围术期电针刺激对妇科腹腔镜手术患者术后早期恢复质量的影响

Effect of perioperative electro-acupuncture stimulation on early postoperative quality of recovery in patients undergoing gynecological laparoscopic surgery

目的探讨围术期电针刺激对妇科腹腔镜手术患者术后早期恢复质量的影响。方法选择择期行妇科腹腔镜手术的患者49例,年龄20~60岁,BMI 18~32 kg/m^(2),ASAⅠ或Ⅱ级。将患者随机分为两组:电针刺激组(EA组,n=25)和假电针刺激组(C组,n=24)。入室后EA组电针针刺中脘穴(CV12)、双侧内关穴(PC6)和合谷穴(LI4);C组电针针刺相应穴位旁2 cm处。电针预刺激20 min后开始麻醉诱导,手术野消毒前撤去两组CV12穴位电针,保留双侧PC6、LI4穴位电针持续电刺激至麻醉苏醒。记录术前1 d、术后1 d的40项恢复质量评分(QoR-40)、空腹血糖(FBG)、胰岛素(INS)浓度,并计算胰岛素抵抗指数(HOMA2-IRI),记录术后1 d疼痛视觉模拟评分(VAS)最高分、术后恶心呕吐(PONV)评分、补救镇痛和止吐治疗例数。结果与术前1 d比较,术后1 d C组QoR-40量表中情绪状态、身体舒适度、自理能力、疼痛评分及总评分均明显降低,FBG、INS和HOMA2-IRI均明显升高,术后1 d EA组QoR-40量表中身体舒适度、自理能力、疼痛评分及总评分均明显降低(P<0.05)。与C组比较,术后1 d EA组QoR-40量表中情绪状态、身体舒适度、自理能力、疼痛评分及总评分均明显升高,FBG、VAS疼痛评分最高分和严重PONV发生率、术后补救镇痛和止吐治疗的比例明显降低(P<0.05)。结论围术期电针刺激CV12、双侧PC6和LI4能够改善妇科腹腔镜手术患者的术后早期恢复质量,在预防术后高血糖、减轻术后疼痛和预防术后恶心呕吐方面效果显著。

Objective To explore the effect of perioperative electro-acupuncture(EA)stimulation on early postoperative quality of recovery in patients undergoing gynecological laparoscopic surgery.MethodsForty-nine patients scheduled for gynecological laparoscopic surgery,aged 20-60 years,BMI 18-32 kg/m^(2),ASA physical statusⅠorⅡ,were randomly assigned into two groups:EA stimulation group(group EA,n=25)and sham EA stimulation group(group C,n=24).After the patients entering the operating room,EA was performed at Zhongwan(CV12),bilateral Neiguan(PC6)and Hegu(LI4)in group EA,while it was performed at points located about 2 cm next to the corresponding acupoints with shallow acupuncture in group C.After EA stimulation in advance for 20 minutes,induction of general anesthesia was started.In both groups,EA stimulation at CV12 continued until disinfection of surgical field,and EA stimulation at bilateral PC6 and LI4 continued until awakening from anesthesia.The quality of recovery-40 scores(QoR-40),fasting blood glucose(FBG)concentrations,and insulin(INS)concentrations were recorded in the two groups 1 day before operation and 1 day after operation,and the insulin resistance index(HOMA2-IRI)was calculated,and the highest value of VAS pain score,postoperative nausea and vomiting(PONV)score and the number of patients receiving postoperative analgesia and antiemetics treatment were recorded 1 day after operation.Results Compared with 1 day before operation,the emotional state,physical comfort,self-care ability,pain and total score of the QoR-40 scale were significantly lower in group C 1 day after operation,FBG,INS and HOMA2-IRI were significantly higher,physical comfort,self-care ability,pain and total score of the QoR-40 scale were significantly lower in group EA 1 day after operation(P<0.05).Compared with group C,the emotional state,physical comfort,self-care ability,pain and total scores of the QoR-40 scale were significantly higher in group EA 1 day after operation,FBG,the highest VAS pain score and incidence of severe PONV,the rate of patients receiving postoperative analgesia and antiemetics treatment were significantly lower in group EA 1 day after operation(P<0.05).ConclusionPerioperative electro-acupuncture stimulation at CV12,bilateral PC6 and LI4 acupoints can improve early postoperative quality of recovery in patients undergoing gynecologicallaparoscopic surgery in terms of preventing postoperative hyperglycemia,reducing postoperative pain and preventing postoperative nausea and vomiting.