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经皮穴位电刺激对肾移植术后胃肠功能障碍的干预效果评价
张桂诚,喻文立
天津市第一中心医院麻醉科天津 300192
摘要:
目的:评价围术期经皮穴位电刺激对肾移植患者术后恶心呕吐、腹胀、腹痛等胃肠功能障碍的干预效果。方法:选择拟行肾移植术患者60 例,随机分为T 组和S 组,每组30 例。T 组麻醉诱导前30min 于合谷、内关、足三里穴行经皮穴位电刺激持续至术毕,术后回复苏室继续刺激6h ;S 组选择刺激穴位旁开0.5cm 非经非穴位置贴刺激电极,不予电刺激。记录术后6 h、6 h~24 h 恶心、呕吐、腹胀、腹痛发生率和2h、6h、12h、24h 严重程度评分,自控镇痛使用次数、镇痛止吐补救药物用量,肠鸣音恢复时间、首次排气时间、PACU 停留时间。结果:T 组瑞芬太尼用量[(1679±382) μg] 少于S组[(1891±372)μg]、自控镇痛按压次数[0(1) 次]少于S 组[1(2) 次],T 组术后肠鸣音恢复时间[(15±3)h]、排气时间[(22±4)h]、PACU 停留时间[(23±6)h] 均短于S 组[(18±4)h]、[(26±4)h]、[(31±5)h],T 组恶心在6h、6 h~24 h 两时间段发生率分别为20%、13% 均低于S 组发生率47%、55%,T 组腹痛发生率在6h、6 h~24 h 两时间段分别为33%、27%,低于S 组47%、55%,与S 组比较,T 组恶心、呕吐、腹胀、腹痛评分在2h、6h、12h、24h(除呕吐)降低,差异有统计学意义(P <0.05);芬太尼、镇痛止吐补救药物用量、腹胀、呕吐发生率、24h 时呕吐评分差异无统计学意义(P>0.05)。结论:围术期经皮穴位电刺激可减轻肾移植术后恶心呕吐等胃肠功能障碍发生率,促进胃肠功能恢复。
关键词:  经皮穴位电刺激  术后恶心呕吐  胃肠功能障碍  肾移植术  加速康复外科
DOI:10.3969/j.issn.1007-6948.2020.05.013
投稿时间:2020-03-15
基金项目:天津市自然科学基金面上项目(18JCYBJC27500,17JCYBJC28000);天津市临床重点学科(麻醉学)建设项目;天津医学会麻醉学分会中青年科研培育基金项目(TJMZJJ-2019-06)
Effect of Perioperative Transcutaneous Electrical Acupoint Stimulation on Postoperative Nausea and Vomiting and Gastrointestinal Function in Patients undergoing Kidney Transplantation
ZHANG Guicheng,YU Wen-li
Department of Anesthesiology, Tianjin First Central Hospital, Tianjin 300192, China
Abstract:
Objective To evaluate the antiemetic effects and gastrointestinal (GI) function of transcutaneous acupoint stimulation(TEAS)in patients undergoing kidney transplantation. Methods 60 patients, scheduled for kidney transplantation under general anesthesia, aged 18 to 65 year old, ASA Ⅱ ~ Ⅲ , were randomly divided into two groups (n=30 each) who using sealed envelopes into sham stimulation group (group S) and TEAS group (group T). The patients in group T received TEAS on bilateral PC6-LI4-ST36 acupoints, performing from 30 mins before induction of anesthesia to the end of operation, which stimulus frequency was 2/100Hz and the intensity was the maximum current that could be tolerated. While the patients in group S adhered the electrodes 0.5cm lateral to the selective acupoints but received no stimulation. Visual analogue score (VAS) (0=no,10=worst) were adopted to evaluate the level of nausea, vomiting, abdominal distension and abdominal pain separately at 2 h, 6 h, 12 h, 24 h after operation. Besides total amount rescue antiemetic and analgesics, length of PACU stay, recovery time of gastrointestinal function and incidence of postoperative nausea and vomiting,abdominal distension, abdominal pain during first 6h and (6h to 24h) after operation were also recorded.Results VAS scores of nausea, vomiting, abdominal distension and abdominal pain at 2h,4h,12h,24h (except vomiting) after operation in group T were lower than those in group S. The incidence of postoperative nausea in group T and S during first 6h and (6h to 24h) were 20% vs 47%,13% vs 55%. Abdominal pain were 33% vs 67 %, 27 % vs 83%. Recovery time of bowel sounds and expelling gas time,length of PACU stay in group T and S were (15±3) h vs(18±4) h, (22±4) h vs (26±4) h, (23±6) h vs (31±5) h , which the difference was statistically signi?cant (P<0.05). However, there was no statistically signi?cant difference in vomiting at 24h, consumption of rescue antiemetic and analgesics after operation, incidence of postoperative vomiting and abdominal distension as well as other complications (P>0.05). Conclusion Perioperative TEAS could decrease the incidence of PONV and other GI motility as well as promote the recovery of gastrointestinal function.
Key words:  Transcutaneous Electrical Acupoint Stimulation  postoperative nausea and vomiting  kidney transplantation  gastrointestinal motility  enhanced recovery after surgery

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