穴位电刺激对腹腔镜胆囊切除术后恶心呕吐(PONV)的干预作用  

Intervention effect on acupoint electrical stimulation of postoperative nausea and vomiting(PONV) after laparoscopic cholecystectomy

作　　者：魏林志 曲宁[1] 管永明 WEI linzhi;QU Ning;GUAN Yongming(Department of Anesthesiology,Qinghai Provincial Hospital of Traditional Chinese Medicine,Xining 810000,China)

机构地区：[1]青海省中医院麻醉科,西宁810000

出　　处：《新疆医科大学学报》2022年第3期339-344,共6页Journal of Xinjiang Medical University

基　　金：青海省中藏医药创新研究项目(J2020019)。

摘　　要：目的探讨穴位电刺激对腹腔镜胆囊切除术后恶心呕吐(PONV)的干预作用。方法将青海省中医院收治的择期行腹腔镜胆囊切除术的80例患者,采用随机数字表法分为对照组和电刺激组,各40例。对照组于手术开始10 min后给予昂丹司琼治疗,电刺激组在对照组基础上给予穴位电刺激,电刺激自麻醉诱导前30 min持续至手术结束。比较两组患者术后PONV发生率与严重程度、胃肠激素水平、胃肠功能恢复情况、血浆5-羟色胺(5-HT)、血清白细胞介素-6(IL-6)、白细胞介素-10(IL-10)、肿瘤坏死因子-α(TNF-α)水平。结果电刺激组重度PONV发生率及总发生率均低于对照组(P<0.05);气腹后20 min(T_(1))、放气后10 min(T_(2))两组血浆胃泌素(GAS)、胃动素(MTL)水平均低于术前(T_(0))(P<0.05),血浆血管活性肠肽(VIP)水平均高于T_(0)(P<0.05),但电刺激组T_(1)、T_(2)血浆GAS、VIP水平均低于对照组(P<0.05),血浆MTL水平均高于对照组(P<0.05);电刺激组肠鸣音恢复时间、首次肛门排气及排便时间均短于对照组(P<0.05);术后2 h、术后12 h两组血浆5-HT、血清IL-10水平均低于术前(P<0.05),血清IL-6、TNF-α水平均高于术前(P<0.05),但电刺激组术后2 h、术后12 h血浆5-HT及血清IL-6、TNF-α水平均低于对照组(P<0.05),血清IL-10水平均高于对照组(P<0.05)。结论于麻醉诱导前30 min对行腹腔镜胆囊切除术患者实施穴位电刺激,可有效预防PONV发生,调节胃肠激素,促进胃肠功能恢复,并可降低血浆5-HT水平,调节炎性细胞因子水平,减轻炎症反应。Objective To explore the intervention effect of acupoint electrical stimulation on postoperative nausea and vomiting (PONV) after laparoscopic cholecystectomy.Methods 80 patients undergoing elective laparoscopic cholecystectomy admitted in the hospital were selected and divided into the control group and the electrical stimulation group by random digital table method,with 40 cases in each group.The control group was given ondansetron 10 minutes after the start of operation,while the electrical stimulation group was given acupoint electrical stimulation on the basis of the control group,and the electrical stimulation lasted about 30 minutes before anesthesia induction to the end of operation.The incidence and severity of PONV after operation,the levels of gastrointestinal hormones,the recovery of gastrointestinal function,the levels of plasma 5-hydroxytryptamine (5-HT),serum interleukin-6 (IL-6),interleukin-10(IL-10) and tumor necrosis factor-α (TNF-α) were compared between the two groups.Results The incidence rate of severity of PONV and the total incidence rate of PONV in electrical stimulation group were lighter than those in the control group (P<0.05).The plasma gastrin (GAS) and motilin (MTL) levels at 20 minutes after pneumoperitoneum (T_(1)and 10 minutes after deflation (T_(2)) of the both groups were lower than preoperative (T_(0)) (P<0.05),and the plasma vasoactive intestinal peptide (VIP) levels of the both groups were higher than T_(0)(P<0.05).But the plasma GAS and VIP levels at T_(1)plasma MTL levels were higher than those in the control group (P<0.05).The recovery time of bowel sounds first anal exhaust and defecation time in electrical stimulation group were shorter than those in the control group (P<0.05).The levels of plasma 5-HT and serum IL-10 at 2 hours,and T_(2)in electrical stimulation group was lower than those in the control group (P<0.05),and the 12 hours after operation in the both groups were lower than those before operation (P < 0.05),and the levels of serum IL-6 and TNF-α were high

关 键 词：穴位电刺激 腹腔镜胆囊切除术 恶心呕吐 

分 类 号：R[医药卫生]