经皮穴位电刺激联合托烷司琼、地塞米松预防日间甲状腺切除术后恶心呕吐40例

Transcutaneous acupoint electrical stimulation combined with tropisetron and dexametha‑sone to prevent PONV after day thyroidectomy:40 cases

目的观察经皮穴位电刺激(TAES)联合托烷司琼、地塞米松预防日间甲状腺切除术后恶心呕吐(PONV)的效果。方法选取2018年4月至2019年4月在山西医科大学第一医院拟行甲状腺切除术的日间手术病人80例,按随机数字表法分为观察组与对照组,每组各40例,两组均在麻醉诱导前给予地塞米松8 mg,手术结束20 min前给予托烷司琼2 mg,对照组病人在双侧合谷穴和内关穴处黏贴电极片,不予刺激。观察组病人在双侧合谷和内关穴处黏贴电极片,诱导前30 min进行电刺激直至手术结束。记录两组术后24 h内PONV的发生率,术后24 h疼痛视觉模拟评分(VAS)和布鲁格曼舒适度量表(BCS)舒适度评分,记录病人48 h内出院率和其他不良反应,测量术前及术后24 h外周静脉血清5-羟色胺(5-HT)浓度,术前及术后12 h血浆胃动素(MTL)的浓度。结果观察组术后24 h内PONV的发生率明显低于对照组(7.5%比27.5%,P=0.019),观察组24 h VAS评分明显低于对照组[(1.55±0.69)分比(2.60±0.82)分,P<0.001],BCS评分高于对照组[(2.85±0.99)分比(2.10±1.07)分,P=0.002],观察组48 h内出院率高于对照组(95.0%比77.5%,P=0.023),观察组术后24 h血清5-HT浓度明显低于对照组[(223±72)ng/L比(311±76)ng/L,P<0.001],观察组术后12 h血浆MTL浓度明显低于对照组[(290.87±18.66)pg/mL比(350.47±19.78)pg/mL,P<0.001],观察组与对照组其他不良反应比较,差异无统计学意义(15.0%比12.5%,P=0.745)。结论经皮穴位电刺激联合托烷司琼、地塞米松能显著降低日间甲状腺切除术后恶心呕吐的发生率,降低术后血清5-HT浓度,抑制MTL过多分泌,减缓病人术后疼痛,提高舒适度。

Objective To observe the effect of transcutaneous acupoint electrical stimulation(TAES)combined with tropisetron and dexamethasone in preventing nausea and vomiting(PONV)after day thyroidectomy.Methods Eighty patients scheduled to undergo thyroidectomy in First Hospital of Shanxi Medical University from April 2018 to April 2019 were assigned into two groups according to random number table,40 cases in each group.Patients in both groups were given 8 mg of dexamethasone before anesthesia induction,and 2 mg of tropisetron 20 min before the end of surgery.Patients in the group M were stuck with electrodes at bilateral hegu point and neiguan point without stimulation.In group N,electrodes were pasted at bilateral hegu and neiguan points,and electrical stimulation was conducted 30 minutes before induction until the end of the surgery.The incidence of PONV within 24 hours after operation,pain visual analogue scale(VAS)and brugman comfort scale(BCS)within 24 hours after operation,discharge rate and other adverse reactions within 48 hours were recorded.The serum 5-hydroxytryptamine(5-HT)levels in peripheral veins before and after operation were measured,and the plasma motilin(MTL)levels before and 12 hours after operation were measured.Results The incidence of PONV in group N within 24 hours after operation was significantly lower than that in group M(7.5%vs.27.5%,P=0.019),the VAS score in group N was significantly lower than that in group M[(1.55±0.69)vs.(2.60±0.82),P<0.001],the BCS score was higher than that in group M[(2.85±0.99)vs.(2.10±1.07),P=0.02],the discharge rate in group N within 48 hours was higher than that in group M(95.0%vs.77.5%,P=0.023),and the serum 5-HT concentration in group N at 24 hours after operation was significantly lower than that in group M[(223±72)ng/L vs.(311±76)ng/L,P<0.001].The plasma MTL concentration in group N was significantly lower than that in group M at 12 hours after operation[(290.87±18.66)pg/mL vs.(350.47±19.78)pg/mL,P<0.001].There was no significant difference in other adverse reactions between the two groups(15.0%vs.12.5%,P=0.745).Conclusion Transcutaneous acupoint electrical stimulation combined with tropisetron and dexamethasone can significantly reduce the incidence of nausea and vomiting after day thyroidectomy,reduce the postoperative serum concentration of 5-HT,inhibit MTL oversecretion,alleviate postoperative pain of patients,and improve comfort level.