电针与吗啡静脉自控镇痛对腹腔镜胆囊切除患者术后恢复影响的比较研究  

Effects of electroacupuncture on postoperative recovery of patients with laparoscopic cholecystectomy compared with patient-controlled intravenous analgesia with morphine

作　　者：王剑[1] 傅国强[1] 袁岚[1] 沈卫东[1] 王珂[1] 

机构地区：[1]上海中医药大学附属曙光医院麻醉科,上海201203

出　　处：《上海中医药杂志》2016年第9期52-56,共5页Shanghai Journal of Traditional Chinese Medicine

基　　金：上海市卫计委市级医院新兴前设技术联合攻关项目(SHDC12013120)

摘　　要：目的比较电针与吗啡静脉自控镇痛(PCIA)对腹腔镜胆囊切除患者术后恢复的影响。方法将90例择期行腹腔镜胆囊切除术患者随机分为治疗A组、治疗B组及对照组,每组30例。治疗A组术后予电针治疗治疗B组术后采用吗啡PCIA,对照组术后仅观察护理;各组仅在必要时给予杜冷丁肌肉注射补救镇痛。各组疗程均为24 h,随访至72 h。观察并比较术后疼痛视觉模拟评分(VAS)、术后24 h内恶心与呕吐(PONV)发生情况、首次排气排便时间及术后警觉与镇静评分(OAA/S评分)的变化情况。结果①治疗A组、治疗B组与对照组组间各时点比较,T_2、T_3、T_4、T_5时VAS评分差异有统计学意义,两组疼痛VAS评分较对照组明显下降(P<0.05);治疗A组与治疗B组各时点比较,XAS评分差异无统计学意义(P>0.05)。②24 h内,治疗A组、治疗B组及对照组PONV发生率分别为30.00%、50.00%及16.67%;组间PONV发生率比较,治疗B组最高(P<0.05),治疗A组与对照组差异无统计学意义(P>0.05)。各组PONV发生程度评分比较差异无统计学意义(P>0.05)。③试验期间治疗A组术后首次肛门排气、排便时间最早,对照组次之,治疗B组最晚(P<0.05)。④T_1、T_2时组间比较,治疗B组OAA/S评分分级最低,镇静程度最高(P<0.05)治疗A组、对照组OAA/S评分分级差异无统计学意义(P>0.05);T_1、T_2时组内OAA/S评分分级比较,治疗B组OAA/S评分分级差异有统计学意义(P<0.05)。结论电针能够有效减轻腹腔镜胆囊切除患者术后疼痛,促进术后胃肠功能恢复,且致PONV的可能性小、无过度镇静作用。Objective To observe the effects of electroacupuncture on postoperative recovery of patients with laparoscopic cholecystectomy compared with patient-controlled intravenous analgesia with morphine. Methods 90 patients undergoing laparoscopic cholecystectomy were randomly divided into the treatment group A, treatment group B and control group C ,30 case in each group. Patients in treatment group A was treated with electroacupuncture, whereas morphine in the form of patient-controlled intravenous analgesia （PCIA） was used in the treatment group B. The control group was only received nursing care;each group was intramuscular injected with pethidine for analgesia when necessary. The course of treatment in all groups was 24 h, followed up to 72 h, The visual analogue score （VAS） of postoperative pain, postoperative nausea and vomiting（PONV） within 24 h, first time of flatus and defecation and observe assessment of alertness/sedation （OAA/ S） score were observed and compared. Results ①Compared with the control group at each timepoint, the difference of VAS score in the treatment group A and B at T2-T5 was statistically significant, and the VAS score in these two groups significantly deoreased （P 〈 0.05 ） ;there was no statistically significant difference on VAS score between the treatment group A and B （ P 〉 0.05 ）. ②Within 24 hours, the incidence of PONV of the treatment group A, B and control group were 30.00%, 50.00% and 16.67 %, respectively ; Among, the incidence of PONV of the treatment group B was the highest （ P 〈 0.05 ）, the difference between the treatment group A and control group was not statistically significant（ P 〉 0.05 ）. There was no statistically significant difference on the incidence of PONV among groups （ P 〉 0.05 ）.③The first exhaust time and defecation time in the treatment group A was the earliest, the control group followed, and the treatment group B was latest （P 〈0.05 ）. ④Compared at T1 and T2, the OAA/S score grade in the treatment g

关 键 词：腹腔镜胆囊切除术 电针 吗啡 镇痛 术后恢复 

分 类 号：R614[医药卫生—麻醉学]