不同穴位配伍TEAS联合全麻对腹腔镜胆囊切除术患者术后不良反应的影响

Effect of TAES with Different Acupoint Compatibility Combined with General Anesthesia on Postoperative Adverse Reactions in Patients with Laparoscopic Cholecystectomy

目的探讨不同穴位配伍经皮穴位电刺激(TEAS)联合全麻对腹腔镜胆囊切除术(LC)患者术后胃肠功能及恶心呕吐的影响。方法将LC患者120例,将其按随机数字表法分为A组、B组、C组,各40例。A组采用常规全麻,B组采用常规全麻联合TEAS(内关、合谷),C组采用常规全麻联合TEAS(内关、合谷、足三里)。比较3组患者术中丙泊酚与瑞芬太尼用量、气管拔管时间、术后补救镇痛、胃肠激素水平及术后恶心呕吐分级情况。结果术后2、12、24 h,B组、C组疼痛视觉模拟(VAS)评分明显低于A组(P<0.05),且B组、C组间比较差异无统计学意义(P>0.05);治疗后,B组、C组丙泊酚、瑞芬太尼用量、气管拔管时间及术后补救镇痛率明显低于A组(P<0.05),且B组、C组间比较差异无统计学意义(P>0.05);术后12 h,各组胃动素、胃泌素水平较术前明显降低(P<0.05),且B组、C组明显高于A组(P<0.05),C组明显高于B组(P<0.05);术后24 h,C组恶心呕吐分级情况明显优于A、B组(P<0.05),A组、B组比较差异无统计学意义(P>0.05)。结论TEAS可减少LC患者术中阿片类药物使用量,减轻患者术后疼痛;且内关、合谷、足三里穴配伍TEAS有助于改善LC患者胃肠功能及恶心呕吐情况。

Objective:To explore the effects of transcutaneous acupoint electrical stimulation(TAES)with different acupoint compatibility combined with general anesthesia on the gastrointestinal function,nausea and vomiting in patients undergoing laparoscopic cholecystectomy(LC).Methods:A total of 120 patients undergoing LC admitted were selected and divided into groups A,B,and C according to random number table method,with 40 cases in each group.Group A used conventional general anesthesia,group B used conventional general anesthesia combined with TAES(Neiguan,Hegu),and group C used conventional general anesthesia combined with TAES(Neiguan,Hegu,Zusanli).The intraoperative propofol and remifentanil dosages,tracheal extubation time,postoperative salvage analgesia,gastrointestinal hormone levels and postoperative nausea and vomiting were compared among the three groups.Results:At 2,12 and 24 h after surgery,the visual analogue scale(VAS)scores of pain in group B and group C were significantly lower than those in group A(P<0.05),and there was no statistically significant difference between group B and group C(P>0.05);after treatment,the dosage of propofol,remifentanil,tracheal extubation time and postoperative salvage analgesia rate in groups B and C were apparently lower than those in group A(P<0.05),and there was no significant difference between group B and group C(P>0.05);12 h after operation,the levels of motilin and gastrin in the three groups were apparently lower than those before operation(P<0.05),and group B and group C were apparently higher than those of group A(P<0.05),group C was apparently higher than those of group B(P<0.05);after 24 h,the classification of nausea and vomiting in group C was apparently better than that in groups A and B(P<0.05),and there was no significant difference between group A and group B(P>0.05).Conclusion:TAES can reduce the amount of opioids used in LC patients and relieve postoperative pain;and the compatibility of Neiguan,Hegu,and Zusanli points with TEAS can help improve gastrointestinal function and nausea and vomiting in patients with LC.