经皮穴位电刺激联合雷莫司琼对全麻术后恶心呕吐的影响

Effect of Transcutaneous Electrical Acupoint Stimulation Combined with Ramosetron on Postoperative Nausea and Vomiting in Patients Under General Anesthesia

目的:评价经皮穴位电刺激联合盐酸雷莫司琼对全麻术后恶心呕吐(PONV)的影响。方法:选择择期拟行全麻腹腔镜手术患者90例,随机分为三组。Ⅰ组手术结束前15 min静脉给予盐酸雷莫司琼0.3 mg,Ⅱ组麻醉诱导前30 min给予经皮电刺激30 min,Ⅲ组重复上述两组操作。分别于入室(T0)、术毕(T1)、术后24 h(T2)采集外周静脉血样,测定胃泌素(GAS)浓度并记录术后24小时内PONV的发生情况。结果:与T0时比较,Ⅱ组、Ⅲ组T2时GAS浓度下降,Ⅰ组T2时GAS浓度升高(P<0.05);与I组比较,T2时Ⅱ组、Ⅲ组GAS浓度降低(P<0.05);与Ⅰ组、Ⅱ组比较,Ⅲ组术后PONV的发生率及发生的严重程度均下降(P<0.05)。Ⅰ组、Ⅱ组间PONV发生率及发生的严重程度无明显差异(P>0.05)。结论:经皮穴位电刺激可以降低全麻患者术后PONV的发生率,与盐酸雷莫司琼效果相近,二者联用止吐效果更佳,其机制可能与降低GAS浓度有关。

Objective：To evaluate the effect oftranscutaneous electrical aeupoint stimulation （TEAS） combined with ramosetron on postoperative nausea and vomiting （PONV） in patients underg general anesthesia.Methods：90 patients under general anesthesia were randomly divided into three groups respectively.Group Ⅰ was given 0.3 mg ramosetron intravenously 15 rnin before the end of the operation,group Ⅱ was treated with TEAS for 30 mins at 30 rmins before anesthetic induction,and group Ⅲ was treated with the combination treatment of group Ⅰ and group Ⅱ.The peripheral venous blood samples at the time point of upon entering the operating room （T0）,at the end of the operation （T1）,24 h after the operation （T2） were collected to analyze the GAS concentration.The incidence rate of PONV within 24 h after the operation was recorded and compared between two groups.Results：Compared with the time point of T0,GAS concentration decreased at T2 in group Ⅱ and group Ⅲ,and GAS concentration increased at T2 in group Ⅰ （P〈0.05）;Compared with group Ⅰ,GAS concentration decreased at T2 in group Ⅱ and group Ⅲ （P〈0.05）;compared with group Ⅰ and group Ⅱ,the incidence rate or the severity of PONV was decreased in group Ⅲ.There was no statistical differences between group Ⅰ and group Ⅱ in the incidence rate or the severity of PONV （P〉0.05）.Conclusion：TEAS could reduce the incidence rate of PONV of patients undergo-ing general anesthesia and its effect was similar to ramosetron,the effect of combination of two treatments was better,and its mechanism might be related to the reduction of GAS concentration.