足三里穴位注射山莨菪碱对内镜袖状胃成形术患者术后恢复质量的影响

Effect of anisodamine injection at the Zusanli acupoint on postoperative recovery quality of patients undergoing laparoscopic sleeve gastrectomy

目的探讨足三里穴位注射山莨菪碱对内镜袖状胃成形术患者术后早期恢复质量的影响。方法选取择期行内镜袖状胃成形术的患者117例,按随机数字表法分为空白对照组(C组)、足三里穴位注射生理盐水组(S组)、足三里穴位注射山莨菪碱组(A组),每组39例。C组不做特殊干预,S组在两侧足三里穴位注射生理盐水,A组在两侧足三里穴位注射山莨菪碱氯化钠溶液。记录患者一般资料;记录患者术前1 d(D0)及术后1 d(D1)、术后3 d(D3)、术后7 d(D7)的40项恢复质量量表(QoR-40)评分(包含身体舒适度、情绪状态、自理能力、心理支持和疼痛感受5个维度);于麻醉诱导后(T_(0))和术后24 h(T_(1))收集患者静脉血,采用酶联免疫吸附测定(ELISA)法检测血浆白细胞介素-6(IL-6)、P物质(SP)和胃动素(MTL)水平;记录拔管时间、麻醉后监测治疗室(PACU)停留时间、不良事件(呃逆、呼吸抑制、头晕、尿潴留、术后出血等)发生情况、术后24 h数字分级评分法(NRS)疼痛评分、术后第1天地佐辛使用量、术后恶心呕吐(PONV)情况、术后首次下床活动时间、术后首次肛门排气时间和住院时长等术后指标。结果3组患者一般资料差异无统计学意义(均P>0.05)。与D0时比较,D1时A组患者QoR-40总分、情绪状态、自理能力、疼痛感受评分均下降(均P<0.05),S组和C组患者QoR-40总分、身体舒适度、情绪状态、自理能力、疼痛感受评分均下降(均P<0.05);D3时A组患者QoR-40总分、疼痛感受评分均下降(均P<0.05),S组和C组患者QoR-40总分、身体舒适度、疼痛感受评分均下降(均P<0.05);D7时S组和C组患者QoR-40总分均下降(均P<0.05),C组患者疼痛感受评分下降(P<0.05)。与C组比较,A组患者D1、D3时QoR-40总分、身体舒适度评分均增加(均P<0.05),D1、D3和D7时疼痛感受评分均增加(均P<0.05),S组患者D1时QoR-40总分增加(P<0.05);与S组比较,A组患者D1时QoR-40总分增加(P<0.05)。与D0时比较,D1时3组患者心理支持差异均无统计学意义(均P>0.05);D3时3组患者情绪状态、自理能力和心理支持差异均无统计学意义(均P>0.05);D7时3组患者身体舒适度、情绪状态、自理能力和心理支持差异均无统计学意义(均P>0.05)。与C组比较,A组和S组患者D0、D7时QoR-40总分、身体舒适度差异均无统计学意义(均P>0.05),A组和S组患者各时点情绪状态、自理能力和心理支持差异均无统计学意义(均P>0.05)。与S组比较,D0、D1、D3和D7时A组患者身体舒适度、情绪状态、自理能力、心理支持和疼痛感受差异均无统计学意义(均P>0.05)。T_(0)时3组患者IL-6、SP、MTL水平比较,差异均无统计学意义(均P>0.05)。3组患者T_(1)时血浆中IL-6和SP水平较T_(0)时均明显升高,而MTL水平较T_(0)时明显降低(P<0.05)。T_(1)时3组患者SP水平差异无统计学意义(均P>0.05);A组患者IL-6水平低于C组(P<0.05);A组患者MTL水平明显高于S组、C组(均P<0.05),S组患者MTL水平高于C组。3组患者拔管时间、PACU停留时间、不良事件发生情况、术后首次下床活动时间和住院时长差异均无统计学意义(均P>0.05)。A组患者术后24 h NRS疼痛评分低于S组和C组(均P<0.05),且S组术后24 h NRS疼痛评分低于C组(P<0.05)。与C组比较,A组患者术后第1天地佐辛使用量减少,PONV评分降低,术后首次肛门排气时间缩短(均P<0.05)。结论足三里穴位注射山莨菪碱可降低内镜袖状胃成形术患者体内炎症水平,促进胃肠功能恢复,缓解术后疼痛及恶心呕吐,提高术后早期恢复质量。

ObjectiveTo investigate the effect of anisodamine injection at the Zusanli acupoint on the postoperative quality of early recovery in patients undergoing laparoscopic sleeve gastrectomy.MethodsA total of 117 patients who underwent elective laparoscopic sleeve gastrectomy were selected.According to the random number table method,they were divided into three groups(n=39):a blank control group(group C),a group with normal saline injection at the Zusanli acupoint(group S),and a group with scopolamine injection at the Zusanli acupoints(group A).Group C did not receive any special interventions,group S was injected with normal saline at each Zusanli acupoint on both sides,group A was injected with anisodamine sodium chloride solution at each Zusanli acupoint on both sides.Their general information were recorded;their 40-item Quality of Recovery Scale(QoR-40)scores(including five dimensions:physical comfort,emotional state,self-care,psychological support and pain perception)were recorded on preoperative day 1(D0)and postoperative day 1(D1),postoperative day 3(D3),and postoperative day 7(D7).After anesthesia induction(T_(0))and on postoperative 24 h(T_(1)),their venous blood samples were collected,the levels of plasma interleukin-6(IL-6),substance P(SP),and motilin(MTL)were measured by enzyme-linked immunosorbent assay(ELISA).The time to extubation,the length of post-anesthesia care unit(PACU)stay,the incidences of adverse events(hiccup,respiratory depression,dizziness,urinary retention,and postoperative bleeding),Numerical Rating Scale(NRS)score at postoperative 24 h,the consumption of analgesic dezocine on postoperative day 1,the incidence of postoperative nausea and vomiting(PONV),the time to first postoperative off-bed activity,the time to first postoperative anal exhaust,and the length of hospitalization stay were recorded.ResultsThere was no statistical difference in general information among the three groups(P>0.05).On D1,group A showed decreases in QoR-40 total score,emotional state,self-care ability,and pain perception scores(all P<0.05),while group S and group C presented decreases in QoR-40 total score,physical comfort,emotional state,self-care ability,and pain perception scores(all P<0.05),compared with those on D0.On D3,group A showed decreases in QoR-40 total score and pain perception scores(all P<0.05),while group S and group C presented decreases in QoR-40 total scores,physical comfort,and pain perception scores(all P<0.05),compared with those on D0.On D7,QoR-40 total scores decreased in group S and group C(all P<0.05),while pain perception scores decreased in group C(P<0.05).Compared with group C,group A showed increases in QoR-40 total scores and physical comfort scores on D1 and D3(all P<0.05),and increases in pain perception scores on D1,D3,and D7(all P<0.05),while group S showed increased QoR-40 total score on D1(P<0.05).Compared with group S,group A presented increased QoR-40 total score on D1(P<0.05).Compared with those on D0,there was no statistical difference in psychological support among the three groups on D1(all P>0.05);there was no statistical difference in emotional state,self-care ability and psychological support among the three groups on D3(all P>0.05);and there was no statistical difference in physical comfort,emotional state,self-care ability and psychological support among the three groups on D7(all P>0.05).Compared with group C,the differences in QoR-40 total score and physical comfort were not statistically significant on D0 and D7 for group A and group S(all P>0.05),and the differences in emotional state,self-care ability and psychological support were not statistically significant for groups A and S(all P>0.05).Compared with group S,the differences in physical comfort,emotional state,self-care ability,psychological support and pain perception of patients in group A on D0,D1,D3 and D7 were not statistically significant(all P>0.05).There was no statistical difference as to the above mentioned three indicators at T_(0)(all P>0.05).The three groups demonstrated obviously increased plasma IL-6 and SP levels at T_(1),compared with those at T_(0);MTL levels were obviously reduced at T_(0)(P<0.05).There was no statistical difference in SP among the three groups at T_(1)(all P>0.05);group A showed lower IL-6 levels than group C(P>0.05);group A demonstrated remarkably higher MTL levels than group S and group C(all P>0.05),group S presented higher MTL levels than group C.No statistical difference was seen among the three groups in time to extubation,the length of PACU stay,the incidences of adverse events,time to first postoperative off-bed activity and the length of hospitalization stay(all P>0.05).Postoperative 24 h NRS scores in group A were lower than those in group S and group C(both P<0.05),and postoperative 24 h NRS scores in group S were lower than those in group C(P<0.05).Compared with group C,the consumption of diazoxide on postoperative day 1 was lower,the PONV scores were lower,and the time to first postoperative anal exhaust was shorter in group A(all P<0.05).ConclusionsZusanli acupoint injection of anisodamine can reduce the level of inflammation in patients undergoing laparoscopic sleeve gastrectomy,promote the recovery of gastrointestinal function,relieve postoperative pain and nausea and vomiting,and improve the postoperative quality of early recovery.