格拉司琼静脉注射联合氯化钠穴位注射对术后恶心呕吐的影响

Effect of intravenous granisetron combined and acupuncture point injection at PC6(Neiguan) with 0.9% sodium chlorideon postoperative nausea and vomiting after gynecological laparoscopy

目的观察静脉注射格拉司琼与内关穴注射0.9%氯化钠对妇科腹腔镜手术患者术后恶心呕吐的影响。方法按前瞻性随机对照研究设计。选择北京航天总医院和南京医科大学附属杭州医院2017年2月至2018年11月期间择期行腹腔镜手术且不要求术后静脉镇痛泵镇痛的妇科患者94例,随机数字表法分为3组:双侧非穴位注射0.9%氯化钠+静脉注射格拉司琼(A组,n=31)、双侧内关穴注射0.9%氯化钠+静脉注射0.9%氯化钠(B组,n=33)和双侧内关穴注射0.9%氯化钠+静脉注射格拉司琼(C组,n=30)。分别记录患者年龄、体质指数(BMI)、手术术式和历时、麻醉历时、术中入液量和出液量、术毕至拔除气管导管时间、术毕至听从指令时间、麻醉恢复期呼吸抑制、躁动、心律失常等不良反应,根据术后12h的恶心视觉模拟评分(NVAS)评估恶心呕吐的严重程度,记录给予止吐药的剂量及次数、肛门首次排气时间及术后24h的疼痛评分;分别在入手术室后、拔管清醒后、术后12h检测患者胃动素水平。结果A、B、C组术后恶心呕吐发生率分别为35.5%、33.3%、10.0%,差异有统计学意义(χ2=0.654,P<0.05),术后12h血浆胃动素水平分别为(564±76)、(559±84)、(472±69)ng/L,差异有统计学意义(F=14.033,P<0.05),C组恶心呕吐发生率和术后12h的胃动素水平均低于A组和B组;A、B、C组术后肛门首次排气时间分别为(19±8)、(19±7)、(14±8)h,差异有统计学意义(F=4.532,P<0.05),C组早于A组和B组。结论穴位注射0.9%氯化钠和静脉注射格拉司琼均能有效降低妇科腹腔镜手术后恶心呕吐的发生率,但静脉注射格拉司琼联合内关穴注射0.9%氯化钠效果更优,且能促进术后首次排气,有利于快速康复。

Objective To observe the effects of intravenous granisetron and acupuncture point injection at PC6(Neiguan) with 0.9% sodium chloride on postoperative nausea and vomiting (PONV) after gynecological laparoscopic surgery. Methods Qualified cases were collected according to prospective randomized controlled clinical trial design. 94 cases patients undergoing gynecological laparoscopic surgery without postoperative intravenous analgesia were selected from February 2017 to November 2018 in Beijing Aerospace General Hospital and The Affiliated Hangzhou Hospital of Nanjing Medical University. The patients were randomly divided into three groups: bilateral PC6 sham injection of 0.9% sodium chloride+ intravenous granisetron(group A, n=31);bilateral acupuncture point injection at PC6 of 0.9% sodium chloride+ intravenous 0.9% sodium chloride(group B, n=33);bilateral acupuncture point injection at PC6 of 0.9% sodium chloride+ intravenous granisetron(group C, n=30). The indexes including age, body mass index(BMI), type of surgery, surgery time, anesthesia time, liquid intake and output volume, the time from the completion of the operation to the removal of the tracheal catheter, the time from the completion to follow the instruction, respiratory depression, restlessness, arrhythmias and other adverse reactions during anesthesia recovery were recorded. Evaluated the nausea and vomiting according to the visual analogue scales (nausea visual analog scale, NVAS) 12 hours after the operation. Not only the dose and the related frequency of antiemetic drugs for rescue, but also the time of the first anal exsufflation and the pain 24 hours after the operation were recorded. Detected the concentration of motilin (MTL), when the operation started/awake after extubation/12 hours after the operation Results The incidence of nausea and vomiting 12 hours after the operation in group A, B and C was 35.5%, 33.3%, 10.0%. The difference was statistically significant (χ2=0.654, P<0.05). The motilin after 12 hours of operation in group A, B and C was (564±76),(559±84),(472±69) ng/L. The difference was statistically significant (F=14.033, P<0.05). The incidence of nausea and vomiting and the motilin after 12 hours of operation in group C were lower than group A and B. The time for the first anal exsufflation in group A, B and C was (19±8),(19±7),(14±8)h.The difference was statistically significant (F=4.523, P<0.05). The time for the first anal exsufflation in group C was earlier than group A and B. Conclusion Either intravenous granisetron or acupuncture point injection at PC6 of 0.9% sodium chloride can effectively reduce the incidence of postoperative nausea and vomiting after gynecological laparoscopic surgery. Intravenous granisetron combined with acupuncture point injection at PC6 of 0.9% sodium chloride has better effect and promotes the first anal exsufflation time, which is conducive to the rapid postoperative recovery of patients.