تأثیر طب فشاری در نقطه LI4 بر درد و اضطراب حین سقط: یک کارآزمایی بالینی تصادفی کنترل شده دوسوکور

نوع مقاله : اصیل پژوهشی

نویسندگان

1 مربی گروه مامایی، مرکز تحقیقات مراقبت سالمندی، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی رفسنجان، رفسنجان، ایران.

2 استادیار گروه پرستاری سلامت جامعه، مرکز تحقیقات عوامل اجتماعی مؤثر بر سلامت، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی رفسنجان، رفسنجان، ایران.

چکیده

مقدمه: درد و اضطراب به‌عنوان ویژگی‌های قابل پیش‌بینی فرآیند سقط، می‌توانند منجر به کاهش کیفیت مراقبت‌های بالینی شوند، لذا مطالعه حاضر با هدف تعیین تأثیر طب فشاری در نقطه LI4 بر درد و اضطراب حین سقط انجام شد.
روشکار: این مطالعه کارآزمایی بالینی تصادفی کنترل شده در سال 1400 بر روی 120 نفر از زنان در حال سقط بستری‌شده در زایشگاه نیک‌نفس رفسنجان انجام شد. افراد به‌طور مساوی در سه گروه مداخله، لمس و کنترل تخصیص یافتند. در گروه مداخله طب فشاری در نقطه LI4 به‌صورت دوطرفه در دوره‌های 10 ثانیه‌ای فشار و 2 ثانیه استراحت به‌مدت 20 دقیقه و در گروه لمس، نقطه فوق بدون فشار لمس گردید. قبل، بلافاصله و نیم ساعت بعد از مداخله نمره درد و اضطراب به‌ترتیب توسط مقیاس آنالوگ دیداری (VAS) و پرسشنامه اضطراب حالت اشپیل‌برگر سنجیده شد. تجزیه و تحلیل داده‌ها با استفاده از نرم‌افزار آماری SPSS (نسخه 22) و آزمون‌های آماری آنالیز واریانس یک‌طرفه، کروسکال والیس و اندازه‌گیری مجدد انجام شد. میزان p کمتر از 05/0 معنی‌دار در نظر گرفته شد.
یافته‌ها: بر اساس نتایج، سه گروه به‌غیر از تعداد سقط و زایمان، در سایر ویژگی‌های جمعیت‌شناختی مشابه هم بودند. بعد از تعدیل اثر تعداد سقط و زایمان، میانگین نمره درد در درون گروه‌ها (اثر زمان) (291/0=p) و بین گروه‌ها (اثر گروه) (572/0=p) و روند تغییرات نمره درد در بین گروه‌ها در زمان‌های اندازه‌گیری متوالی (تعامل بین زمان و گروه) (262/0=p) تفاوت آماری معنی‌داری نداشت. پس از تعدیل اثر تعداد سقط، تعداد زایمان و نمره اضطراب پایه، مقایسه روند تغییرات نمره اضطراب سه گروه در دو بار اندازه‌گیری‌های متوالی (اثر تعاملی زمان و گروه) نیز تفاوت آماری معنی‌داری را نشان نداد (896/0=p).
نتیجه‌گیری: بر اساس نتایج این تحقیق، مداخله طب فشاری نتوانست درد و اضطراب زنان در حال سقط را مدیریت کند.

کلیدواژه‌ها


عنوان مقاله [English]

The effect of acupressure at LI4 point on pain and anxiety during abortion: a double-blind randomized controlled clinical trial

نویسندگان [English]

  • Zohreh Sahebi 1
  • Tayebeh Negahban Bonabi 2
1 Instructor, Department of Midwifery, Geriatric Care Research Center, School of Nursing and Midwifery, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.
2 Assistant Professor, Department of Community Health Nursing, Social Determinants of Health Research Center, School of Nursing and Midwifery, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.
چکیده [English]

Introduction: Pain and anxiety as predictable features of abortion process can reduce the quality of clinical care. Therefore, this study was performed aimed to determine the effect of acupressure at LI4 point of pain and anxiety during abortion.
Methods: This randomized clinical controled trial studywas done in 2021 on 120 women during abortion hospitalized in Niknafs maternity hospital in Rafsanjan. The subjects were equally divided into three groups of intervention, touch and control. In the intervention group, acupressure at LI4 point was applied bilaterally during 10-second periods of pressure and 2-second rest for 20 minutes. In the touch group, the above point was touched without pressure. Before, immediately and half an hour after the intervention, pain and anxiety scores were measured by Visual Analog Scale(VAS) and Spielberger state anxiety questionnaire, respectively. Data were analyzed by SPSS software (version 22) using one-way analysis of variance (ANOVA), Kruskal-wallis, Repeated Measurement. P< 0.05 was considered statistically significant.
Results: The results showed that the three groups were similar in demographic characteristics, except for the number of abortions and deliveries. After adjusting the effect of the number of abortions and deliveries, the mean score of pain within the groups (time effect) (p = 0.291), and between the groups (group effect) (p = 0.572) and the trend of pain score changes between the groups in consecutive measurement times (p = 0.262) were not significantly different. After adjusting the effect of the number of abortion, number of delivery and baseline anxiety score, comparison of the trend of changes in anxiety scores of the three groups in two consecutive measurement (interaction effect of time and group) did not show a statistically significant difference (p = 0.896).
Conclusion: Based on the results of this study, acupressure intervention could not manage the pain and anxiety of women during abortion.

کلیدواژه‌ها [English]

  • Abortion
  • Acupressure
  • Complementary medicine
  • Pain
  • Situational anxiety
  1. Dragoman MV, Grossman D, Kapp N, Huong NM, Habib N, Dung DL, et al. Two prophylactic medication approaches in addition to a pain control regimen for early medical abortion< 63 days’ gestation with mifepristone and misoprostol: study protocol for a randomized, controlled trial. Reproductive health 2016; 13(1):1-0.
  2. Fiala C, Danielsson KG. Review of medical abortion using mifepristone in combination with a prostaglandin analogue. Contraception 2006; 74(1):66-86.
  3. Spitz IM, Bardin CW, Benton L, Robbins A. Early pregnancy termination with mifepristone and misoprostol in the United States. New England Journal of Medicine 1998; 338(18):1241-7.
  4. World Health Organization. Medical management of abortion. Geneva: World Health Organization; 2018. Availabe at: https://apps.who.int/iris/bitstream/handle/10665/278968/9789241550406-eng.pdf
  5. Taylor D, Postlethwaite D, Desai S, James EA, Calhoun AW, Sheehan K, et al. Multiple determinants of the abortion care experience: from the patient’s perspective. American Journal of Medical Quality 2013; 28(6):510-8.
  6. Gullich I, Ramos AB, Zan TR, Scherer C, Mendoza-Sassi RA. Prevalence of anxiety in patients admitted to a university hospital in southern Brazil and associated factors. Revista Brasileira de Epidemiologia 2013; 16:644-57.
  7. MSC BR, PhD AO. Perception of situational stress associated with hospitalization among selected Nigerian patients. Journal of advanced nursing 1991; 16(4):469-74.
  8. Chhari N, Mehta SC. Stress among patients during hospitalization: A study from Central India. Orthopedics 2016; 175:25.
  9. Williams JB, Alexander KP, Morin JF, Langlois Y, Noiseux N, Perrault LP, et al. Preoperative anxiety as a predictor of mortality and major morbidity in patients aged> 70 years undergoing cardiac surgery. The American journal of cardiology 2013; 111(1):137-42.
  10. AbuRuz ME. Persistent anxiety and in-hospital complications after acute coronary syndrome. International journal of health sciences 2018; 12(2):50.
  11. Dahlén I, Janson C. Anxiety and depression are related to the outcome of emergency treatment in patients with obstructive pulmonary disease. Chest 2002; 122(5):1633-7.
  12. Gouin JP, Kiecolt-Glaser JK. The impact of psychological stress on wound healing: methods and mechanisms. Immunology and Allergy Clinics 2011; 31(1):81-93.
  13. Woo AK. Depression and anxiety in pain. Reviews in pain 2010; 4(1):8-12.
  14. Gudmundsson G, Gislason T, Janson C, Lindberg E, Hallin R, Ulrik CS, et al. Risk factors for rehospitalisation in COPD: role of health status, anxiety and depression. European respiratory journal 2005; 26(3):414-9.
  15. Bailey L. Strategies for decreasing patient anxiety in the perioperative setting. AORN journal 2010; 92(4):445-60.
  16. Wingo AP, Gibson G. Blood gene expression profiles suggest altered immune function associated with symptoms of generalized anxiety disorder. Brain, behavior, and immunity 2015; 43:184-91.
  17. Kidd T, Poole L, Leigh E, Ronaldson A, Jahangiri M, Steptoe A. Attachment anxiety predicts IL-6 and length of hospital stay in coronary artery bypass graft surgery (CABG) patients. Journal of Psychosomatic Research 2014; 77(2):155-7.
  18. Grossman D, Raifman S, Bessenaar T, Duong LD, Tamang A, Dragoman MV. Experiences with pain of early medical abortion: qualitative results from Nepal, South Africa, and Vietnam. BMC women's health 2019; 19(1):1-11.
  19. Laine L. Gastrointestinal effects of NSAIDs and coxibs. Journal of Pain and Symptom Management 2003; 25(2):32-40.
  20. Harirforoosh S, Asghar W, Jamali F. Adverse effects of nonsteroidal antiinflammatory drugs: an update of gastrointestinal, cardiovascular and renal complications. Journal of Pharmacy & Pharmaceutical Sciences 2013; 16(5):821-47.
  21. Louie K, Chong E, Ginde S, Kuehl L, Washington S, Gatter M, et al. A survey study of marijuana use for pain management during first-trimester medical abortion. Contraception 2016; 94(4):394.
  22. Wiebe E, Podhradsky L, Dijak V. The effect of lorazepam on pain and anxiety in abortion. Contraception 2003; 67(3):219-21.
  23. Rousdy A. Effectiveness of acupressure at the Zusanli (ST-36) acupoint as a comfortable treatment for diabetes mellitus: a pilot study in Indonesia. Journal of acupuncture and meridian studies 2017; 10(2):96-103.
  24. Ganji G, Keramat A, Ahmad Shiravani M. Effect of acupressure on labor pain relief: a systematic review of clinical trials. Iran J Obstet Gynecol Infertil 2014; 17(119):8-17.
  25. Negahban Bonabi T, Ansari Jaberi A, Esmaeilzadeh S, Hasanshahi Ravizi A. Comparison of the effect of acupressure at LI4 and SP6 points on the intensity of post cesarean pain. Iran J Obstet Gynecol Infertil 2018; 21(6):9-17.
  26. Ranjkesh F, Mehri Z, Mafi M, Habibi M, Moafi F. Effects of acupressure at LI4, He7, SP6 and Neima points on labor anxiety in nulliparous women: randomized clinical trial. Iran J Obstet Gynecol Infertil 2019; 22(4):25-35.
  27. Mohammadifard M, Salarfard M, Samieean M. The effect of H7 acupressure on amniocentesis anxiety in pregnant women: A randomized controlled trial. Nursing and Midwifery Studies 2021; 10(4):222-8.
  28. Akhavan Amjadi M, Shahbazzadegan S, Shakiba M. Comparison of Acupressure Effect on Two Points, Sanyinjiao versus Tai Chong, on Primary Dysmenorrhea. Journal of Ardabil University of Medical Sciences 2015; 15(1):97-106.
  29. Ndubisi C, Danvers A, Gold MA, Morrow L, Westhoff CL. Auricular acupuncture as an adjunct for pain management during first trimester abortion: a randomized, double-blinded, three arm trial. Contraception 2019; 99(3):143-7.
  30. Feng X, Ye T, Wang Z, Chen X, Cong W, Chen Y, et al. Transcutaneous acupoint electrical stimulation pain management after surgical abortion: A cohort study. International Journal of Surgery 2016; 30:104-8.
  31. Pandis N. Randomization. part 2: minimization. American journal of orthodontics and dentofacial orthopedics 2011; 140(6):902-4.
  32. Dabiri F, Shahi A. The effect of LI4 acupressure on labor pain intensity and duration of labor: a randomized controlled trial. Oman medical journal 2014; 29(6):425.
  33. Reich A, Heisig M, Phan NQ, Taneda K, Takamori K, Takeuchi S, et al. Visual analogue scale: evaluation of the instrument for the assessment of pruritus. Acta Dermato Venereologica 2012; 92(5):497-501.
  34. Ferreira-Valente MA, Pais-Ribeiro JL, Jensen MP. Validity of four pain intensity rating scales. Pain® 2011; 152(10):2399-404.
  35. Price DD, McGrath PA, Rafii A, Buckingham B. The validation of visual analogue scales as ratio scale measures for chronic and experimental pain. Pain 1983; 17(1):45-56.
  36. Spielberger CD, Gorsuch RL, Lushene R, Vagg PR, Jacobs GA. State-trait anxiety inventory for adults: Manual, instrument, and scoring guide. Mind Garden, Incorporated; 1983.
  37. Mahram B. Standardization of Spielberger’s test anxiety inventory in Mashhad. Tehran: Allameh Tabatabaei University; 1994.
  38. Ramezani S, Hamidzadeh A, Abdollahpour S, Khosravi A. Effects of LI4 acupressure on post-cesarean section pain. International Journal of Health Studies 2016; 2(2).
  39. Dewi R, Idiana A. Effectivity of Large Intestine 4 Point Accupressure on Labour Pain Stage-I Active Phase. Bioscientia Medicina: Journal of Biomedicine and Translational Research 2021; 5(11):1117-22.
  40. Smith CA, Collins CT, Levett KM, Armour M, Dahlen HG, Tan AL, et al. Acupuncture or acupressure for pain management during labour. Cochrane Database of Systematic Reviews 2020(2).
  41. Chen Y, Xiang XY, Chin KH, Gao J, Wu J, Lao L, et al. Acupressure for labor pain management: a systematic review and meta-analysis of randomized controlled trials. Acupuncture in Medicine 2021; 39(4):243-52.
  42. Mirzaee F, Hasaroeih FE, Mirzaee M, Ghazanfarpour M. Comparing the effect of acupressure with or without ice in LI-4 point on labour pain and anxiety levels during labour: a randomised controlled trial. Journal of Obstetrics and Gynaecology 2021; 41(3):395-400.
  43. Rarani SA, Rajai N, Sharififar S. Effects of acupressure at the P6 and LI4 points on the anxiety level of soldiers in the Iranian military. BMJ Mil Health 2021; 167(3):177-81.
  44. Masoudi Z, AkbarZadeh M, Zare N. Comparison of the effects of maternal supportive care and Acupressure (at BL32 Acupoint) during labor on the mother’s anxiety level and Arterial oxygen pressure of the umbilical cord of infants (PO2). Research of Womens 2020; 1(1):87.
  45. Fazeli F, Moeindarbary S, Ahmadi R, Dehghani41 N. Effect of Acupressure Point (LI4) on Anxiety Levels of Pregnant Women during Labor: A Systematic Review and Meta-Analysis. Med Edu Bull 2020; 1(1):49-56.