耳穴贴压对全麻下妇科腹腔镜术后患者血浆胃动素的影响

Effects of auricular point sticking on plasma motilin in patients after gynecological laparoscopic operation under general anesthesia

目的:观察耳穴贴压防治全麻下妇科腹腔镜术后患者胃肠道并发症的临床疗效,探索其是否通过影响血浆胃动素(motilin,MTL)分泌发挥作用。方法:将60例择期全麻下行妇科腹腔镜手术患者随机分为观察组和对照组,每组30例。观察组于每天早晚及麻醉前30min、术毕清醒后、术后24h给予耳穴贴压,取耳穴神门、胃、贲门、交感、皮质下,用胶布粘住王不留行籽贴在耳穴处按压3~5min,直至患者有酸、麻、胀为度,持续1周;对照组于相同时间点只在相应耳穴上粘贴外观相同的胶布,在耳穴处按压3~5min。记录肛门恢复排气、排便时间并听取肠鸣音;检测麻醉前30min(T0)、术后24h(T1)、术后48h(T2)血浆MTL水平;观察手术结束至干预结束期间恶性呕吐的发生情况。结果:与对照组比较,观察组术后恶心呕吐发生率降低(均P<0.05),恢复排气、排便时间明显缩短(均P<0.05),肠鸣音恢复快(P<0.05);两组术后24、48h MTL水平均较术前升高(均P<0.05),观察组术后24、48h血浆MTL水平较对照组显著降低(均P<0.05)。结论:耳穴贴压辅助全麻应用于妇科腹腔镜手术可降低恶心呕吐发生率,加速胃肠功能恢复,并且可能与抑制MTL过度释放有关。

Objective To observe the clinical efficacy of auricular point sticking on prevention and treatment of gastrointestinal complications after gynecological laparoscopic operation of general anesthesia,and to explore whether it is achieved by regulating the secretion of plasma motilin（MTL）.Methods Sixty patients who received selective gynecological laparoscopy under general anesthesia were randomly assigned into an observation group and a control group,30 patients in each one.The patients in the observation group were treated with auricular point sticking at each morning and night,30 min before anesthesia,revival after surgery and 24 hafter surgery.The adhesive fabric with vaccaria seeds was pressed at shenmen（TF4）,wei（CO4）,benmen（CO3）,jiaogan（AH6a）and pizhixia（AT4）for 3to 5min until the sensation of sourness,distension and numb appeared.The treatment was given for one week.The patients in the control group were treated only with similar adhesive fabric at auricular points at identical time points;each auricular point was pressed for 3to 5min.The anus exhaust time,defecating time and borborygmus were recorded;the level of plasma MTL was tested 30 min before anesthesia,24 hafter operation and 48 hafter operation;the occurrence of nausea and vomiting from the end of operation to the end of treatment were also recorded.Results Compared with the control group,the occurrence of nausea after operation was reduced in the observation group（P〈0.05）,and the anus exhaust time and defecating time were shortened（both P〈0.05）,and the recovery of borborygmus was improved（P〈0.05）.The levels of MTL 24 hand 48h after surgery were higher than those before operation in the two groups（all P〈0.05）;The levels of MTL 24 h and 48 hafter surgery in the observation group were significantly lower than those in the control group（both P〈0.05）.Conclusion The assist of auricular point sticking could reduce the occurrence of nausea-vomiting andaccelerate the recovery of gastrointestinal function in gynecological laparoscopic operation under general anesthesia,which is likely to be related with the inhibition on excess secretion of MTL.