基于“气机升降”理论经皮穴位电刺激对全麻腹腔镜胆囊切除术后患者自主神经和胃肠功能的影响

Effect of transcutaneous electrical acupoint stimulation based on the theory of“qi ascending and descending movement”on autonomic nervous system and gastrointestinal function in patients after general anesthesia laparoscopic cholecystectomy

目的:观察以“气机升降”理论为组方选穴原则的经皮穴位电刺激(TEAS)对全麻腹腔镜胆囊切除术后患者的治疗作用,探讨TEAS对患者自主神经和胃肠功能的影响。方法:选取204例择期行全麻腹腔镜胆囊切除术的患者并随机分为对照组、双穴组、多穴组,每组68例。多穴组于麻醉诱导前30 min TEAS足三里、天突、膻中、中脘、太冲、内关至术毕,双穴组仅TEAS足三里、内关,对照组不采取任何电刺激。对比3组患者的术后腹胀情况、肠鸣音恢复时间、首次排气时间、首次排便时间、住院时间和恶心呕吐情况;采用十二导联心电图监测心率变异性,监测低频功率/高频功率比值(LF/HF)、全部窦性RR间期标准差(SDNN)、相邻RR间期差值均方根(RMSSD),以评价患者的自主神经功能。结果:术后6、24 h,多穴组和双穴组患者腹胀及恶心呕吐情况较对照组明显改善(P<0.05),且多穴组优于双穴组(P<0.05)。与对照组比较,多穴组和双穴组患者的肠鸣音恢复时间、首次排气时间、首次排便时间及住院时间均明显缩短(P<0.05),且多穴组优于双穴组(P<0.05)。术后1、2 d,多穴组和双穴组患者LF/HF明显低于对照组(P<0.05),SDNN和RMSSD明显高于对照组(P<0.05),且多穴组与双穴组比较变化更显著(P<0.05)。结论:基于“气机升降”理论行TEAS治疗可缓解全麻腹腔镜胆囊切除术患者术后胃肠功能紊乱,降低术后早期交感神经兴奋,维持副交感神经紧张,促进胃肠功能恢复。

Objective To observe the therapeutic effect of transcutaneous electrical acupoint stimulation(TEAS)based on the theory of"qi ascending and descending movement"in patients after general anesthesia laparoscopic cholecystectomy,so as to explore the impact of TEAS on the autonomic nervous system and gastrointestinal function of patients.Methods A total of 204 patients scheduled to undergo general anesthesia laparoscopic cholecystectomy were selected and randomly divided into control,double acupoints and multiple acupoints groups,with 68 cases in each group.For patients in the multiple acupoints group,TEAS was applied at Zusanli(ST36),Tiantu(CV22),Danzhong(CV17),Zhongwan(CV12),Taichong(LR3),and Neiguan(PC6)30 min before anesthesia induction until the end of the surgery.In the double acupoints group,TEAS was applied only at ST36 and PC6.No electrical stimulation was applied in the control group.The postoperative bloating,bowel sound recovery time,first farting time,first defecation time,length of hospital stay,nausea and vomiting were compared among the three groups.Heart rate variability was monitored by twelve-lead electrocardiogram to evaluate the autonomic nervous function of the patients,including the low frequency power/high frequency power ratio(LF/HF),the standard deviation of all sinus RR intervals(SDNN),and the root mean square of difference between successive normal RR intervals(RMSSD).Results At 6 h and 24 h after surgery,the symptoms of bloating,nausea and vomiting in the multiple acupoints group and double acupoints group were significantly improved compared to the control group(P<0.05),and the multiple acupoints group was superior to the double acupoints group(P<0.05).Compared with the control group,the bowel sound recovery time,first farting time,first defecation time,and length of hospital stay were significantly shorter(P<0.05)in the multiple acupoints group and double acupoints group,and the multiple acupoints group was superior to the double acupoints group(P<0.05).At 1 d and 2 d after surgery,compared with the control group,LF/HF was decreased(P<0.05)while SDNN and RMSSD were increased(P<0.05)in the multiple acupoints group and double acupoints group,and there was a significant difference between the two groups(P<0.05).Conclusion TEAS treatment based on the theory of“qi ascending and descending movement”can relieve gastrointestinal dysfunction,reduce early postoperative sympathetic nerve excitement and maintain parasympathetic nerve tension in patients after general anesthesia laparoscopic cholecystectomy,thereby promoting gastrointestinal function recovery.