经皮穴位电刺激在妇科术后加速康复中的应用

Application of transcutaneous electrical acupoint stimulation in gynecological enhanced recovery after surgery

目的研究内关、合谷、足三里及三阴交联合经皮穴位电刺激(transcutaneous electrical acupoint stimulation,TEAS)对妇科腹腔镜手术患者实施加速康复外科(enhanced recovery after surgery,ERAS)临床路径中各指标的影响。方法选择行ERAS临床路径的择期妇科腹腔镜手术患者60例,随机分为两组,每组30例。ERAS组:围术期按常规ERAS临床路径实施;ERAS+TEAS组:在麻醉诱导前30 min及术后6 h行双侧合谷、内关、足三里、三阴交4穴位联合TEAS,每次刺激持续30 min。记录两组患者丙泊酚麻醉诱导用量;患者入手术室时(t0)、诱导后插管前(t1)、气管插管成功即刻(t2)、插管1 min后(t3)4个时间点SBP、DBP、MAP及HR;术毕0~6 h和6~24 h患者恶心、呕吐发生率;术毕、术毕6 h及术毕24 h 3个时间点患者疼痛评分;术后肠鸣音恢复时间、术后首次排气时间、术后首次离床活动时间和术后住院天数。结果ERAS+TEAS组较ERAS组麻醉诱导丙泊酚用量少;术后肠鸣音恢复时间、首次排气时间及首次离床活动时间早,差异有统计学意义(P<0.05)。结论ERAS临床路径妇科腹腔镜患者针对合谷、内关、足三里及三阴交联合TEAS可节俭围术期麻醉用药,促进患者早期肠蠕动、排气、早期离床活动,进而提高患者术后肠道功能,为ERAS临床路径提供新思路。

Objective To explore the impact of the transcutaneous electrical acupoint stimulation(TEAS)at Hegu(LI4),Neiguan(P6),Zusanli(ST36),Sanyinjiao(SP6)in indicators of the clinical pathway of enhanced recovery after surgery(ERAS).Methods Sixty patients undergoing the clincal pathway of ERAS of gynecological laparoscopic surgery were enrolled and randomized into two groups with 30 patients in each:ERAS group(perioperative implementation according to routine ERAS clinical pathway);ERAS+TEAS group(at 30 minutes before induction of anesthesia and 6 h after operation,patients accepted a thirty minutes TEAS at bilateral LI4,P6,ST36,SP6).The dosage of propofol during anesthesia induction were recorded.SBP,DBP,MAP and HR at four time points:entered the operating room(t0),after induction and before intubation(t1),immediately after tracheal intubation(t2)and 1 minute after intubation(t3)were well monitored and recorded.Data were respectively documented of the incidence of postoperative nausea and vomiting in 0~6 h and 6~24 h;pain score of patients at 0,6 and 24 h after operation;the recovery time of bowel sounds;the first time of exhaust after operation;the first time of getting out of bed after operation and the number of days of hospitalization.Results The dosage of propofol in ERAS+TEAS group were lower than those in ERAS group(P<0.05),whereas the recovery time of bowel sounds,the time of first exhaust and the time of first out-of-bed activity after operation were significantly different(P<0.05).Conclusion TEAS at bilateral LI4,P6,ST36,SP6 in patients with gynecological laparoscopic surgery can save propofol dosage during induction of anesthesia,promote early intestinal peristalsis,exhaust and early bed-leaving activities,and then improve the intestinal function of patients after operation,providing a new idea for ERAS clinical pathway.