| Objective:This study compared the difference clinical efficacy of auricular point pressing pill with that of sham auricular point pressing pill in the treatment of postoperative pain of mixed hemorrhoids,to clarify the inherent authenticity of the postoperative analgesic effect of auricular acupoint pill.The anti-inflammatory analgesic mechanism of auricular point pressing pill in the treatment of postoperative pain of mixed hemorrhoids was explored through the serological indexes of some participants.Methods:The research consists of two parts.The first part is a randomized controlled trial to observe the clinical efficacy.The second part,on the basis of the first part of clinical outcomes,the changes of serological indexes of some participants in the two experimental groups before and after treatment with different auricular acupoints were observed.The research patients were from the inpatient ward of the anorectal department of the Affiliated Hospital of Chengdu University of Traditional Chinese Medicine.1.In the clinical trial,80 patients with mixed hemorrhoids were randomly assigned to two groups: according to the previous literature review,shenmen,anus,internal secretion,stomach and subcortical points were selected as intervention points in the auricular point group,while those irrelevant to the disease were selected as intervention points in the sham auricular point group: eye,pillow,tonsil,lower auricular root,back of auricular kidney and back of auricular lung.Two groups of patients were treated with Milligan-Morgan of mixed hemorrhoids,general anesthesia or yaoshu point anesthesia.Patients whose VAS score was still higher than 3 at 3 hours after operation were treated with auricular acupoint pressing.Cowherb seed pressing pill was used to stimulate the auricle.The left and right sides were alternately pressed and cowherb seed was replaced once e very two days Ask the patient or the patient’s family to press for 4-8 times a day and press for 1 minute on each point.When the pain is severe,increase the frequency or time of pressing on each point.Three hours after operation,and on the 1,3,5 and 7 day after operation,the pain degree of patients in two states of quiet lying and defecation were evaluated respectively.The secondary efficacy indicators included hospital anxiety and depression score,edema score,the use rate of analgesics and other outcomes.2.20 patients who met the inclusion criteria were randomly assigned to two groups.Interventions are the same as in Part I.Blood samples were taken on 1 day and 7 days after surgery,respectively,to observe the changes of serum Interleukin-1 beta(IL-1β),Tumor necrosis factor α(TNF-α),in the patients,and to explore the anti-inflammatory analgesic of auricular analgesia.Results:1.VAS: Compared with baseline,the overall pain of patients in both groups showed a downward trend after auricular acupoint intervention.In the state of calm,compared with 1th day,the improvement of VAS score at the auricular acupoint group on 7th day was 3.19±2.07,while the sham auricular acupoint was 3.14±2.11.In the state of defecation,compared with3 th day,the improvement of VAS score on 7th day in the auricular acupoint group was2.17±2.30,while the improvement of auricular acupoint was 1.94±2.46.The auricular point group showed a trend to be better than that of sham auricular points group.But there was no significant difference between the two groups(P>0.05).2.HAD: There was no significant difference in HAD between auricular point group and sham auricular point group at baseline and three days after operation(P < 0.05),but there was significant difference in anxiety and depression score 7 days after operation(P < 0.05).Compared with the baseline,on the 3th day after the operation,there was no significant difference in hospital anxiety and depression score(HAD)between the auricular point group and the sham auricular acupoint group(P=0.079>0.05).But HAD on the 7th day after the operation,there was a significant difference between the two groups(P=0.029<0.05).It means the auricular point group had the effect of relieving negative emotions after operation.3.There were significant differences in the usage rate and dosage of Nonsteroidal Antiinflammatory Drugs(NSAIDs),between the two groups(P=0.044 < 0.05).The use of analgesics in the auricular point group was significantly lower than that of the sham auricular point group.4.There was no significant difference in the expression levels of pro-inflammatory cytokines 1L-1 β,and TNF-α between auricular point group and sham auricular point group on the 1 day and the 7 day after operation,but the expression of pro-inflammatory cytokines was inhibited.Conclusion:1.For postoperative pain of mixed hemorrhoids,auricular acupoints and sham auricular acupoints can improve pain and relieve anxiety and depression,while specific auricular acupoints for disease have a better improvement trend.2.The use of auricular acupoint reduces the application of non-steroidal analgesics,and there is no significant adverse reaction.It can be used as an adjunctive treatment for postoperative analgesia,with certain specificity,but it still needs to be further confirmed by larger sample studies.3.The auricular acupoints played a positive role in alleviating the negative emotion generated by postoperative pain,and there was a significant difference between auricular acupoints and non-auricular acupoints in alleviating the emotion 7 days after surgery(P<0.05)to provide evidence for the existence of specificity,but more high-quality tests are still needed.4.The auricular acupoint may inhibit the level of pro-inflammatory cytokines IL-1β and TNF-α by stimulating the auricular branch of the vagus nerve,thus exerting analgesic effect.In this study,there was no significant difference in the change of pro-inflammatory cytokines,but the overall level showed an inhibitory trend,which needs further verification. |
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