针药结合在促进减重代谢手术后快速康复中的应用

Application of acupuncture combined with drug in anaesthesia of laparoscopic bariatric surgery

目的旨在观察静滴硫酸镁复合电针在促进减重代谢手术患者术后快速康复的临床疗效。方法2021年9月-2022年4月于南京医科大学附属常州第二人民医院招募行减重代谢手术患者92例,随机分成常规组(C组)和针药结合组(ITCW组),每组46例。针药结合组(ITCW组)患者在常规组基础上,于气腹前静脉滴注硫酸镁(30 mg/kg),术后于恢复室针刺穴位(足三里、中脘、内关及合谷)治疗3次。计算三组患者气腹后即刻(T 1)、气腹后15 min(T 2)及气腹后30 min(T 3)平均动脉压(mean arterial,MAP)和心率的变化值;记录术后24 h疼痛视觉模拟量表(Visual analog scale,VAS)评分及镇痛泵按压次数、恶心呕吐的发生率、肠道首次排气时间、术后生活质量评分及术后出院时间。结果主要指标:(1)ITCM组患者术后24 h疼痛评分显著低于常规组(F=6.63;P<0.05);(2)ITCM组患者术后24 h恶心与呕吐(Postoperative nausea and vomiting,PONV)发生率显著低于常规组(F=6.81;P<0.05);(3)ITCM组患者肠道首次排气时间及术后恢复时间均显著优于常规组(F=5.89,F=7.49;P<0.05)。次要指标:ITCM组患者术后24 h生活质量显著优于常规组(F=3.90;P<0.05)。结论硫酸镁复合电针的针药结合策略可显著减少减重代谢手术患者术后恶心呕吐、疼痛等并发症,同时促进胃肠蠕动及患者术后恢复。

Objective To observe the clinical efficacy of intravenous magnesium sulfate combined with electroacupuncture on the rapid recovery of patients after laparoscopic bariatric surgery.Methods From September 2021 to April 2022,92 patients undergoing metabolic surgery for weight loss in Changzhou Second People's Hospital were recruited and randomly divided into routine group(group C)and acupuncture and drug combination group(ITCW group),with 46 patients in each group.Patients in the combination of acupuncture and medicine group(ITCW group)were given magnesium sulfate(30 mg/kg)intravenously before CO2 pneumoperitoneum on the basis of the conventional group,and were treated with electroacupuncture at acupoints(Zusanli,Zhongwan,Neiguan and Hegu)in the PACU for 3 times after operation.Changes of mean arterial pressure(MAP)and heart rate immediately after pneumoperitoneum(T1),15 min after pneumoperitoneum(T2)and 30 min after pneumoperitoneum(T3)were calculated.Postoperative Visual Analog Scale(VAS)score,times of analgesic pump pressure,incidence of nausea and vomiting,time of first intestinal exhaust,postoperative quality of life score and postoperative discharge time were recorded.Results Comparisons of the main evaluation index were as follows:(1)24 h postoperative pain score in ITCM group was significantly lower than that in conventional group(F=6.63;P<0.05);(2)the incidence of 24 h postoperative nausea and vomiting(PONV)in ITCM group was significantly lower than that in conventional group(F=6.81;P<0.05);(3)the time of first intestinal exhaust and postoperative recovery in ITCM group were significantly better than those in conventional group(F=5.89,F=7.49;P<0.05).Comparisons of the secondary evaluation index were as follows:24 h postoperative quality of life in ITCM group was significantly better than that in conventional group(F=3.90;P<0.05).Conclusion The combination of acupuncture and medicine with magnesium sulfate combined with electroacupuncture can significantly reduce postoperative complications such as nausea,vomiting and pain,and promote gastrointestinal peristalsis and postoperative recovery in patients undergoing sleeve surgery.