经皮穴位电刺激对腹腔镜胆囊切除术后应激反应及胃肠功能的影响

Effects of transcutaneous electrical acupoint stimulation on stress response and gastrointestinal function after laparoscopic cholecystectomy

目的观察围术期行右侧合谷、内关、足三里、胆囊穴经皮穴位电刺激对腹腔镜胆囊切除术后应激反应及胃肠功能的影响。方法选择2019年1-12月择期行腹腔镜胆囊切除术患者100例,男48例,女52例,年龄30~55岁,BMI 20~25 kg/m^(2),ASAⅠ或Ⅱ级。采用随机数字表法将患者分为两组:经皮穴位电刺激组(T组)和对照组(C组)。T组在麻醉诱导前15 min及术中全程接受右侧内关、合谷、足三里、胆囊穴经皮电刺激;C组采用单纯全麻。记录麻醉诱导前、拔管时及拔管后5 min的HR和MAP。记录术中丙泊酚和瑞芬太尼用量。记录麻醉诱导前和拔管后5 min血清去甲肾上腺素、肾上腺素、血管紧张素-Ⅱ浓度。记录拔管后5 min、术后6、12、24 h静息时VAS疼痛评分。记录术后恶心呕吐发生情况及术后首次肛门排气时间。结果与C组比较,T组拔管时和拔管后5 min HR明显减慢、MAP明显降低,拔管后5 min血清去甲肾上腺素、肾上腺素和血管紧张素-Ⅱ浓度明显降低,术中瑞芬太尼用量明显减少,拔管后5 min、术后6、12 h静息时VAS疼痛评分明显降低,术后首次肛门排气时间明显缩短,恶心呕吐发生率明显降低(P<0.05)。结论经皮电刺激右侧内关、合谷、足三里、胆囊穴可降低腹腔镜胆囊切除术后应激反应,促进胃肠功能恢复。

Objective To observe the effects of transcutaneous electrical acupoint stimulation(TEAS)at right side Hegu,Neiguan,Zusanli and gallbladder on stress response and gastrointestinal function after laparoscopic cholecystectomy.Methods A total of 100 patients,48 males and 52 females,aged 30-55 years,BMI 20-25 kg/m^(2),ASA physical statusⅠorⅡ,were selected for laparoscopic cholecystectomy.The patients were divided into two groups:TEAS group(group T)and control group(group C)by randomized number table method.Group T received Neiguan,Hegu,Zusanli,gallbladder TEAS 15 minutes before induction of general anesthesia and throughout of operation,and group C only received general anesthesia.HR and MAP were recorded before anesthesia induction,at extubation and 5 minutes after extubation.The consumption of propofol and remifentanilwere recorded during the operation.Serum concentrations of norepinephrine,epinephrine and angiotensinⅡ(AT-Ⅱ)were detected before anesthesia induction and 5 minutes after extubation.The VAS pain scores at rest were recorded 5 minutes after extubation,6,12,and 24 hours after surgery.The incidence of postoperative nausea and vomiting and exhaust time were recorded.Results Compared with group C,HR and MAP were significantly decreased at extubation and 5 minutes after extubation,serum concentrations ofnorepinephrine,epinephrine and AT-Ⅱwere significantly decreased 5 minutes after extubation,remifentanil consumption was significantly reduced,VAS pain scores at rest were significantly decreased 5 minutes after extubation,6 and 12 hours after surgery,the postoperative exhaust time was significantly shortened,the incidence of nausea and vomiting were significantly decreased in group T(P<0.05).Conclusion Rght side Neiguan,Hegu,Zusanli,gallbladder TEAS can reduce stress response and promote gastrointestinal function recovery after laparoscopic cholecystectomy.