acupuncture at double Neiguan point can feel better.The result suggested that acupuncture can relive the symptoms of postoperative nausea and vomiting.Conclusion:electro-acupuncture interventional therapy on patients with multiple oocyte aspiration process of in vitro fertilization and embryo transfer treating can release the pain of the operation,and reduce the abdominal pain of postoperative adverse reaction.更多还原