经皮穴位电刺激复合腹横肌平面阻滞在加速康复外科中的应用

Application of Transcutaneous Electrical Acupoint Stimulation Combined with Transversus Abdominis Plane Block to Enhanced Recovery After Surgery in Patients Undergoing Laparoscopic Colorectal Cancer Resection:A Randomized Controlled Clinical Trial

目的:观察运用经皮穴位电刺激(TEAS)复合腹横肌平面(TAP)阻滞对加速康复外科(ERAS)中各指标的影响,探讨TEAS在ERAS中的临床意义。方法:将择期在全麻下行腹腔镜肠癌切除术的101例患者,随机分为对照组34例、TAP组35例、TEAS+TAP组32例。TEAS+TAP组在麻醉诱导开始前30min刺激双侧足三里穴,持续至手术结束;TAP组及TEAS+TAP组在麻醉诱导完成后手术开始前于双侧腹部行TAP阻滞;3组患者围手术期的麻醉管理均按照加速康复指南进行。观察并记录3组患者手术开始后1h的血糖值、术中瑞芬太尼的用量;随访并记录3组患者术后4、12、24、48h的疼痛视觉模拟量尺(VAS)评分;记录3组患者术后康复的相关指标。结果:TAP组及TEAS+TAP组术中血糖值、瑞芬太尼的用量均低于对照组(P<0.05)。TAP组患者术后4、12、24h的VAS评分均低于对照组(P<0.05);TEAS+TAP组患者4个时点的VAS评分均低于对照组(P<0.05),且术后48h的评分低于TAP组(P<0.05)。TAP组及TEAS+TAP组术后首次肛门排气时间短于对照组(P<0.05);TEAS+TAP组短于TAP组(P<0.05)。TAP组及TEAS+TAP组患者术后进食时间短于对照组(P<0.05)。结论:TEAS复合TAP镇痛有助于缩短术后胃肠功能恢复时间,促进患者术后快速康复。TEAS复合TAP镇痛优于单纯TAP镇痛,可能有助于延长单纯TAP的镇痛时间。

Objective To explore the effect of transcutaneous electrical acupoint stimulation（TEAS）combined with transversus abdominis plane（TAP）block in the enhanced recovery after surgery（ERAS）in patients undergoing laparoscopic colorectal cancer resection（LCCR）.Methods A total of 101 patients undergoing LCCR were randomly divided into three groups：control（n=34）,TAP（n=35）and TEAS＋TAP（n=32）.Conventional perioperative anesthesia management of the 3 groups was performed according to the ERAS guidelines.All the patients experienced patient controlled epidural analgesia（PCEA）,and those of the TAP and TEAS＋TAP groups received TAP block by injection of 0.3% Roperca hydrochloride（15 mL）into the space between the internal oblique and the transverse abdominis after induction of anesthesia.For patients of the TEAS＋TAP group,TEAS（2 Hz/10 Hz,an endurable stimulation strength）was applied to bilateral Zusanli（ST 36）from 30 min before anesthesia to the end of the surgery.The blood glucose value and dosage of Remifentanil used were recorded.The pain severity was assessed at 4,12,24 and 48 hafter surgery by using visual analogue scale（VAS）.Moreover,postoperative anal exhaust time,postoperative oral feeding time,postoperative first ambulation time and postoperative hospital stay length were recorded.Results The total dosages of Remifentanil used during surgery,and the blood glucose levels were significantly lower in the TAP and TEAS＋TAP groups than in the control group（P〈0.05）,but had no significant differences between the TAP and TEAS＋TAP groups（P〈0.05）.The VAS scores of the TAP and TEAS＋TAP groups were considerably lower than those of the control group at 4,12,24 and 48 hafter surgery（P〈0.05,except 48 hof TAP group）.Of the 34,35 and 32 cases in the control,TAP and TEAS＋TAP groups,5（14.7%）,3（8.6%）and 1（3.1%）on the 1 st day post-surgery,and 2（5.9%）,0（0）and 0（0）on the 2 nd day after surgery experienced nausea and vomiting.The postoperative anal exhaust time and postoperative oral feeding time were significantly earlier in both TAP and TEAS＋TAP groups than in the control group（P〈0.05）,and the exhaust time of the TEAS＋TAP group was even earlier than that of the TAP group（P〈0.05）.No significant differences were found among the 3 groups in the postoperative ambulation time and postoperative hospitalization time（P〈0.05）.Conclusion TEAS combined with TAP block analgesia is superior to simple TAP block analgesia in relieving postoperative pain,shortening the recovery time of gastrointestinal function and promoting postoperative rehabilitation in patients undergoing LCCR.