术前针刺内关穴对妇科腹腔镜术后恶心呕吐及血浆胃肠激素水平的影响

Effect of preoperative acupuncture at bilateral neiguan points on postoperative nausea and vomiting and plasma gastrointestinal hormone levels after gynecological laparoscopy

目的:探讨术前针刺双侧内关穴对妇科腹腔镜术后恶心呕吐(PONV)以及血浆胃动素(MTL)、胃泌素(GAS)水平的影响。方法:将2017年3月至2019年11月我院收治的60例拟行择期妇科腹腔镜手术的患者随机分为研究组及对照组,各30例。研究组于麻醉诱导前30 min持续针刺双侧内关穴,留针20 min后起针,并于针刺穴位处贴上不透明的贴膜;对照组未行针刺,相同的装置置于患者双侧内关穴但不做电刺激,操作相同但不开启电源。2组均采用全凭静脉麻醉,术后患者均行静脉自控镇痛(PCIA)。于针刺干预前(T_0)、气腹后30 min (T_1)、术毕即刻(T_2)、术后6 h (T_3)、术后24 h (T_4)时采用ELISA法检测血浆MTL和GAS水平变化,同时记录术后2 h内、2~6 h、6~12 h、12~24 h的PONV发生情况。结果:与同组组内T_0时刻比较,2组T_1~T_3时刻血浆MTL、GAS水平均增加;与对照组同一时刻相比较,研究组T_2、T_3时刻血浆MTL、GAS水平均下降(P<0.05)。研究组术后2 h内、术后2~6 h的PONV发生率低于对照组(P<0.05)。结论:术前针刺双侧内关穴减少妇科腹腔镜术后早期PONV发生率,并且可能与抑制MTL、GAS过度释放有关。

Objective:To investigate the effect of preoperative acupuncture at bilateral neiguan points on postoperative nausea and vomiting(PONV)and levels of plasma motilin(MTL)and gastrin(GAS)after gynecological laparoscopy.Methods:A total of 60 patients who underwent elective gynecological laparoscopic surgery were randomly divided into the study group and the control group,30 cases in each group.At 30 mins before anesthesia induction,the study group received electroacupoint stimulation at bilateral neiguan points for 20 mins.The control group did not receive the electric stimulation.Both groups received intravenous anesthesia,and all patients underwent PCIA after surgery.The levels of plasma MTL and GAS were measured by ELISA before acupuncture intervention(T0),at 30 mins after pneumoperitoneum(T1),immediately after surgery(T2),and at 6 h(T3)and 24 h(T4)after surgery.The incidences of PONV within 2 h,2-6 h,6-12 h,and 12-24 h after surgery were recorded respectively.Results:Compared with T0,the levels of plasma MTL and GAS in both groups were higher at T1,T2 and T3(P<0.05).Compared with the control group,the levels of plasma MTL and GAS were lower in the study group at T2 and T3(P<0.05).The incidences of PONV within 2 h and 2-6 h after surgery in the study group were lower than those in the control group(P<0.05).Conclusion:Preoperative acupuncture at bilateral neiguan points reduces the incidence of early PONV after gynecological laparoscopy,which may be related to the suppression of excessive release of MTL and GAS.