经皮穴位电刺激治疗剖宫产产妇恶心呕吐及对血浆5-HT浓度的影响

Impacts of transcutaneous acupoint electric stimulation on the postoperative nausea and vomiting and plasma 5-HT concentration after cesarean section

目的：观察经皮穴位电刺激干预剖宫产产妇恶心呕吐的效果并探讨其作用机制。方法：将美国麻醉师协会（ASA）Ⅰ~Ⅱ级择期剖宫产产妇90例,随机分为经皮穴位电刺激组（A组）、假穴位组（B组）、空白对照组（C组）,每组30例。A组于术前30min给予经皮穴位电刺激双侧内关、足三里穴,术中持续刺激至术后1h;B组在内关、足三里穴位内侧旁开3cm处给予上述相同的电刺激;C组仅在双侧内关、足三里穴粘贴电极片,但不予电刺激。各组均采用腰硬联合麻醉,术后镇痛方法均保持一致。于穴位刺激前（T0）、切皮时（T1）、胎儿剖出时（T2）、腹腔探查时（T3）、术后1h（T4）记录平均动脉压（MAP）、心率（HR）、血氧饱和度（SpO2）、恶心呕吐视觉模拟评分,术中出血量及缩宫素、麻黄碱、阿托品使用情况,于穴位刺激前（T0）、电刺激30min后测定血浆五羟色胺（5-HT）浓度的变化。结果：3组各时间点MAP、HR、SpO2差异无统计学意义（均P〉0.05）;3组术中出血量及缩宫素、麻黄碱、阿托品使用率差异无统计学意义（均P〉0.05）;A组于T1~T4时点恶心呕吐评分均低于B组与C组（均P〈0.05）;A组经皮穴位电刺激30min后血浆5-HT浓度均低于B组与C组（均P〈0.01）。结论：经皮穴位电刺激能明显改善剖宫产产妇术中及术后恶心呕吐,其机制与降低血浆5-HT浓度有关。

Objective To observe the effect of transcutaneous acupoint electric stimulation on the postoperative nausea and vomiting（PONV）and explore its mechanism.Methods Ninety cases of elective cesarean section ofⅠtoⅡ grade in American Society of Anesthesiologists（ASA）were collected and randomized into a transcutaneous acupoint electric stimulation group（group A）,a sham-acupoint group（group B）and a blank control group（group C）,30 cases in each one.In the group A,30 min before operation,the transcutaneous electric stimulation was applied to bilateral Neiguan（PC 6）and Zusanli（ST 36）.The stimulation lasted during operation and 1hafter operation.In the group B,the same electric stimulation was given at the sites 3cm lateral to the medial sides of Neiguan（PC 6）and Zusanli（ST 36）.In the group C,the electric plaster was attached to bilateral Neiguan（PC 6）and Zusanli（ST 36）,without any electric stimulation.The lumbar epidural combined anesthesia and the postoperative analgesia were same in each group.The mean arterial pressure（MAP）,heart rate（HR）,oxygen saturation of blood（SpO2）and the VAS（visual analogue scale）score of nausea and vomiting were recorded before acupoint stimulation（T0）,at skin incision（T1）,fetal delivery（T2）,abdominal exploration（T3）and 1hafter operation（T4）as well as bleeding and application of oxytocin,ephedrine and atropine during operation separately.The changes of plasma 5-hydroxytryptamine（5-HT）concentration were observed at T0 and 30min after electric stimulation.Results The differences were not significant in MAP,HP and SpO2 at each time point of the three groups（all P〉0.05）.The differences were not significant in bleeding and application of oxytocin,ephedrine and atropine during operation（all P〉0.05）.The scores of nausea and vomiting in the group A during T1 to T4 were lower than those in the group B and group C（all P〈0.05）.In the group A,30 min after transcutaneous acupoint electric stimulation,plasma 5-HT concentration was lower than those in the group B and group C（both P〈0.01）.Conclusion The transcutaneous acupoint electric stimulation apparently relieves nausea and vomiting during and after cesarean section and the mechanism is relevant with the decrease of plasma 5-HT concentration.