姜辣素穴位敷贴对全麻患者术后恶心呕吐的作用及机制

Effect of gingerol acupoint application on postoperative nausea and vomiting in patients with general anesthesia and its mechanism

目的探讨姜辣素穴位敷贴对全麻患者术后恶心呕吐(PONV)的作用及机制。方法67例全麻患者分为对照组(手术结束前静脉滴注昂丹司琼注射液4 mg)和观察组(全麻诱导前和术后24 h姜辣素穴位敷贴),收集2组患者一般资料信息,记录术后第1天、第2天及第3天PONV和不良反应的发生情况,采用视觉模拟(VAS)评分和Osoba量表评估PONV发生的严重程度和对患者生活质量的影响;抽取2组患者术前及术后第1天外周静脉血,采用酶联免疫吸附法检测血清5-羟色胺(5-HT)、胃动素(MTL)及胃泌素(GAS)水平。结果观察组患者术后第1天和第2天PONV发生率低于对照组(P<0.05),观察组患者术后第1天、第2天及第3天VAS评分明显低于对照组(P<0.001);观察组患者术后第1天和第2天CR、CC均高于对照组(P<0.05或P<0.01);2组患者术后第1天血清5-HT、MTL及GAS均高于术前,且观察组患者<对照组(P<0.05或P<0.01);观察组患者术后第1天和第2天Osoba评分低于对照组(P<0.05);2组患者术后3 d内不良反应检出率比较,差异无统计学意义(χ^(2)_(校正)=2.688,P=0.101)。结论姜辣素穴位敷贴可有效预防全麻患者术后PONV的发生,且可减轻PONV发生的严重程度,提高患者生活质量,可能与抑制5-HT、MTL及GAS的表达有关。

Objective To investigate the effect and mechanism of gingerol acupoint application on postoperative nausea and vomiting(PONV)in patients with general anesthesia.Methods Sixty-seven patients with general anesthesia were divided into control group(intravenous infusion of Ondansetron injection 4 mg before the end of surgery)and observation group(gingerol acupoint application before induction of general anesthesia and 24 h after surgery).General information of patients in the two groups was collected,and the occurrence of PONV and adverse reactions on the first,second and third days after surgery were recorded.Visual analogue scale(VAS)and Osoba scale were used to evaluate the severity of PONV and its impact on patients'quality of life.Peripheral venous blood was collected from 2 groups before and on the first day after surgery.Enzyme-linked immunosorbent assay was used to detect levels of serum 5-hydroxytryptamine(5-HT),motilin(MTL)and gastrin(GAS).Results The incidence of PONV in the observation group was lower than that in the control group on the 1st and 2nd day after surgery(P<0.05),and the VAS scores of the patients in the observation group on the 1st,2nd and 3rd day after surgery were significantly lower than those in the control group(P<0.001);CR and CC of patients in the observation group on the 1st and 2nd days after surgery were higher than those in the control group(P<0.05 or P<0.01);levels of serum 5-HT,MTL and GAS of patients in the 2 groups on the 1st day after surgery were higher than those before surgery,and the patients in the observation group were lower than those in the control group(P<0.05 or P<0.01);the Osoba scores of the patients in the observation group on the 1st and 2nd days after surgery were lower than those in the control group(P<0.05);the detection rates of adverse reactions of the patients in the 2 groups within 3 days after surgery had no statistically significant difference(χ^(2)_(correction)=2.688,P=0.101).Conclusion Gingerol acupoint application can effectively prevent the occurrence of PONV after general anesthesia in middle-risk patients,and reduce the severity of PONV and improve the quality of life of patients,which may be related to the inhibition of the expression of 5-HT,MTL,and GAS.