韩氏穴位神经刺激仪围术期应用对剖宫产产妇术后镇痛和镇吐的效果

Perioperative application of Han’s acupoint nerve stimulator in women receiving cesarean section:a study on postoperative analgesia and antiemetic effect

目的评估韩氏穴位神经刺激仪(HANS)围术期应用对剖宫产产妇术后镇痛和镇吐的效果。方法选取2017年1月-2018年12月在上海市嘉定区妇幼保健院行择期剖宫产术的初产妇135例,随机分为刺激组[行硬膜外患者自控镇痛(PCEA)联合应用HANS刺激]、安慰组(行PCEA联合应用HANS进行安慰性刺激)、空白组(仅行PCEA)3组,每组45例。分别于术后6 h(T 1)、12 h(T 2)、24 h(T 3)和36 h(T 4)时进行疼痛VAS评分,记录术毕至T 1、T 1至T 2、T 2至T 3、T 3至T 44个时间段镇痛泵中镇痛药物的用量和用药总量。记录产妇镇痛泵自控按压次数、有效按压次数、有效按压比例,术后恶心、呕吐发生率,以及产妇满意度评分。结果3组间产妇各时间点疼痛VAS评分的差异均无统计学意义(P值均>0.05)。刺激组术后镇痛药物的用药总量为(72.7±12.2)mL,显著少于安慰组的(94.2±9.3)mL和空白组的(97.9±9.5)mL(P值均<0.05);安慰组与空白组间术后镇痛药物用药总量的差异无统计学意义(P>0.05)。刺激组术后4个时间段患者镇痛药物用量均显著少于安慰组和空白组(P值均<0.05),安慰组与空白组术后各时间段镇痛药物用量的差异均无统计学意义(P值均>0.05)。刺激组产妇PCEA按压次数和有效按压次数均显著少于安慰组和空白组(P值均<0.05),有效按压比例显著高于安慰组和空白组(P值均<0.05);安慰组与空白组间PCEA按压次数、有效按压次数和有效按压比例的差异均无统计学意义(P值均>0.05)。刺激组产妇术后恶心、呕吐发生率均显著低于安慰组和空白组(P值均<0.05),总体满意度评分显著高于安慰组和空白组(P值均<0.05),安慰组与空白组间产妇术后恶心、呕吐发生率和总体满意度评分的差异均无统计学意义(P值均>0.05)。结论围术期应用PCEA联合HANS刺激,可为行剖宫产术的产妇提供满意的术后镇痛,减少镇痛药物用量,降低恶心、呕吐发生率,提高产妇满意度,是一种值得在临床上推广的多模式镇痛方法。

Objective To observe the effect of Han’s acupoint nerve stimulator(HANS)on postoperative analgesia and vomiting control in women receiving cesarean section.Methods A total of 135 primiparas,who underwent elective cesarean section in Maternal and Child Health Hospital of Jiading District from January 2017 to December 2018,were randomly divided into three groups(n=45):stimulation group(patient-controlled epidural analgesia[PCEA]combined with HANS),placebo group(PCEA combined with HANS for comfort)and blank group(PCEA only).Pain VAS scores and the amount of analgesic drugs were recorded at 6 h(T 1),12 h(T 2),24 h(T 3)and 36 h(T 4)after the operation.The PCEA frequency,the ratio of effective compressions,the incidence of postoperative nausea and vomiting,and the satisfaction of primiparas were also recorded.Results There was no significant difference in pain VAS scores among the three groups at any time point(all P>0.05).The total amount of postoperative analgesics in the stimulation group was significantly less than those in the placebo group and blank group([72.7±12.2],[94.2±9.3]and[97.9±9.5]mL,both P<0.05).And there was no significant difference in the total amount of postoperative analgesics between placebo group and blank group(P>0.05).The dosage of analgesics in the stimulation group was also significantly less than those in the placebo group and blank group at T 1,T 2,T 3 and T 4(all P<0.05).There was no statistical difference in the amounts of analgesics between placebo group and blank group at these time points(all P>0.05).The numbers of PCEA compressions and effective compressions in the stimulation group were significantly less than those in the placebo group and blank group(all P<0.05),but the effective compression ratio in the stimulation group was significantly higher than those in the other groups(all P<0.05).No significant difference was found in the number of PCEA compressions,effective compressions or effective compression ratio between placebo group and blank group(all P>0.05).The stimulation group had lower incidence of postoperative nausea and vomiting and higher overall satisfaction rate than placebo group and blank group(all P<0.05);there was no significant difference in these parameters between placebo group and blank group(all P>0.05).Conclusion PCEA combined with HANS in the perioperative period can provide satisfactory postoperative analgesia for women receiving cesarean section,reduce the amount of analgesic drugs,decrease the incidence of nausea and vomiting,and increase maternal satisfaction.