电针预处理对腹腔镜胃肠道肿瘤手术患者苏醒质量的影响  

Effect of electroacupuncture pretreatment on the quality of recovery in the patients undergoing laparoscopic gastrointestinal surgery

作　　者：周攀利 张彩举 周民涛 付金厚 何金乾 孙宁[1] 曹维福 ZHOU Panli;ZHANG Caiju;ZHOU Mintao;FU Jinhou;He Jinqian;SUN Ning;CAO Weifu(Department of Anesthesiology,First People's Hospital of Nanyang City Affiliated to Henan University,Nanyang 473010,China)

机构地区：[1]河南大学附属南阳市第一人民医院麻醉科,南阳473010

出　　处：《中国针灸》2024年第12期1377-1382,共6页Chinese Acupuncture & Moxibustion

基　　金：河南省医学科技攻关计划项目:LHGJ20221045。

摘　　要：目的:观察电针预处理对腹腔镜胃肠道肿瘤手术患者苏醒质量的影响。方法:将60例择期于全身麻醉下行腹腔镜胃肠道肿瘤切除术患者随机分为观察组和对照组,每组30例。对照组采用常规静吸复合全身麻醉;在对照组基础上,观察组于麻醉诱导前30 min电针刺激双侧内关与内麻点30 min,采用疏密波,频率2 Hz/100 Hz。比较两组患者自主呼吸恢复时间、苏醒时间、拔管时间及麻醉恢复室(PACU)滞留时间,记录两组患者电针刺激前(T0)、拔管前(T1)、拔管即刻(T2)、拔管后5 min(T3)、拔管后10 min(T4)、出PACU(T5)平均动脉压(MAP)、心率(HR)及血氧饱和度(SpO_(2)),观察两组患者T3、T4、T5疼痛视觉模拟量表(VAS)评分、Ramsay镇静评分,于T5评定两组躁动及恶心呕吐发生情况,检测两组患者T0、T5血清肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)及皮质醇含量。结果:观察组患者自主呼吸恢复时间、苏醒时间、拔管时间及PACU滞留时间均短于对照组(P<0.001)。观察组患者MAP、HR在T2时间点低于对照组(P<0.01,P<0.05)。观察组患者T3、T4、T5时间点疼痛VAS评分低于对照组(P<0.001,P<0.01);观察组患者T3时间点Ramsay镇静评分低于对照组(P<0.05);观察组患者恶心呕吐发生率低于对照组(P<0.05)。与T0时间点比较,两组患者血清TNF-α、IL-6及皮质醇含量在T5时间点升高(P<0.001),观察组患者血清TNF-α、IL-6及皮质醇含量在T5时间点低于对照组(P<0.01,P<0.05)。结论:电针预处理能够提高腹腔镜胃肠道肿瘤手术患者麻醉苏醒质量,缩短自主呼吸恢复时间、苏醒时间、拔管时间及PACU滞留时间,减轻术后疼痛,降低应激反应。Objective To investigate the effect of electroacupuncture pretreatment on the quality of recovery in the patients undergoing laparoscopic gastrointestinal surgery.Methods Sixty patients for elective laparoscopic resection of gastrointestinal tumors under general anesthesia were randomly assigned to either an observation group or a control group,with 30 patients in each group.In the control group,the routine inhalation-intravenous combined general anesthesia was adopted.On the basis of the control group,in the observation group,30 min before anesthesia induction,electroacupuncture was applied to bilateral Neiguan(PC 6) and Neimadian(Extra) for 30 min,using disperse-dense wave and at 2 Hz/100 Hz.The recovery time of spontaneous breathing,awakening time,extubation time,and the post-anesthesia care unit(PACU) stay time were compared between the two groups.Mean arterial pressure(MAP),heart rate(HR),and oxygen saturation(SpO_2)were recorded at multiple time points:before electroacupuncture(T0),before extubation(T1),immediately after extubation(T2),5 minutes(T3) and 10 minutes(T4) after extubation,and upon discharge from PACU(T5).The visual analogue scale(VAS) score for pain and Ramsay sedation score at T3,T4 and T5 were observed;and the incidence of agitation,nausea and vomiting at T5 was evaluated in the two groups.At T0 and T5,the serum levels of tumor necrosis factor-alpha(TNF-α),interleukin-6(IL-6),and cortisol were determined in the two groups.Results In the observation group,the recovery time of spontaneous breathing,awakening time,extubation time,and PACU stay time were shorter(P<0.001),MAP and HR at T2were lower(P<0.01,P<0.05),the VAS scores for pain at T3,T4,and T5 dropped(P<0.001,P<0.01),and the Ramsay sedation score at T3 reduced(P<0.05) compared with those in the control group.The incidence of nausea and vomiting was lower in the observation group when compared with that in the control group(P<0.05).In comparison with the indexes at T0,the serum levels of TNF-α,IL-6,and cortisol increased at T5 in both gr

关 键 词：胃肠道肿瘤手术 腹腔镜 电针 苏醒质量 随机对照试验 

分 类 号：R246.2[医药卫生—针灸推拿学]