围术期经皮穴位电刺激对妇科腹腔镜手术患者术后恢复质量的影响

Effects of perioperative transcutaneous electrical acupoint stimulation on postoperative gastrointestinal dysfunction and quality of postoperative recovery in patients undergoing gynecologic laparoscopy

目的观察围术期经皮穴位电刺激(TEAS)对行妇科腹腔镜手术患者术后胃肠功能紊乱(PGID)及术后恢复质量的影响。方法选择喉罩全麻下行妇科腹腔镜手术患者66例,年龄18~64岁,BMI 18~30 kg/m^(2),ASAⅠ或Ⅱ级。采用随机数字表法将患者分为两组:TEAS组(T组)和对照组(C组),每组33例。T组于麻醉诱导前30 min、术后1、2 d选择双侧足三里穴、上巨虚穴、内关穴、三阴交穴行TEAS,时间持续30 min;C组在相同时点和穴位贴电极片,不进行刺激。术后3 d采用进食-恶心-呕吐-查体-症状持续时间评分系统(I-FEED)进行评分。记录术后首次肛门排气时间、术后首次排便时间和肠鸣音恢复时间。记录术后2、6、12 h恶心呕吐、腹痛腹胀VAS评分。记录术前1 d和术后2 d血浆胃动素和胃泌素浓度。记录术前1 d、术后1、2 d、术后1个月QoR-15评分、失眠严重指数(ISI)评分和术后睡眠障碍(POSD)发生情况。记录手术时间、麻醉时间、拔除喉罩时间、术中输液量、出血量和尿量。结果与C组比较,T组I-FEED评分、PGID发生率、术后2、6、12 h恶心呕吐、腹痛腹胀VAS评分、术后2 d血浆胃动素和胃泌素浓度、术后1、2 d ISI评分和POSD发生率明显降低(P<0.05),术后首次肛门排气时间、术后首次排便时间和肠鸣音恢复时间明显缩短(P<0.05),术后1、2 d QoR-15评分明显升高(P<0.05)。结论围术期TEAS能降低妇科腹腔镜手术患者PGID发生率,减轻恶心呕吐和腹痛腹胀程度,缩短术后首次肛门排气时间、术后首次排便和肠鸣音恢复时间,升高血浆胃动素和胃泌素浓度,提高术后恢复质量。

Objective To observe the effects of perioperative transcutaneous electrical acupoint stimulation(TEAS)on postoperative gastrointestinal dysfunction(PGID)and quality of postoperative recovery in patients undergoing gynecologic laparoscopic surgery.Methods Sixty-six patients,aged 18-64 years,BMI 18-30 kg/m^(2),ASA physical statusⅠorⅡ,were selected for gynecologic laparoscopic surgery under general anesthesia by laryngeal mask.The patients were divided into two groups by using the randomized number table method:TEAS group(group T)and control group(group C),33 patients in each group.In group T,TEAS was performed at bilateral Zusanli acupoints,upper Giuhu acupoints,Neiguan acupoints,and Sanyinjiao acupoints 30 minutes before anesthesia induction,1 day and 2 days after operation,each time last for 30 minutes,and electrode tablets were applied at the same time and the same acupoints without stimulation in group C.The intake,feeling nauseated,emesis,exam,and duration of symptoms scoring system(I-FEED)scores were recorded 3 days after operation.The time of the first postoperative anal exhaust,the time of the first postoperative defecation,and the time of the recovery of bowel sounds were recorded.Nausea and vomiting,abdominal pain and distension VAS scores 2,6,and 12 hours after operation were recorded.Plasma gastrin and gastrin concentrations were recorded 1 day before operation and 2 days after operation.The QoR-15 score,insomnia severity index(ISI)score,and the incidence of postoperative sleep disturbance(POSD)were recorded 1 day before operation,1 day and 2 days after operation,and 1 month after operation.The duration of surgery,time of anesthesia,time of laryngeal mask removal,intraoperative fluid infusion,bleeding,and urine output were recorded.Results Compared with group C,I-FEED score,PGID incidence,postoperative nausea and vomiting,abdominal pain and distension VAS scores 2,6,and 12 hours after operation,concentrations of plasma gastrokinetic and gastrin 2 days after operation,ISI scores,and the incidence of POSD 1 day and 2 days after operation were significantly decreased(P<0.05),the time of first postoperative anal exhaust,the time of first postoperative defecation,and time of recovery of bowel sounds were significantly shortened(P<0.05),QoR-15 scores were significantly increased 1 day and 2 days after operation in group T(P<0.05).Conclusion Perioperative TEAS can reduce the incidence of PGID in gynecologic laparoscopic surgery patients,reduce the degree of nausea and vomiting and abdominal pain and distension,shorten the time of the first postoperative anal exhanst,the time of the first postoperative defecation and the time of the recovery of the bowel sounds,elevate plasma gastrin and gastrin concentrations,and improve the quality of postoperative recovery.