经皮穴位电刺激对开颅手术患者术后恶心呕吐的影响

Influence of transcutaneous acupoint electrical stimulation on postoperative nausea and vomiting in patients after craniotomy

目的观察内关穴联合合谷穴经皮穴位电刺激(TAES)对神经外科颅内肿瘤切除术患者术后恶心呕吐(PONV)发生率的影响。方法选择100例择期拟行颅内肿瘤切除术的患者,采用随机数字表法分为对照组(C组)和TAES组(T组)。T组麻醉诱导前30 min经皮穴位电刺激患者双侧内关穴和合谷穴至手术结束。分别于术前(T0)、术毕(T1)、术毕12 h(T2)、术毕24 h(T3)采集患者外周静脉血标本,测定血浆胃动素浓度。记录患者术后0~2 h、2~6 h、6~24 h、0~24 h内各时点PONV发生情况。结果与C组比较,T组术后0~2 h、2~6 h、6~24 h及0~24 h内PONV的发生率降低,差异有统计学意义(P<0.05);与C组比较,T组患者T1及T2时点血浆胃动素浓度降低,差异有统计学意义(P<0.05)。结论在预防性用药的基础上,内关穴联合合谷穴经皮穴位电刺激能够进一步降低颅内肿瘤切除术患者术后恶心呕吐的发生率,其机制可能与降低胃动素浓度有关。

Objective To observe the effects of Neiguan and Hegu transcutaneous acupoint electrical stimulation(TAES)on postoperative nausea and vomiting(PONV)in patients who underwent intracranial tumor resection.Methods One hundred patients who underwent intracranial tumor resection were randomly divided into control group(group C)and TAES group(group T).In the TEAS group,30 minutes before anesthesia induction,the patients were treated with transcutaneous acupoint electrical stimulation at both the Neiguan and Hegu until the end of the operation.Patients′peripheral venous blood samples were collected at following time points:before operation(T0),at the end of the operation(T1),and 12 h and 24 h after operation(T2,T3),and the plasma motilin concentration was measured.The incidence of PONV was recorded at 0-2 h,2-6 h,6-24 h,and 0-24 h after surgery.Results Compared with the control group,the incidence of PONV in the TAES group decreased within 0-2 h,2-6 h,6-24 h,and 0-24 h after surgery,and the difference was statistically significant(P<0.05).Compared to the control group,the serum concentration of plasma motilin were significantly decreased at T1and T2 in TAES group(P<0.05).Conclusion On the basis of preventive medication,transcutaneous acupoint electrical stimulation at Neiguan and Hegu can further reduce the incidence of postoperative nausea and vomiting in patients who underwent intracranial tumor resection,the mechanism may be related to its effect in reducing motilin concentration.