足三里穴位注射右美托咪定对妇科腹腔镜术后PONV及胃肠激素水平的影响  

Effect of Dexmedetomidine Injection at Zusanli Acupoint on PONV and Gastrointestinal Hormone Levels after Gynecological Laparoscopy

作　　者：易玲梅 尉明洋[1] 周璟 张梅 李进进 芦曼 YI Lingmei;WEI Mingyang;ZHOU Jing;ZHANG Mei;LI Jinjin;LU Man(The First Affiliated Hospital of Zhejiang Chinese Medicine University,Hangzhou,Zhejiang 310003)

机构地区：[1]浙江中医药大学附属第一医院,浙江杭州310003

出　　处：《中国中医药科技》2024年第4期580-585,共6页Chinese Journal of Traditional Medical Science and Technology

基　　金：浙江省中医药科技计划项目(2022ZQ043)。

摘　　要：目的:探讨足三里穴位注射右美托咪定对妇科腹腔镜术后恶心呕吐(PONV)及胃肠激素水平的影响。方法:纳入2021年7月—2022年11月本院收治的120例妇科腹腔镜手术患者,并按随机数字表法将其分为4组,每组30例。A组患者于足三里注射右美托咪定;B组患者于足三里注射酚妥拉明+右美托咪定;C组患者于足三里注射生理盐水;D组患者于静脉注射右美托咪定。比较4组患者手术及麻醉指标、PONV发生情况、胃肠激素水平、胃肠功能恢复情况及5-羟色胺受体3(5-HT3)水平变化。结果:4组患者手术时间、麻醉时间、气腹时间、气腹压力、麻醉药物(舒芬太尼)用量比较差异无统计学意义(P>0.05)。术后1 d内各时段,A组PONV发生率均低于D组,A、B组PONV发生率均低于C组,各组在术后0~2 h和2~8 h比较差异具有统计学意义(P<0.05)。相较于术前1 d(T0),术后2 h(T1)、术后8 h(T2)、术后24 h(T3),4组患者胃泌素(GAS)和胃动素(MLT)水平先升高再降低,T1时最高,T3时回落至T0水平,其中T1、T2时GAS、MLT水平明显高于T0(P<0.05),T1、T2时GAS、MLT水平A组低于D组(P<0.05),A组<B组<C组(P<0.05)。A组首次排便时间、首次排气时间、肠鸣音恢复时间、首次进食时间及住院时间明显短于D组(P<0.05),且A组<B组<C组(P<0.05)。T1、T2、T3时,4组患者5-羟色胺水平明显高于T0(P<0.05),T1最高,随后逐渐降低,相邻时间点之间比较差异有统计学意义(P<0.05),在各时间点下A组<D组,A组<B组<C组(P<0.05)。结论:足三里穴位注射右美托咪能有效降低妇科腹腔镜手术患者PONV的发生率,加速胃肠功能恢复,可能与其激动α2受体、调节机体血清因子分泌作用有关。Objective:To investigate the effects of Dexmedetomidine Injection at Zusanli acupoint on nausea and vomiting(PONV)and gastrointestinal hormone levels after gynecological laparoscopic surgery.Methods:120 gynecological laparoscopic surgery patients admitted to our hospital from July 2021 to November 2022 were included and divided into four groups according to random number table method,with 30 cases in each group.Group A was injected with Dexmedetomidine in Zusanli;Group B was injected with Phenobenzamine+Dexmedetomidine in Zusanli;Group C was injected with normal saline in Zusanli;Group D recieved Dexmedetomidine intravenously.The indexes of operation and anesthesia,PONV occurrence,gastrointestinal hormone level and gastrointestinal function recovery of the 4 groups were compared.Results:There were no significant differences on operation time,anesthesia time,pneumoperitoneum time,pneumoperitoneum pressure and dosage of anesthesia drug(sufentanil)among the four groups(P>0.05).Within 1 day after surgery,PONV incidence in group A was lower than that in group D,and PONV incidence in groups A and B was lower than that in group C,and the differences were statistically significant 0~2 h and 2~8 h after surgery(P<0.05).At 2 h(T1),8 h(T2)and 24 h(T3)after surgery,compared with 1 d(T0)before surgery,the levels of GAS and MLT in the four groups first increased and then decreased,the highest level was reached at T1,and the levels of GAS and MLT were significantly higher than those of T0 at T1 and T2(P<0.05).GAS and MLT levels at T1 and T2 were in group A<group D(P<0.05),group A<group B<group C(P<0.05).The first defecation time,first exhaust time,bowel sound recovery time,first feeding time and length of stay in group A were significantly shorter than those in group D(P<0.05),and group A<group B<group C(P<0.05).At T1,T2 and T3,the levels of 5-hydroxytryptamine in the four groups were significantly higher than those of T0(P<0.05),and T1 was the highest and then gradually decreased,and the difference between adjacent time points

关 键 词：妇科腹腔镜手术后 穴位注射 足三里穴 右美托咪定 PONV 胃肠激素 5-羟色胺 

分 类 号：R614[医药卫生—麻醉学]