Ye Fu-ying (葉富英), Yu Ya-ping (余亞萍), Huang Wen-hong (黃文紅)

The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310005, China

Pain is listed as the fifth primary vital sign following body temperature, blood pressure, pulse and breathing rate[1]. Analgesia is the key point in post-surgery nursing care. With the development of medical science, venous analgesia pump (VAP) can effectively alleviate pain and reduce complications in peri-operative period. Such method is conductive to health rehabilitation and has been widely used in clinical practice[2]. However, the incidence of adverse event following VAP is as high as 65%, which mainly manifests as symptoms of spleenstomach disharmony including nausea, vomiting,abdominal bloating[3-4]. We used acupoint sticking of Chinese medicine at Shenque (CV 8) to prevent spleenstomach disharmony caused by VAP. The report is now given as follows.

1 Clinical Materials

1.1 Diagnostic criteria

Conforming to the diagnostic criteria of nausea,vomiting and abdominal bloating intheInternal Medicine of Traditional Chinese Medicine[5].

1.2 Inclusion criteria

Post-surgery patients using VAP in our hospital; aged between 18 and 65 years; informed consent and voluntary participation.

1.3 Exclusion criteria

Not conforming to the inclusion criteria above;accompanied with other diseases involving nerve or endocrine system; with a history of pelvic operation or lower urinary tract trauma; with mental disorders.

1.4 Statistical method

All data were analyzed using the SPSS version 18.0 software. Measuremenxtdata were expressed as mean ±standard deviation (±s), paired samplet-test was used for intra-group comparison, and independent samplet-test was used for between-group comparison.Non-ranked data were compared using Chi-square test,and ranked data were compared using rank-sum test. APvalue less than 0.05 indicated a statistical significance.

1.5 General data

A total of 120 post-surgery patients with VAP in our hospital were included between October 2016 and March 2017. The age ranged from 28 to 65 years, and the average age was 57.2 years. All patients were randomized into a treatment group of 62 cases and a control group of 58 cases by a random number table.The difference of the general data in two groups showed no statistical significance (allP＞0.05), indicating that the two groups were comparable (Table 1).

Table 1. Comparison of general data between the two groups

2 Treatment Methods

Patients in both groups received the treatment of self-controlled VAP in our hospital. The pharmaceutical formulation consisted of 100-150 μg sufentanil, 3 mg butophanol and 40 mg granisetron. Medicines above were dissolved into 100 mL 0.9% sodium chloride injection. The medicine was released by a dose of 1.5 mL every time with a 15-minute interval, which was 2.0 mL/h. The whole VAP treatment lasted for 48 h.

2.1 Control group

Patients in the control group received conventional post-surgery nursing care which included instructions on position, catering and movement.

2.2 Treatment group

Patients in the treatment group received acupoint sticking treatment on the basis of conventional nursing care.

Acupoint: Shenque (CV 8).

Components: Medicinal herbs includingChen Xiang(Lignum Aquilariae Resinatum),Rou Gui(Cortex Cinnamomi),Hou Pu(Cortex Magnoliae Officinalis) andWu Yao(Radix Linderae) at the ratio of 1:1:1:1.5 were ground into powder and preserved in a sealed pot.

Method: Took medicinal powder of 5 g and mediated it with paraffin oil to make a paste. Then warped the paste with gauze and put it on a medical paste of 6 cm ×7 cm. After locating the acupoint, Rou-kneaded the acupoint with thumb for 5 min until local skin turned red. Then put the medicinal paste on the acupoint.Replaced it with another paste every 24 h for a total of 3 times.

3 Therapeutic Efficacy Evaluation

3.1 Observation items

Recorded the incidence and severity of symptoms of nausea, vomiting and abdominal bloating during 72 h after surgery in both groups. The criteria for the degree of post-surgery nausea, vomiting and abdominal bloating was shown as follows[5].

3.1.1 Nausea degree

0: No nausea.

I: Nausea, no influence on feeding and normal living activities.

II: Nausea, with influence on feeding and normal living activities.

Ⅲ: Nausea which requires bed rest.

3.1.2 Vomiting degree

0: No vomiting.

Ⅰ: Mild vomiting (1-2 times/d).

Ⅱ: Moderate vomiting (3-5 times/d).

Ⅲ: Severe vomiting (＞5 times/d).

3.1.3 Abdominal bloating degree[6]

0: No abdominal bloating, no stomach or abdominal discomfort.

Ⅰ: Mild abdominal bloating, feeling of fullness in stomach.

Ⅱ: Moderate abdominal bloating, feeling of fullness in stomach and abdomen.

Ⅲ: Severe abdominal bloating lasting over 36 h,accompanied by nausea and unbearable abdominal bloating. Obvious dilation of the abdomen, and hyperresonant percussion.

3.2 Results

3.2.1 Comparison of the incidence of spleen-stomach disharmony during 72 h after surgery

After treatment, the incidence of spleen-stomach disharmony during 72 h after surgery in the treatment group was substantially lower than that in the control group, and between-group comparison showed a statistical significance (P＜0.05), (Table 2).

3.2.2 Comparison of the severity of spleen-stomach disharmony during 72 h after surgery

After treatment, the severity of spleen-stomach disharmony during 72 h after surgery in the treatment group was substantially lower than that in the control group, and between-group comparison showed a statistical significance (P＜0.05), (Table 3).

Table 2. Comparison of the incidence of spleen-stomach disharmony during 72 h after surgery between the two groups (case)

Table 3. Comparison of the severity of spleen-stomach disharmony during 72 h after surgery between the two groups (case)

4 Discussion

Pain is a common post-surgery problem, and the usage of analgesic will cause adverse reactions such as nausea and vomiting.

The main ingredient in the formula of self-controlled VAP in our hospital is sufentanil, an opioid analgesic which is the main cause of nausea and vomiting. The possible mechanism may be the action of opioid substances on opioid receptor[7-8]. Abdominal bloating is caused by the inhibition of peristalsis due to analgesics[9-10].

Shenque (CV 8) is an important acupoint on the Conception Vessel (CV), which runs along thorax and abdomen region where digestive organs such as stomach and intestines lay underneath. CV starts from uterus together with the Governor Vessel and the Thoroughfare Vessel. Meridian qi of the three vessels are linked with each other and interconnected with viscus and bowel, and exteriorly connected with limbs and orifices[11-13]. Umbilical skin is thin and easy for medicine to permeate. Therefore, medicine can be absorbed quickly through it. Chinese medicinal sticking on umbilicus can circulate CV and thus active constituents can reach disease location quickly. Such method has the function of dredging meridians,harmonizing Zang-fu organs, clearing heat and relaxing bowels[14-16]. The therapeutic effect may relate to the specific structure of the umbilicus, and the effects of Chinese medicine. For example,Rou Gui(Cortex Cinnamomi) can tonify qi and warm yang;Chen Xiang(Lignum Aquilariae Resinatum) can warm the middle and direct qi downward;Hou Pu(Cortex Magnoliae Officinalis) can direct qi downward and dry dampness;Wu Yao(Radix Linderae) can regulate qi and clear depression. Many ingredients in this formula can dredge meridians with aroma which is suitable for umbilicus therapy. Sticking this medical pastry onto Shenque (CV 8)can warm yang and tonify qi, clear heat and resolve dampness, dissipate and remove stagnation, regulate qi and unblock bowels, promote gastrointestinal motility and anus exhausting, decrease the incidence of nausea and vomiting, and abdominal bloating, and effectively prevent spleen-stomach disharmony caused by VAP.

In this study, Chinese medicinal sticking at Shenque(CV 8) can effectively prevent spleen-stomach disharmony like nausea and vomiting in post-surgery patients using VAP and alleviate pain. This method is convenient and noninvasive, and thus is worth clinical popularization.

Conflict of Interest

The authors declared that there was no potential conflict of interest in this article.

Acknowledgments

This work was supported by Traditional Chinese Medicine Science Research Planning Project of Zhejiang Province (浙江省中醫(yī)藥科技計劃基金項目,No.2016ZA054).

Statement of Informed Consent

Informed consent was obtained from the patients in this study.

Received: 6 September 2017/Accepted: 9 October 2017

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