| 摘要: |
| 目的：探讨经皮穴位电刺激疗法（TEAS）对全麻腹腔镜胆囊切除术患者术后恶心呕吐（PONV）的防治效果及起效机制。方法：将50 例行全麻腹腔镜下胆囊切除术伴PONV的女性患者随机分为治疗组和对照组，每组各25 例。对照组予以盐酸氢吗啡酮治疗，治疗组在对照组基础上加用TEAS治疗。观察2组术后不同时间段［术后T1（≤6 h)、T2（＞6 h，但≤12 h）、T3(＞12 h，但≤24 h）、T4(＞24 h，但≤48 h）］PONV发生例数及疼痛视觉模拟量表（VAS）评分、首次排气及首次排便时间、术前与术后24 h内血清胃肠激素［胃泌素（GAS）、胃动素（MTL）、血管活性肠肽（VIP）］及血清5-羟色胺（5-HT）的变化。结果：治疗组术后各时间段PONV发生例数均少于对照组，其中T2、T3、T4时间段发生例数分别为7、4、1例，对照组分别为15、11、6例，2组比较，差异均有统计学意义（P<0.05）;治疗组4个时间段VAS评分均低于对照组（P<0.05）;术后首次排气时间、首次排便时间均短于对照组（P<0.05）;2组术后24 h内血清GAS、MTL水平均较术前下降，血清VIP、5-HT水平均较术前升高，且治疗组血清GAS、MTL水平下降幅度及血清VIP、5-HT水平升高幅度均小于对照组（P<0.05）。结论：TEAS刺激内关穴、合谷穴可有效减少行全麻腹腔镜下胆囊切除术患者PONV的发生，并减轻其其他并发症的严重程度，其机制可能与其可调节血清5-HT的水平有关。 |
| 关键词: 术后恶心呕吐 腹腔镜手术 经皮穴位电刺激 内关穴 合谷穴 起效机制 5-HT |
| DOI： |
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| Effect of transcutaneous electrical acupoint stimulation in prevention and treatment of postoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy under general anesthesia |
| DAI Yong,LIU Qing,WU Gangfa |
| (Yueyang Municipal Hospital of Traditional Chinese Medicine，Yueyang 414000，Hunan，China) |
| Abstract: |
| Objective：To investigate the effect of transcutaneous electrical acupoint stimulation (TEAS) in the prevention and treatment of postoperative nausea and vomiting (PONV) in patients undergoing laparoscopic cholecystectomy under general anesthesia.Methods：A total of 50 female patients with PONV who underwent laparoscopic cholecystectomy under general anesthesia were randomly divided into treatment group and control group，with 25 patients in each group.The patients in the control group were treated with hydromorphone hydronchloride，and those in the treatment group were given TEAS in addition to the treatment in the control group.The two groups were observed in terms of the number of cases with PONV and Visual Analogue Scale (VAS) score during different time periods after surgery (T1：≤6 hours;T2：>6 hours and ≤12 hours;T3：>12 hours and ≤24 hours;T4：>24 hours and ≤48 hours)，time to first flatus，time to first defecation，and the serum levels of gastrointestinal hormones (gastrin ［GAS］，motilin ［MTL］，and vasoactive intestinal peptide ［VIP］) and 5-hydroxytryptamine (5-HT) before surgery and within 24 hours after surgery.Results：The treatment group had a lower number of cases with PONV than the control group at each time point after surgery，with 7 cases during T2，4 cases during T3，and 1 case during T4 in the treatment group and 15 cases during T2，11 cases during T3，and 6 cases during T4 in the control group，and there was a significant difference between the two groups (P<0.05).The treatment group had a significantly lower VAS score than the control group during the four time periods (P<0.05).Compared with the control group，the treatment group had significantly shorter time to first flatus and time to first defecation (P<0.05).Both groups had reduced serum levels of GAS and MTL and increased serum levels of VIP and 5-HT within 24 hours after surgery, and the treatment group showed smaller reductions in GAS and MTL and smaller increases in VIP and 5-HT than the control group (P< 0.05). Conclusion: TEAS at Neiguan and Hegu points can effectively reduce PONV in patients undergoing laparoscopic cholecystectomy under general anesthesia and alleviate other complications, possibly by regulating the serum level of 5-HT. |
| Key words: postoperative nausea and vomiting thoracoscopic surgery transcutaneous electrical acupoint stimulation Neiguan point Hegu point effect mechanism 5-hydroxytryptamine |
