不同时机针刺经穴对直肠癌根治术患者术后恶心呕吐发生的影响：血浆胃泌素浓度的测定  

Effects of acupuncture at acupoints at different time points on occurrence of postoperative nausea and vom- iting in patients undergoing radical rectal＇ cancer operation： determination of plasma gastrin concentration

作　　者：姚新宇[1] 杨华[2] 田小林[3] 蒋奕红[1] 

机构地区：[1]桂林医学院附属医院麻醉科,541001 [2]桂林医学院附属医院中医科,541001 [3]桂林医学院附属医院胃肠外科,541001

出　　处：《中华麻醉学杂志》2012年第7期820-823,共4页Chinese Journal of Anesthesiology

基　　金：广西医疗卫生重点科研课题（重2010053）;广西自然科学基金（桂科自0848013）

摘　　要：目的评价不同时机针刺经穴对直肠癌根治术患者术后恶心呕吐（PONV）发生的影响。方法择期拟行直肠癌根治术患者130例，年龄40～59岁，性别不限，BMI20-25kg／m2，ASA分级Ⅰ～Ⅲ级，采用随机数字表法，将患者随机分为5组（n=25）：空白对照组（I组）、常规药物治疗组（Ⅱ组）、术前针刺组（Ⅲ组）、术中针刺组（Ⅳ组）、术后针刺组（Ⅴ组）。Ⅰ组不予任何PONV干预；Ⅱ组于手术结束前静脉注射格拉司琼3mg；Ⅲ组于麻醉诱导前30min针刺经穴；Ⅳ组于切皮时针刺经穴；V组于术毕时针刺经穴。选取双侧内关穴、合谷穴、支沟穴、曲池穴，针刺时间均为30min。于入室（L）、切皮后1h（T1）、术毕（T2）、术后24h（B）时采集外周静脉血样，测定血浆胃泌素浓度，记录术后2h内、2～6h、6～12h、12～24h及24h内PONV的发生情况。结果与Ⅰ组比较，Ⅱ组和Ⅲ组术后2h内及24h内PONV发生率及B时血浆胃泌素浓度降低（P〈0．05），Ⅳ组和Ⅴ组上述指标差异无统计学意义（P〉0．05）。与Ⅱ组比较，Ⅲ组L时血浆胃泌素浓度降低（P〈0．05），PONV的发生率差异无统计学意义（P〉0．05），Ⅳ组和V组术后2h内及24h内PONV的发生率升高（P〈0．05）。与Ⅲ组比较，Ⅳ组和Ⅴ组术后2h内及24h内PONV的发生率及B时血浆胃泌素浓度升高（P〈0．05）。Ⅳ组和Ⅴ组间各指标差异无统计学意义（P〉0．05）。结论术前针刺经穴可降低直肠癌根治术患者PONV的发生，且与常规药物防治效果近似，其机制与降低术后血浆胃泌素浓度有关。Objective To investigate the effects of acupuncture at acupoints at different time points on the occurrence of postoperative nausea and vomiting （PONV） in patients undergoing radical rectal cancer operation. Methods One hundred and thirty ASA I - III patients, aged 40-59 yr, with body mass index of 20-25 kg/m2 , scheduled for elective radical rectal cancer operation, were randomly divided into 5 groups （ n = 25 each） ： control group （group i ）, treatment with the conventional drug group （group l] ）, preoperative acupuncture group （ group III ）, acupuncture during operation group （group 1V ）, and postoperative acupuncture group （groupV）. Granisetron 3 mg was injected intravenously before the end of the operation in group III . Acupuncture was performed at 30 min before induction of anesthesia, at skin incision and at the end of operation in groups m, IV and V respectively. Bilateral Neiguan （ PC6 ）, Hegu （ LI4 ）, Zhigou （ SJ6 ）, and Quchi （ LI11 ） acupoints were selected in groups m, and V . Acupuncture stimulation lasted for 30 rain. Blood samples were collected from the peripheral vein after admission to the operating room （To ）, at 1 h after skin incision （T1 ）, at the end of operation （T2 ）,and at 24 h after operation （T3 ） to determine the plasma gastrin concentration. The occurrence of PONV was recorded within 2 h after operation, during 2-6 h, 6-12 h and 12-24 h after operation, and within 24 h after operation. Results Compared with group I , the incidence of PONV within 2 and 24 h after operation, and the plasma gastrin concentration at T3 were significantly decreased in groups II and III （ P 〈 0.05）, and no significant change was found in the indexes mentioned above in groups iv andV （P 〉 0.05）. Compared with group II ,the plasma gastrin concentration at T3 was significantly decreased in group III , the incidence of PONV within 2 and 24 h after operation was significantly increased in groups IV and V （ P 〈 0.05 ）. Compared wit

关 键 词：电针麻醉 胃泌素类 手术后恶心呕吐 

分 类 号：R614[医药卫生—麻醉学]