| [Objective]?Through randomized controlled clinical trials to explore the effect of aromatherapyacupoint massage on preventing PONV in patients with orthopedic general anesthesia,compare the incidence of PONV and the severity of PONV symptoms;?Comparative analysis of aromatherapy and acupressure two different traditional Chinese medicine nursing methods to prevent PONV effect in patients with orthopedic general anesthesia,moreover,the differences of the economic costs and nursing time of the two nursing measures are analyzed.?The effects of aromatherapy on 5-HT and dopamine in rats were observed by animal experiments,and the mechanism of aromatherapy on PONV was discussed.[Methods]This subject is divided into two parts,one is clinical research,the other is animal experiment research.Clinical study:a total of 270 patients were admitted to the department of orthopaedics and traumatology of a top three Chinese Medicine hospital in Suzhou and received general anesthesia from November 2017 to August 2018,which selected by convenience sampling method.According to the random numbers generated by the computer software,the patients were divided into aromatherapy group,acupoint massage group and control group,with 90 patients in each group.Patients in the three groups were given a unified anesthesia program,and patients in the control group received intravenous injection of azasqiqiong 10mg at the end of the operation.After the operation,sleep,nutrition,analgesia,rehabilitation and other management contents were performed according to the recommendations of the guidelines for rapid rehabilitation in orthopedics.The aromatherapy group used the routine nursing content of the control group and gave essential oil inhalation aromatherapy.Two interventions were given within 24 hours after the operation.The patient was firstly returned to the ward immediately after the patient was snorted for 6 hours(adding 0.3 ml at intervals of 2 hours).Essential oil),the second time was implemented 12 hours after the first intervention.In addition to the routine nursing content of the control group,the acupoint massage group was given acupressure,and was intervened twice within 24 hours after the operation.The first time was returned to the ward after surgery,the duration of the massage was 25 min/time,and the acupuncture points selected bilateral Neiguan points and Hegu.Acupoints and Zusanli points were administered for the second time 12 hours after the first intervention.The incidence and severity of postoperative nausea and vomiting,postoperative nausea duration and the number of additional cases of metoclopramide were observed in the three groups.The economic costs and nursing time differences of the aromatherapy group and the acupressure group were also analyzed.Experimental study:20 SD rats were randomly divided into model group and aromatherapy group.Morphine was injected subcutaneously into the abdomen to establish the vomiting model of rats.Rats in the model group were fed without intervention.In the aromatherapy group,the rats were given inhalation aromatherapy of essential oil.0.3ml of essential oil was dropped onto the filter paper,placed in the bottom tank of the feeding cage,and continuously sniffed for 6 hours.To maintain the concentration of essential oil,0.3ml of essential oil was added every 2 hours.The contents of 5-ht and dopamine in serum of the two groups of rats at 6h and 24h after intervention were observed.[Results]Clinical study:a total of 270 patients participated in the study,90 in each group,without shedding cases.There was no significant difference in baseline data among the three groups(P>0.05),which was comparable.After the intervention,the PONV incidence was 12 cases(13.3%)in the aromatherapy group,17 cases(18.9%)in the acupoint massage group,and 46 cases(51.1%)in the control group within 24 hours after the operation,respectively.The PONV incidence in the aromatherapy group and acupoint massage group was lower than that in the control group,and the difference was statistically significant(P<0.0167).Although the incidence of PONV in the aromatherapy group was lower than that in the acupoint massage group,the difference was not statistically significant(P>0.05).The severity of PONV was lower in the aromatherapy group and acupoint massage group than in the control group,and the difference was statistically significant(P<0.05),but there was no statistically significant difference between the aromatherapy group and acupoint massage group(P>0.05).The number of PON duration and metoclopramide addition cases in the aromatherapy group and acupoint massage group were all lower than those in the control group,and the comparison was statistically significant(P<0.05),but the difference between the aromatherapy group and acupoint massage group was not statistically significant(P>0.05).From the perspective of economic costs,the average cost of care materials per patient in the aromatherapy group was 25.02 RMB,and the cost of total nursing materials was 2251.80 RMB.The average cost of care for each patient in the acupressure group was 20 RMB,and the cost of total nursing materials was 1,800 RMB.From the cost-effectiveness ratio and the incremental-cost effect ratio,the results show that the composition-effect ratio of aromatherapy is 25.97,and the acupoint massage composition-effect ratio is 22.19.From the incremental cost-effectiveness ratio,the result is 80.68.It shows that compared with the acupressure group,the incidence of PONV in the aromatherapy group needs to cost 80.68 RMB for every one percentage point decrease.From the point of nursing time,the time taken for each aromatherapy is 12 minutes,and the acupressure is 31 minutes.Experimental study:pica was observed in all the modeling animals,and kaolin consumption increased(P<0.05),indicating successful modeling.The results of this study showed that the content of serum 5-HTand DA in the aromatherapy group was(0.289±0.069)?g,(0.554±0.083)?g,and that in the model group was(0.473±0.088)?g,(0.776±0.102)?g 6 hours after the intervention,and the difference between the two groups was statistically significant(P<0.05).24h after the intervention,serum 5-HT and DA levels in the aromatherapy group were(0.231±0.037)?g,(0.472±0.089)p,g,and those in the model group were(0.425±0.099)?g,(0.743±0.104)?g.The difference between the two groups was statistically significant(P<0.05).However,there was no significant difference between the intergroups(P>0.05).[Conclusion]Clinical study:?aromatherapy and acupoint massage can reduce PONV incidence,PONV severity and PON duration in patients with orthopedic general anesthesia.?aromatherapy and acupoint massage have similar effect on the prevention of PONV in patients with orthopedic general anesthesia,which can reduce the incidence of PONV,reduce the severity of symptoms,and reduce PON duration.?The cost of the two nursing measures is not high,the difference is not big,but the acupressure composition is relatively low.However,acupressure takes longer to care for and manpower costs;Experimental study:aromatherapy can reduce the content of 5-HT and DA in serum. |
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