针刺穴位对妇科腔镜术后恶心、呕吐及肠道菌群的影响

Effect of acupuncture on point postoperative nausea and vomiting and intestinal flora in gynecological endoscopic surgery

目的旨在评估针刺阴维穴对女性腹部手术患者术后恶心、呕吐(postoperative nausea and vomiting,PONV)的临床效果及对肠道菌群的影响。方法选取2021年1月至2024年4月间于金华市中心医院行妇科腔镜手术的患者184例,采用随机数字法分为对照组(n=93)及针刺组(n=91)。对照组患者手术完成时予以盐酸托烷司琼静脉注射5mg,针刺组在对照组基础上,手术操作前行双前臂掌侧阴维穴针刺30min进行干预,比较两组患者PONV的发生率及严重程度。此外,于术前、术后收集两组患者的粪便样本,采用肠道微生物16S扩增子绝对定量测序技术分析群落结构的差异。结果术后0~24h,针刺组和对照组分别有40例和56例患者发生PONV。针刺组患者发生PONV的比例均明显低于对照组(均P<0.05)。针刺组患者术后恶心的严重程度,术后服用止吐药的比例均显著低于对照组(P<0.05)。两组患者术前Observed、Chao1、ACE、Shannon和Simpon比较,差异无统计学意义(P>0.05)。针刺组患者术后Observed、Chao1、ACE和Shannon均明显高于对照组(P<0.05)。两组患者的术后Simpon比较,差异无统计学意义(P>0.05)。针刺组患者术后Observed、Chao1、ACE和Shannon明显高于术前(P<0.05)。针刺组和对照组的不良反应发生率分别为8.8%和8.6%,差异无统计学意义(P>0.05)。结论针刺阴维穴联合静脉注射托烷司琼可降低妇科腔镜手术患者PONV的发生率。

Objective To evaluate the effect of acupuncture at Yin Wei point on postoperative nausea and vomiting(PONV)in female patients undergoing abdominal surgery.The clinical efficacy of postoperative nausea and vomiting(PONV)and its impact on gut microbiota.Methods This study included 184 patients who underwent gynecological laparoscopic surgery in Jinhua Central Hospital from January 2021 to April 2024.They were randomly divided into control group(n=93)and acupuncture group(n=91)using a random number method.At the completion of surgery,the control group received intravenous injection of 5mg of tropisetron hydrochloride.In acupuncture group,on the basis of control group,intervention was performed by needling the palmar Yin Wei points of both forearms for 30 minutes before surgery.The incidence and severity of PONV were compared between two groups of patients.In addition,fecal samples were collected from two groups of patients before and after surgery,and differential analysis of gut microbiota community structure was performed using 16S amplicon absolute quantitative sequencing technology.Results In the 0-24 hours after surgery,40 cases of the acupuncture group and 56 cases of control group experienced PONV.The acupuncture group’s PONV incidence was lower than control group’s(P<0.05).The nausea severity of acupuncture group after surgery was significantly lower than that of control groups.The proportion of patients taking antiemetic drugs after surgery in acupuncture group was also significantly lower than that in control group(P<0.05).Before surgery,the two groups have no significant difference regarding Chao1,ACE,Shannon,and Simpson indices(P>0.05).After surgery,the acupuncture group’s Chao1,ACE,and Shannon indices were significantly higher than control group’s(P<0.05).The Simpson scores of two groups of patients were compared after surgery,and no significant difference was found(P>0.05).The Observed,Chao1,ACE,and Shannon indices were significantly higher in the acupuncture group after surgery than before(P<0.05).The incidence of adverse reactions in acupuncture group and control group were 8.8%and 8.6%,respectively,and there was no statistical significance(P>0.05).Conclusion Acupuncture at Yin Wei point combined with intravenous injection of tropisetron can reduce the incidence of PONV in patients undergoing gynecological laparoscopic surgery.