这项研究由成都中医药大学附属妇科资助。

本研究所有程序均通过临床试验注册进行，并经成都中医药大学附属医院伦理机构批准（备案号：2022SL-015）。本研究中的所有患者都获得了充分的知情同意，并同意研究人员在试验期间使用数据、图像和相关视频拍摄。2023年1月至2023年4月，在成都中医药大学医院住院部通过传单、文字交流、医生推荐等方式招募符合条件的患者。
1. 患者选择
<ol><li>纳入标准<ol><li>确认宫内妊娠。参考美国内科医师学会 2018年 10 月发布的《NVP 诊断和管理指南》，确定早孕呕吐为主要主诉，并确保参与者符合临床 NVP 的诊断标准。</li>
		<li>确认参与者目前没有参加其他临床试验。</li>
	</ol></li>
	<li>排除标准<ol><li>排除患有引起 NVP 的其他病理状况的个体，例如妊娠剧吐、妊娠相关性病毒性肝炎或妊娠相关性急性胃肠炎。</li>
		<li>排除拒绝接受耳膏治疗的参与者。</li>
		<li>排除患有严重 NVP 或对药物或其赋形剂过敏的个体以及耳廓损伤的参与者。</li>
		<li>排除在过去 2 周内接受过 NVP 治疗的患者。</li>
	</ol></li>
	<li>辍学个案的处理<ol><li>如果参与者无法维持对治疗的依从性，则退出试验。如果参与者选择退出研究，允许他们自愿退出研究。</li>
	</ol></li>
	<li>终止试验的标准<ol><li>终止在研究期间出现严重并发症或出现疾病进展的参与者。如果参与者出现严重的不良反应，则停止试验。</li>
	</ol></li>
</ol>2. 患者分组和治疗方案
<ol><li>招募20名患者，并将他们随机分配到实验组或对照组。</li>
	<li>为对照组提供控制饮食并进行常规治疗，包括补液和补充维生素（详见结果部分）。</li>
	<li>对于实验组，除常规治疗外，还进行耳膏治疗。</li>
	<li>确保两组的休息管理保持不变，直到患者出院。</li>
</ol>3. 耳膏治疗程序的准备
<ol><li>收集必要的物品（图1）：剪刀，无菌棉签，镊子，医用胶带，75%酒精和牛草种子（见 材料表）。</li>
	<li>耳膏的准备<ol><li>将胶带切成 0.6 厘米 x 0.6 厘米的正方形。</li>
		<li>取 1 或 2 颗光滑的牛草种子（B. Wang 的种子，从制药公司获得，见 材料表），并将它们放在每个胶带正方形的中心，如图 2 所示。</li>
	</ol></li>
	<li>患者准备<ol><li>指导患者以舒适的姿势坐下。</li>
		<li>检查耳朵皮肤的状况。 注意： 在进行治疗之前，请确保耳朵皮肤完好无损且没有任何异常（例如炎症、溃疡、冻伤等）。不应在耳廓创伤或炎症区域进行耳膏治疗。只有在这些异常消退且创伤愈合后才能进行。如果患者对胶带过敏，请使用替代材料。</li>
	</ol></li>
	<li>穴位的选择<ol><li>定位耳朵上的穴位/敏感区域。用一只手的拇指和食指向上捏住和抬起耳螺旋，使该区域完全暴露，从而稳定耳廓。</li>
		<li>另一只手拿着无菌拭子，轻轻探查患者的耳朵，以确定胃（CO4）、贲门（CO3）、腹部（AH8）、神门（TF4）、皮层下（AT4）和肝脏（CO12）六个耳廓点附近的敏感压力点（图3）。 注意： 敏感点是指在施加压力时与其他区域相比有明显酸痛、麻木、肿胀或疼痛的区域。与其他常见的耳穴相比，这些敏感穴位显示出更好的治疗效果7。根据先前的临床研究，六个耳穴点（CO4、CO3、AH8、TF4、AT4 和 CO12）通常用于治疗 NVP，并具有突出的止吐和镇静作用11,12,13。如果未检测到耳朵上的敏感点，则可以选择上述六个点进行后续治疗。</li>
	</ol></li>
	<li>消毒<ol><li>使用浸有酒精的棉球对操作员的手进行消毒。</li>
		<li>使用蘸有 75% 酒精的无菌棉签对患者的耳廓进行消毒。 注意： 消毒区域应覆盖目标点周围约 1-2 平方厘米的耳廓皮肤。酒精有助于去除皮肤表面的油脂，确保胶带具有更好的粘合性能。如果患者对酒精过敏，可以使用碘伏作为替代药物。</li>
	</ol></li>
</ol>4. 耳膏治疗
<ol><li>一旦该区域干燥，用一只手的拇指和食指捏住耳螺旋，将其向后和向上抬起，以稳定耳廓。</li>
	<li>使用镊子，取出准备好的耳膏（步骤3.2），将牛草的中心种子放在选定的点上， 如图4所示。与患者确认种子放置对应于敏感点或疼痛区域。</li>
	<li>将拇指和食指放在耳廓的前后，以有节奏的按压和放松运动施加适度且可忍受的压力，以刺激耳廓部位的牛草种子。在每个部位按下并松开3-5分钟，保持均匀的节奏。 注意： 根据与患者的沟通调整压力强度，确保在不过度用力的情况下感觉到酸痛、麻木、肿胀和疼痛。</li>
	<li>治疗后监测患者的整体状况 15 分钟。 注意： 如果出现恐慌、胸部不适、头晕或大量出汗，请立即撕下胶带。</li>
	<li>指导患者或其家属每天揉搓种子三次：早上、中午和晚上。 注意：强调当患者感到恶心时需要对种子进行额外刺激。</li>
	<li>三天后取下耳膏，在对侧耳朵上重复上述步骤，在两只耳朵之间交替治疗。 注意：继续治疗，直到患者符合出院标准：PUQE 评分 ≤4 且尿酮体变为阴性。如果耳膏脱落，请重新涂抹。</li>
</ol>5. 患者诊断
<ol><li>从住院第一天开始，每 2 天收集一次新鲜尿液，以测量和记录尿酮水平。注意从治疗开始到尿酮水平转为阴性的持续时间。 注：尿酮水平是评估NVP患者的重要指标。尿酮水平阳性表明持续饥饿和脱水14,15。确保及时检测尿液样本，防止酮体蒸发引起的低值。</li>
	<li>指导患者每天完成妊娠特有的呕吐和恶心量化 （PUQE） 量表（见 表 1）。每天根据他们的实际症状记录分数，直到出院当天。 注意：PUQE 量表广泛用于全球各种实践指南中，以测量患者 NVP 症状的严重程度16.PUQE 分数越高表示病情越严重。</li>
</ol>6. 术后护理
<ol><li>建议患者保持耳朵清洁和干燥。 注意： 种子贴片的放置不会干扰日常活动，例如洗涤和沐浴。</li>
	<li>提供安慰和支持，以减轻患者的紧张和恐惧。</li>
	<li>指导患者在出现恶心和呕吐时进行吞咽动作或深呼吸。</li>
	<li>如果患者在治疗过程中出现局部过敏反应，例如皮肤瘙痒、发红或渗出，请立即撕下胶带并局部涂抹抗过敏软膏以缓解这些症状。</li>
	<li>如果发生感染，应将其作为普通感染进行管理。使用外用抗生素（适用于孕妇）或消炎镇痛软膏进行治疗。</li>
	<li>监测呕吐的频率和量，评估脱水体征，并定期测量尿酮水平。 注意：如果存在影响胎儿发育和母体安全且无法有效解决的情况，请考虑终止妊娠。</li>
</ol>

Managing Gestational Vomiting with Ear Plaster Therapy

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作者声明他们没有利益冲突。

妊娠期恶心和呕吐 （NVP） 是一种常见的疾病，可能对孕妇的健康构成风险，甚至会导致终止妊娠的并发症。通常用于止吐/抗恶心作用的临床药物，如昂丹司琼和异丙嗪，对孕妇有潜在风险，包括肌张力障碍、镇静和降低癫痫发作阈值22.因此，药物治疗有其自身的一系列危险。另一方面，今天通常采用的以症状为中心的治疗方法缺乏特异性，有时无效23.因此，?...

妊娠期恶心和呕吐 （NVP） 很常见，不同程度地影响约 50%-80% 的孕妇1。当NVP进展到中度或重度水平时，它会增加母亲和胎儿不良妊娠结局的风险。因此，NVP 的早期干预可能有助于预防妊娠剧吐2 的发生。NVP 的确切原因在现代生物医学中尚不清楚，但据信它与怀孕期间人绒毛膜促性腺激素血清水平的变化和某些维生素3 的缺乏等因素有关。目前 NVP 的治疗方法包括禁食、输液和纠正电解质失衡，但这些方法都不被认为是可靠的4。因此，找到一种不影响胚胎或胎儿发育的有效治疗方法是一项重大的临床挑战。
耳膏疗法是一种传统的中医治疗方法，涉及使用小而圆的物体，通常是牛草的种子，刺激耳朵上的特定穴位，以预防和治疗疾病5.牛痘的干燥和成熟种子，也称为牛草，用于这种疗法，因为它们被认为可以调节血液和通道，增强血液循环，促进泌乳。耳廓（耳朵的外侧）富含神经，包含许多针灸和敏感穴位6。通过刺激这些穴位，耳朵的软组织可能产生局部无菌炎症，进而可能调节神经内分泌系统，包括垂体-肾上腺皮质和交感神经-肾上腺皮质腺。此外，这种疗法可以潜在地激活人体的非特异性免疫反应，从而产生治疗效果7.耳膏疗法通过靶向耳朵上主要调节自主神经功能障碍、减少胃肠道反应和减轻呕吐感的特定穴位来有效治疗 NVP。它还可以增加Motilin的水平，Motilin是一种促进肠道蠕动的激素8，并恢复孕妇的食欲。此外，以前的一些研究表明，耳膏疗法可能对 NVP 相关的情绪障碍产生有利影响9，因为它在缓解焦虑方面表现出与镇静剂相似的作用。
耳膏疗法是一种简单且易于管理的治疗方法。它可以与常规治疗结合使用，以缓解NVP的症状，同时将母亲和胎儿与药物使用相关的潜在风险降至最低。该协议提供了有关如何进行这种治疗以及在此过程中要考虑的事项的详细说明。我们希望耳膏治疗能够得到更多的关注，并在临床实践中得到推广和利用。

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ear plaster therapy as a safe and effective treatment for gestational vomiting

妊娠期恶心和呕吐 （NVP） 是常见症状，通常使许多女性的妊娠早期复杂化。虽然禁食、输液和营养支持等临床治疗通常用于管理 NVP，但其有效性各不相同。然而，传统的耳膏疗法提供了一种很有前途的替代方案，可以有效缓解症状，并且对胚胎或胎儿的发育没有已知的风险。这种疗法以其易于应用、成本效益和良好的结果而闻名。先前的研究表明，将耳膏疗法与常规治疗相结合在缓解孕妇恶心和呕吐症状方面的有效性超过了单独使用常规治疗所取得的结果。本文介绍的方案描述了一种使用应用于特定耳点的圆形、光滑和坚硬的牛草种子来缓解NVP的方法。利用穴位按摩的原理，将这些种子轻轻擦到耳朵表面。通过刺激指定的耳穴，该程序旨在调节身体的能量流动并恢复平衡，从而降低NVP的严重程度和频率。将牛草种子涂抹在特定的耳穴上是一种简单的技术，医疗保健专业人员可以在适当的指导下轻松实施或由孕妇自行管理。总体而言，耳膏疗法提供了一种安全、有效和经济的方法来控制妊娠呕吐，为女性提供了一种潜在的解决方案，以减轻怀孕期间的不适。

Nausea and vomiting during pregnancy (NVP) are common, affecting approximately 50%-80% of pregnant women to varying degrees1. When NVP progresses to moderate or severe levels, it increases the risk of adverse pregnancy outcomes for both the mother and the fetus. Therefore, early intervention for NVP may be beneficial in preventing the development of hyperemesis gravidarum2. The exact cause of NVP is not well understood in modern biomedicine, but it is believed to be associated with factors such as changes in the serum level of human chorionic gonadotropin during pregnancy and deficiencies of certain vitamins3. Current treatments for NVP include fasting, fluid infusion, and correction of electrolyte imbalances, but none of these approaches are considered reliable4. Consequently, finding an effective treatment that does not impact the development of the embryo or fetus is a significant clinical challenge.
Ear plaster therapy is a traditional Chinese medicine treatment method that involves the use of small, rounded objects, typically the seeds of cowherb, to stimulate specific points on the ear for disease prevention and treatment5. The dried and mature seeds of Vaccaria hispanica, also known as cowherb, are used in this therapy as they are believed to regulate blood and channels, enhance blood circulation, and promote lactation. The auricle (outer part of the ear) is rich in nerves, containing numerous acupuncture and sensitive points6. By stimulating these points, the soft tissues of the ear may produce localized aseptic inflammation, which in turn may regulate the neuroendocrine system, including the pituitary-adrenal cortex and sympathetic-adrenal cortical glands. Additionally, this therapy can potentially invigorate the body's non-specific immune response, leading to therapeutic effects7. Ear plaster therapy effectively treats NVP by targeting specific points on the ear that primarily regulate autonomic dysfunction, reduce gastrointestinal responses, and alleviate the sensation of vomiting. It can also increase the level of Motilin, a hormone that promotes intestinal motility8, and restore the appetite of pregnant women. Moreover, some previous studies suggest that ear plaster therapy may have a favorable impact on NVP-related mood disturbances9, as it exhibits similar actions to sedatives in relieving anxiety.
Ear plaster therapy is a simple and easily administered treatment method. It can be used in conjunction with conventional treatments to alleviate the symptoms of NVP while minimizing the potential risks associated with medication use for both the mother and the fetus. This protocol provides detailed instructions on how to perform this therapy and what to consider during the process. We hope ear plaster therapy will receive increased attention and be promoted and utilized in clinical practice.

Author Spotlight: Alleviating Nausea and Vomiting in Pregnancy with Safe and Effective Auricular Acupuncture 

耳膏疗法是一种安全有效的妊娠呕吐治疗方法

这项临床研究的所有 20 名参与者都成功完成了试验。4例患者符合出院标准，第5天出院，其余16例患者符合出院标准，住院后2周内出院。
试验期间，对照组接受控制饮食和静脉滴注，包括以下成分：维生素C 2g+0.9%氯化钠注射液500 mL、维生素B6 0.2 g+0.9%氯化钠注射液500 mL、甲萘醌钾镁20 mL+5%葡萄糖注射液500 mL、氯化钾15 mL+葡萄糖注射液500 mL、0.9%氯化钠注射液500 mL、 和维生素 B1 20...

Watch this Scientific Journal Video about Alleviating Nausea and Vomiting in Pregnancy with Safe and Effective Auricular Acupuncture at JoVE.com

所提出的方案描述了一种传统的中医治疗程序，以其在管理妊娠呕吐方面的安全性和有效性而闻名。

Nausea and vomiting in pregnancy (NVP) are common symptoms that often complicate early pregnancy for many women. While clinical treatments such as ...

我们的研究重点是开发治疗怀孕期间恶心和呕吐的有效方法。我们的目标是探索在不影响胎儿发育的情况下最好地缓解此类患者症状的方法。治疗妊娠呕吐的最新进展包括许多药物，如维生素 B6、多西拉明和某种抗胆碱能药。此外，一些心理支持已被证明对康复很重要。耳膏治疗简单、经济、安全，在临床实践中被患者高度接受。这种疗法与传统的对症治疗相辅相成，在缓解孕妇呕吐和恶心症状方面更有效。我们的研究证明了我们的眼针治疗妊娠呕吐的有效性和安全性。现在需要更多的随机对照研究和临床试验来评估其疗效和副作用风险。

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Ear Plaster Therapy as a Safe and Effective Treatment for Gestational Vomiting

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Drugs for Nausea and Vomiting

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904 次观看.  Hospital of Chengdu University of Traditional Chinese Medicine. 我们的研究重点是开发治疗怀孕期间恶心和呕吐的有效方法。我们的目标是探索在不影响胎儿发育的情况下最好地缓解此类患者症状的方法。治疗妊娠呕吐的最新进展包括许多药物，如维生素 B6、多西拉明和某种抗胆碱能药。此外，一些心理支持已被证明对康复很重要。耳膏治疗简单、经济、安全，在临床实践中被患者高度接受。这种疗法与传统的对症治疗相辅相成，?...