四子散中药封包联合循经穴位推拿在肩袖损伤关节镜术后尿潴留护理中的应用研究进展

Research Progress on the Application of Sizi Powder Herbal Hot Pack Combined with Meridian Acupoint Massage in Nursing Care for Postoperative Urinary Retention after Arthroscopic Surgery for Rotator Cuff Injury

摘要: 目的：梳理四子散中药封包与循经穴位推拿用于肩袖损伤关节镜术后尿潴留护理的理论依据、相关证据及安全边界，并提出可验证的临床研究方案。方法：以肩部手术后排尿功能障碍、术后尿潴留、四子散、热熨(热奄包)、穴位按摩(推拿)等为主题，对中英文研究进行叙述性归纳；参考“四子散加粗盐循经热熨对脑卒中痉挛性偏瘫患者的影响”的干预标准化与结局评价思路，重构本主题的证据链。结果：肩部手术后排尿功能变化并不少见，但四子散中药封包联合循经穴位推拿在肩袖关节镜患者中的直接研究尚缺乏。现有证据主要来自脑卒中、腰椎消融术及肛肠、妇科等术后人群，提示热熨、穴位刺激及其组合可能改善排尿相关结局；然而研究对象、干预方式、尿潴留定义和结局指标异质性较大，且多为小样本单中心研究。结论：该联合护理可作为常规膀胱管理之外的待验证辅助方案，但现阶段不能据此宣称其可降低肩袖关节镜术后尿潴留发生率。后续应开展预注册、分配隐藏、评价者盲法的随机对照试验，统一药物组成、温度、时长、穴位与手法，并以膀胱超声、首次自主排尿时间和导尿率等客观指标评价有效性与安全性。从机制上看，联合干预可能通过温热与机械感觉输入影响躯体–自主神经反射，并通过缓解焦虑和围术期应激间接促进排尿，但上述路径仍属于有待验证的科学假说。

Abstract: Objective: To clarify the theoretical basis, relevant evidence, and safety boundaries of using a Sizi San herbal medicine pack combined with meridian-based acupoint Tuina for the nursing management of postoperative urinary retention after arthroscopic surgery for rotator cuff injury, and to propose a verifiable clinical research protocol. Methods: A narrative synthesis was conducted of Chinese- and English-language studies addressing postoperative urinary dysfunction after shoulder surgery, postoperative urinary retention, Sizi San, hot fomentation (herbal hot packs), and acupoint massage/Tuina. Drawing on the intervention standardization and outcome-assessment approaches used in the study “Effects of Meridian-Based Hot Fomentation with Sizi San and Coarse Salt in Patients with Spastic Hemiplegia after Stroke,” the evidence chain for the present topic was reconstructed. Results: Changes in urinary function after shoulder surgery are not uncommon. However, direct evidence regarding the use of Sizi San herbal packs combined with meridian-based acupoint Tuina in patients undergoing arthroscopic rotator cuff surgery remains lacking. Existing evidence is derived primarily from patients with stroke, those undergoing lumbar ablation procedures, and patients after anorectal or gynecologic surgery. These studies suggest that hot fomentation, acupoint stimulation, and their combination may improve urinary outcomes. Nevertheless, substantial heterogeneity exists in study populations, intervention protocols, definitions of urinary retention, and outcome measures, and most studies are small, single-center investigations. Conclusion: This combined nursing intervention may be considered an investigational adjunct to routine bladder management. At present, however, the available evidence does not support claiming that it reduces the incidence of postoperative urinary retention after arthroscopic rotator cuff surgery. Future studies should use preregistration, allocation concealment, and blinded outcome assessment. They should also standardize the herbal composition, temperature, treatment duration, acupoints, and Tuina techniques, and evaluate efficacy and safety using objective measures such as bladder ultrasonography, time to first spontaneous urination, and the urinary catheterization rate. Mechanistically, the combined intervention may influence somatic–autonomic reflexes through thermal and mechanical sensory input and may indirectly facilitate urination by reducing anxiety and perioperative stress. However, these proposed pathways remain scientific hypotheses requiring empirical verification.