循证护理联合穴位刺激对脊柱术后恶心呕吐的干预效果评价

Evaluation of the Intervention Effect of Evidence-Based Nursing Combined with Acupoint Stimulation on Postoperative Nausea and Vomiting in Spinal Surgery

摘要: 目的：本研究旨在系统评价循证护理联合穴位刺激这一中西医结合干预方案对脊柱术后PONV的预防和治疗效果，为临床实践提供更优的护理策略。方法：采用单中心回顾性对照研究设计，纳入2023年1月至2023年12月在新疆医科大学第六附属医院脊柱外二科住院治疗并接受脊柱全麻手术的300例患者。采用随机数字表法将患者分为对照组(n = 150)和观察组(n = 150)。对照组接受常规护理，观察组在常规护理基础上给予循证护理联合穴位刺激。结果：观察组在多个关键指标上均显著优于对照组(P < 0.05)。具体而言，观察组PONV发生率(10.66%)较对照组(19.33%)显著降低(P = 0.024)；恶心VAS评分(3.00 ± 1.20 vs. 4.50 ± 1.50)和呕吐次数(1.52 ± 0.81 vs. 3.45 ± 1.03)明显改善；止吐药物追加量减少43% (8.67 ± 2.50 mg vs. 15.22 ± 3.02 mg)；首次下床活动时间提前13.8小时(34.60 ± 5.50 h vs. 48.40 ± 6.52 h)；住院时间缩短3.7天(6.50 ± 1.50 d vs. 10.20 ± 2.00 d)；患者满意度显著提高(4.20 ± 0.60 vs. 3.50 ± 0.80)，观察组在炎症指标(IL-10)和凝血功能(D-二聚体)方面也有明显改善。结论：循证护理联合穴位刺激的综合干预方案能有效降低脊柱全麻术后PONV发生率，减轻症状严重程度，减少止吐药物使用，促进术后康复。该方案实现了安全、有效、经济的干预效果，符合加速康复外科理念。本研究为PONV的防治提供了新的思路和方法，对推动围手术期护理的发展具有重要意义。

Abstract: Objective: This study aims to systematically evaluate the preventive and therapeutic effects of an integrated Chinese and Western medicine intervention combining evidence-based nursing and acupoint stimulation on postoperative nausea and vomiting (PONV) following spinal surgery, providing an optimized nursing strategy for clinical practice. Methods: A single-center retrospective controlled study design was employed, enrolling 300 patients who underwent spinal general anesthesia surgery and were hospitalized in the Department of Spinal Surgery II, Sixth Affiliated Hospital of Xinjiang Medical University, from January 2023 to December 2023. Patients were randomly divided into a control group (n = 150) and an observation group (n = 150) using a random number table. The control group received routine nursing care, while the observation group received evidence-based nursing combined with acupoint stimulation in addition to routine care. Results: The observation group demonstrated significantly superior outcomes across multiple key indicators compared to the control group (P < 0.05). Specifically, the incidence of PONV in the observation group (10.66%) was significantly lower than that in the control group (19.33%, P = 0.024). The nausea VAS score (3.00 ± 1.20 vs. 4.50 ± 1.50) and frequency of vomiting (1.52 ± 0.81 vs. 3.45 ± 1.03) were notably improved. The additional dosage of antiemetic medication was reduced by 43% (8.67 ± 2.50 mg vs. 15.22 ± 3.02 mg). The time to first ambulation was advanced by 13.8 hours (34.60 ± 5.50 h vs. 48.40 ± 6.52 h), and the hospital stay was shortened by 3.7 days (6.50 ± 1.50 d vs. 10.20 ± 2.00 d). Patient satisfaction significantly increased (4.20 ± 0.60 vs. 3.50 ± 0.80). Additionally, the observation group showed notable improvements in inflammatory markers (IL-10) and coagulation function (D-dimer). Conclusion: The comprehensive intervention strategy combining evidence-based nursing and acupoint stimulation effectively reduces the incidence of PONV after spinal general anesthesia, alleviates symptom severity, decreases antiemetic medication use, and promotes postoperative recovery. This approach achieves safe, effective, and economical intervention outcomes, aligning with the principles of enhanced recovery after surgery (ERAS). This study provides new insights and methods for the prevention and treatment of PONV, making a significant contribution to the advancement of perioperative nursing care.