辩证选穴针刺对腹部非胃肠手术患者术后胃肠功能紊乱的影响

Effects of acupuncture of acupoints selected on postsurgical gastrointestinal dysfunction in patients undergoing non-gastrointestinal abdominal surgery

目的 评价辩证选穴针刺对腹部非胃肠手术患者术后胃肠功能紊乱的影响.方法 拟在全身麻醉下择期行胆囊切除术、胆囊切除加胆管探查术患者160例,性别不限,年龄18 ～ 64岁,ASA分级Ⅰ或Ⅱ级,中医辩证为脾气虚.采用随机数字表法,将患者分为4组（n=40）：对照组（C组）、常规选穴针刺组（CA组）、辩证选穴针刺组（SA组）和非穴位针刺组（NA组）.于麻醉诱导前30 min开始CA组、SA组和NA组行针刺干预.CA组选取双侧太冲穴和内关穴;SA组选取双侧足三里穴和合谷穴;NA组选取双侧足三里穴和合谷穴旁开1 cm非经非穴部位,每30 min行针1次,留针直至手术结束.记录术后排气时间、排便时间和肠鸣音恢复时间;记录术后1d内恶心和呕吐的发生情况;分别于术前1d及术后2d时行胃电图检查,记录胃电图频率、幅度和节律;分别于术前1d和术后1d时,采用ELISA法测定血浆胃动素和胃泌素的水平,评价术后胃肠功能恢复情况,计算胃肠功能恢复率.结果 与C组比较,CA组和SA组术后恶心和呕吐的发生率降低,术后排气时间、排便时间和肠鸣音恢复时间缩短,术后胃肠功能恢复率升高,术后2d时胃电图频率、幅度和节律升高,术后1d时血浆胃动素和胃泌素的水平升高（P＜0.05）;与CA组比较,SA组术后恶心和呕吐的发生率降低,术后排气时间、排便时间和肠鸣音恢复时间缩短,术后胃肠功能恢复率升高,术后2d时胃电图频率、幅度和节律升高,术后1d时血浆胃动素和胃泌素的水平升高（P＜0.05）.结论 辩证选穴针刺改善腹部非胃肠手术患者术后胃肠功能紊乱的效果优于常规选穴针刺.

Objective To evaluate the effects of acupuncture of acupoints selected on postsurgical gastrointestinal dysfunction in the patients undergoing non-gastrointestinal abdominal surgery.Methods A total of 160 patients of both sexes,aged 18-64 yr,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,scheduled for elective non-gastrointestinal abdominal surgery under general anesthesia,were randomly divided into 4 groups （n =40 each） using a random number table：control group （group C）,common acupuncture group （group CA）,acupuncture of acupoints selected group （group SA）,and acupuncture of non-acupoint group （group NA）.Acupuncture was performed at 30 min before induction of anesthesia in CA,SA and NA groups.Group CA received acupuncture at bilateral Taichong and Neiguan acupoints,group SA at bilateral Zusanli and Hegu acupoints,and group NA at the points 1 cm lateral to the acupoints of Zusanli and Hegu once every 30 min until the end of surgery.The time when the patients passed flatus,defecating time,and recovery time of bowel sounds were recorded after surgery.The occurrence of nausea and vomiting was recorded within 1 day after surgery.The electrogastrogram （EGG）was performed at 1 day before surgery and 2 days after surgery,and the frequency,amplitude and rhythm of EGG were recorded.At 1 day before and after surgery,the levels of plasma motilin and gastrin were determined using enzyme-linked immunosorbent assay.The recovery of postsurgical gastrointestinal function was assessed,and the recovery rate was calculated.Results Compared with group C,the incidence of postsurgical nausea and vomiting was significantly decreased,the time when the patients passed flatus,defecating time,and recovery time of bowel sounds after surgery were significantly shortened,the recovery rate was significantly increased,the frequency,amplitude and rhythm of EGG were significantly increased at 2 days after surgery,and the levels of plasma motilin and gastrin were significantly increased at 1 day after surgery in CA and SA groups （P〈0.05）.Compared with group CA,the incidence of postsurgical nausea and vomiting was significandy decreased,the time when the patients passed flatus,defecating time,and recovery time of bowel sounds after surgery were significantly shortened,the recovery rate was significantly increased,the frequency,amplitude and rhythm of EGG were significantly increased at 2 days after surgery,and the levels of plasma motilin and gastrin were significantly increased at 1 day after surgery in group SA （P〈 0.05）.Conclusion Acupuncture of acupoints selected provides better efficacy than common acupuncture in improving postsurgical gastrointestinal dysfunction in the patients undergoing nongastrointestinal abdominal surgery.