自控经皮电刺激耳神门穴对剖宫产术恶心及呕吐影响

EFFECT OF SELF-CONTROLLED TRANSCUTANEOUS ELECTRICAL STIMULATION OF AURICULAR SHENMEN POINT ON NAUSEA AND VOMITING IN CESAREAN SECTION

目的探讨自控经皮电刺激耳神门穴对剖宫产术病人恶心及呕吐发生率的影响。方法 160例择期剖宫产产妇,随机分为自控经皮电刺激耳神门穴组(A组)与对照组(B组),各80例。A组产妇入手术室后行自控耳穴电刺激,取神门穴,频率为1.5Hz,强度由产妇自己掌握,刺激30min后行腰麻-硬膜外联合麻醉,术中持续刺激至术后2h;B组不进行电刺激。观察两组病人麻醉开始至胎儿剖出(T1)、胎儿剖出至子宫缝合完毕(T2)、探查腹腔至缝合皮肤切口(T3)、硬膜外腔给予吗啡至术后2h(T4)恶心及呕吐发生率,低血压、低心率发生率;术中甲氧氯普胺、缩宫素、麻黄碱、阿托品使用率,新生儿Apgar评分及术中出血量。结果 A组较B组T3、T4时间段的恶心及呕吐发生率降低(χ2=6.135～17.670,P<0.05),甲氧氯普胺使用率降低(χ2=26.467,P<0.05);两组T1、T2时间段恶心及呕吐发生率,低血压、低心率发生率,缩宫素、麻黄碱、阿托品使用率,术中出血量及新生儿Apgar评分差异无显著性(P>0.05)。结论自控经皮电刺激耳神门穴可明显降低剖宫产术中探查腹腔后与硬膜外使用吗啡后恶心及呕吐的发生率,但对麻醉开始至胎儿剖出时间段恶心及呕吐发生率无影响。

Objective To investigate the effect of selLcontrolled transcutaneous electrical stimulation （TES） of auricular Shenmen point on nausea and vomiting in cesarean section. Methods An elective cesarean section was done in 160 primiparas, who were equally randomized to self-controlled TES group （group A） and control group （group B）. The lying-in women in group A received self-controlled TES on auricular Shenmen point with frequency of 1.5 Hz for 30 minutes, and a combined lumbar epi- dural anesthesia was then conducted, which was kept doing at operation until two hours after surgery. No electric stimulation was given to those in group B. The following parameters-incidence of nausea and vomiting, hypotension, low heart rate, and usage of metoclopramide, oxytocin, ephedrine and atropine-were recorded form the stage of from the start of anesthesia to delivery of fetus （T1）; from delivery of fetus to completion of uterus closure （T2）; from abdominal exploration to skin incision suturing （T3）; from epidural morphine medication to two hours upon completion of surgery （T4）. Apgar score for newborns, and loss of blood volume at surgery were recorded. Results Compared with group B, the rate of nausea and vomiting was lower in group A （X2 = 6. 135-17. 670,P〈0.05） at the time of T3 and T4, and the usage of metoclopramide decreased （x2 =26. 467,P〈0.05） ; at the time of T1 and T2 the incidence of nausea, vomiting, low heart rate and hypotension, the usage of oxytocin, atropine and ephed fine, the volume of blood loss and Apgar score were not significantly different between the two groups （P〉0.05）. Conclusion Self-controlled TES of auricular Shenmen point can obviously decrease the incidence of nausea and vomiting at abdominal exploration and after the epidural use of morphine in cesarean section, but it has no effects on incidence of nausea and vomiting at the time from the start of anesthesia to delivery of fetus.