内关穴注射地塞米松对甲状腺手术后恶心呕吐的防治效果观察

Observation on the preventative and treatment effects of acupoint injectionof dexamethasone at Neiguan point on nausea and vomiting after thyroid surgery

目的探讨内关穴注射地塞米松用于甲状腺手术后恶心呕吐的防治效果。方法选取2018年11月至2019年11月择期行甲状腺手术的患者150例,按随机数字表分为A、B、C组,各50例。A组麻醉诱导后5 min于双侧内关穴分别注射地塞米松5 mg(1 mL),B组麻醉诱导后5 min于双侧内关穴分别注射生理盐水1 mL;C组为对照组麻醉后未加干预。所有患者均接受相同的标准化全身麻醉。观察3组患者手术相关指标,术后72 h内术后恶心呕吐(PONV)发生情况、补救性镇吐药使用率,以及恢复饮食和恢复活动的时间。结果3组患者手术时间、麻醉时间、术中输液量、出血量、尿量、丙泊酚用量、术后患者苏醒时间、拔除气管导管时间比较,差异均无统计学意义(P>0.05)。术后0~<24 h、24~<48 h 3组患者恶心、呕吐发生率比较,差异均有统计学意义(P<0.05),且A组<B组<C组;术后48~72 h 3组恶心、呕吐发生率比较,差异均无统计学意义(P>0.05)。术后0~<24 h 3组患者补救性镇吐药使用率比较,差有统计学意义(P<0.05);其余时间段3组患者补救性镇吐药使用率无明显差异(P>0.05)。3组患者术后恢复进食时间比较,差异有统计学意义(P<0.05),A组<B组<C组;3组恢复运动时间无明显差异(P>0.05)。结论内关穴注射地塞米松可有效防治甲状腺手术PONV的发生。

Objective To investigate the effects of acupoint injection of dexamethasone at Neiguan point on preventation and treatment of nausea and vomiting after thyroid surgery.Methods A total of 150 cases of patients who underwent elective thyroid surgery from November 2018 to November 2019 were selected and divided into groups A,B,and C according to the random number table,50 patients in each group.Group A was injected with 5 mg(1 mL)of dexamethasone at both sides of Neiguan point 5 min after induction of anesthesia,group B was injected with 1 mL of physiological saline at both sides of Neiguan point 5 min after induction of anesthesia,group C,the control group,was not treated with intervention after anesthesia.All patients received the same standardized general anesthesia.The operation-related indicators,the incidence of postoperative nausea and vomiting(PONV)within 72 h after surgery,the use of salvage antiemetics,and the time to resume diet and activities of patients in the three groups were observed.Results There was no statistically significant difference in operation time,anesthesia time,intraoperative infusion volume,blood loss volume,urine volume,propofol dosage,postoperative recovery time and tracheal tube removal time among the three groups(P>0.05).There were statistically significant differences in the incidence of nausea and vomiting among the 3 groups at 0-<24 h and 24-<48 h after operation(P<0.05),and group A<group B<group C.No statistically significant difference was found in the incidence of nausea and vomiting at 48-72 h after surgery among the three groups(P>0.05).There was statistically significant difference in the utilization rate of salvage antiemetics among the three groups at 0-<24 h after operation(P<0.05),while no statistically significant difference was found in utilization rate of salvage antiemetics among the three groups during the other two time period(P>0.05).There was a statistically significant difference in postoperative recovery time among the three groups(P<0.05),and group A<group B<group C.No statistically significant difference in the recovery exercise time was found among three groups(P>0.05).Conclusion Injection of dexamethasone at Neiguan can effectively prevent the occurrence of PONV after thyroid surgery.