腧穴配伍与单穴经皮穴位电刺激对普外科腹腔镜手术患者术后恶心呕吐效果分析

Effects of Acupoints Compatibility and Single-Acupoint TEAS on Postoperative Nausea and Vomiting in Laparoscopy Patients in General Surgery

目的探讨腧穴配伍与单穴经皮穴位电刺激(transcataneous electrical acupoint stimulation,TEAS)对普外科腹腔镜手术患者术后恶心呕吐(pustoperative nausea and vomiting,PONV)效果。方法选取2020年4月—2021年12月衢州市中医医院择期行腹腔镜手术患者204例,采用盲法随机分为内关穴和足三里刺激组(S组)、内关穴组(N组)、足三里穴组(Z组)、空白对照组(K组),每组51例。S组、N组、Z组在麻醉诱导前30 min至手术结束经双侧穴位给予经皮穴位电刺激;K组手术前30 min至手术结束,仅在双侧内关穴和足三里粘贴电极片,不予刺激。观察所有纳入患者术后30 min、2 h、6 h、24 h的PONV发生率,术后24 h内PONV分级情况以及各时间点疼痛视觉模拟评分(visual analogue scale,VAS);检测刺激前和术毕血清5-羟色胺(5-hydroxytryptamine,5-HT)、多巴胺、胃泌素的水平;记录患者苏醒期其他并发症及止吐药物使用情况,并比较两组患者术后住院时间。结果术后30 min~2 h时间段PONV发生率S组、N组、Z组组间比较差异无统计学意义(P>0.05),但各组PONV发生率均低于K组(P<0.05);术后24 h内PONV发生率S组、N组、Z组组间比较差异无统计学意义(P>0.05),但各组PONV发生率均低于K组(P<0.05)。S组、N组、Z组术后24 h内PONV分级情况组间比较差异无统计学意义(P>0.05),但均优于K组(P<0.05)。术后S组、N组、Z组患者血清5-HT、多巴胺、胃泌素水平均降低(P<0.05),且均低于K组(P<0.05)。S组、N组、Z组术后不同时间点VAS评分比较差异无统计学意义(P>0.05),但均低于K组(P<0.05)。S组、N组、Z组术后并发症发生率比较差异无统计学意义(P>0.05),但均低于K组(P<0.05)。各组术后止吐药物使用情况和住院时间比较差异无统计学意义(P>0.05)。结论腧穴配伍与单穴TEAS对普外科腹腔镜手术患者PONV均有预防效果,且能改善患者术后疼痛和并发症发生率,其机制可能与减少血清5-HT、多巴胺、胃泌素水平有关。

Objective To explore the effects of acupoints compatibility and single-acupoint transcutaneous electrical acupoint stimulation(TEAS)on postoperative nausea and vomiting(PONV)in laparoscopy patients in general surgery.Methods A total of 204 patients undergoing elective laparoscopy in Quzhou Hospital of Traditional Chinese Medicine were enrolled between April 2020 and December 2021.According to the blind method,they were randomly divided into Neiguan(PC6)and Zusanli(ST36)group(group S),Neiguan(PC6)group(group N),Zusanli(ST36)group(group Z)and blank control group(group K),51 cases in each group.From 30 minutes before anesthesia induction to the end of surgery,group S,group N and group Z were given TEAS through bilateral acupoints.From 30 minutes before surgery to the end of the surgery,electrodes were pasted on the bilateral Neiguan(PC6)and Zusanli(ST36),but there was no stimulation in group K.The incidence of PONV at 30 min,2 h,6 h and 24 h after surgery,PONV grading within 24 h after surgery and scores of visual analogue scale(VAS)were observed.The levels of serum 5-hydroxytryptamine(5-HT),dopamine and gastrin before stimulation and after surgery were detected.The other complications and usage of antiemetic drugs during recovery were recorded.The postoperative hospitalization time was compared between the two groups.Results From 30 min to 2 h after surgery,there was no significant difference in the incidence of PONV among group S,group N and group Z(P>0.05).However,the incidence of PONV in the above three groups was lower than that in group K(P<0.05).There was no significant difference in the incidence of PONV within 24 h after surgery among group S,group N and group Z(P>0.05),which was lower than that in group K(P<0.05).There was no significant difference in PONV grading among group S,group N and group Z within 24 h after surgery(P>0.05),better than that in group K(P<0.05).After surgery,the levels of serum 5-HT,dopamine and gastrin in group S,group N and group Z were all decreased(P<0.05),lower than those in group K(P<0.05).There was no significant difference in VAS scores among group S,group N and group Z after surgery(P>0.05),lower than those in group K(P<0.05).There was no significant difference in the incidence of postoperative complications among group S,group N and group Z(P>0.05),lower than that in group K(P<0.05).There was no significant difference in the usage of antiemetic drugs or hospitalization time among all groups(P>0.05).Conclusion Both acupoints compatibility and single-acupoint TEAS can prevent PONV in laparoscopy patients in general surgery,which can relieve postoperative pain and reduce incidence of complications.The mechanism may be related to reducing serum 5-HT,dopamine and gastrin levels.