不同频率TEAS结合腕带按压刺激内关穴防治腹腔镜胆囊切除术后恶心呕吐疗效观察
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摘要
目的:比较不同频率的经皮穴位电刺激(TEAS)结合腕带按压刺激内关穴对腹腔镜胆囊切除术后恶心呕吐(PONV)的治疗效果,优化治疗PONV的TEAS频率选择。方法:将行腹腔镜胆囊切除术患者80例按随机数字表法随机分为术后常规护理组、2 Hz TEAS结合腕带按压组、100 Hz TEAS结合腕带按压组和2 Hz/100 Hz TEAS结合腕带按压组,每组20例(术后常规护理组脱落1例)。各组均行腹腔镜下胆囊切除术,在手术后均给予常规护理。术后常规护理组仅接受常规护理,余3组患者在术后常规护理基础上,在术后苏醒即刻分别采用2 Hz TEAS结合腕带按压、100 Hz TEAS结合腕带按压、2 Hz/100 Hz TEAS结合腕带按压刺激内关穴进行治疗,每次治疗30 min,共治疗4次。观察记录各组患者术后0～2 h、2～8 h、8～24 h及24～48 h各个时间段PONV发生率,并评估患者PONV严重程度及术后疼痛程度。结果:与术后常规护理组相比,2 Hz/100 Hz TEAS结合腕带按压组在术后4个时间段均能明显降低患者PONV发生率及严重程度(均P<0.05),2 Hz TEAS结合腕带按压组与100 Hz TEAS结合腕带按压组在术后2 h及2～8 h时间段能显著减轻患者PONV发生率与严重程度(均P<0.05),术后8 h、术后24 h时100 Hz TEAS结合腕带按压组与2 Hz/100 Hz TEAS结合腕带按压组均能减轻患者术后疼痛(均P<0.05)。结论:不同频率TEAS结合腕带按压刺激内关穴对腹腔镜胆囊切除术患者PONV都有一定的治疗效应,2 Hz/100 Hz TEAS结合腕带按压刺激内关穴对腹腔镜胆囊切除术患者PONV治疗效果更明显。2 Hz/100 Hz TEAS与100Hz TEAS结合腕带按压刺激内关穴对腹腔镜胆囊切除术患者均具有术后镇痛效应,2Hz/100Hz TEAS镇痛效应更佳。
Objective To compare the effects of different frequency of transcutaneous electrical acupoint stimulation(TEAS) combined with wristband pressing on Neiguan(PC 6) for nausea and vomiting(PONV) after laparoscopic cholecystectomy, and optimize the TEAS frequency selection for treatment of PONV. Methods Eighty patients undergoing laparoscopic cholecystectomy were randomly divided into a postoperative routine care group, a 2 Hz TEAS combined with wristband pressing group(2 Hz TEAS group), a 100 Hz TEAS combined with combined with wristband pressing group(100 Hz TEAS group) and a 2 Hz/100 Hz TEAS wristband pressing group(2 Hz/100 Hz TEAS group), 20 cases in each group(1 patient dropped off in the postoperative routine care group). All the four groups underwent laparoscopic cholecystectomy, and routine nursing was given after the operation. In the postoperative routine nursing group,only routine nursing was received. In the other three groups, 2 Hz TEAS combined with wristband pressing, 100 Hz TEAS combined with wristband pressing, 2 Hz/100 Hz TEAS combined with wristband pressing to simulate Neiguan(PC 6) were treated on the basis of postoperative routine care after surgery. The treatment was given for 30 min each time for a total of 4 treatments. The incidence of PONV in each group was observed at 0-2 h, 2-8 h, 8-24 h and 24-48 h after operation, and the severity of PONV and postoperative pain were evaluated. Results Compared with the postoperativeroutine care group, the incidence and severity of PONV in the four time periods after surgery were significantly reduced in the 2 Hz/100 Hz TEAS group(all P<0.05), the incidence and severity of PONV in patients at 2 h and 2-8 h after surgery were significantly reduced in the 2 Hz TEAS group and the 100 Hz TEAS group(all P<0.05), the postoperative pain at 8 h and 24 h after surgery was alleviated in the 100 Hz TEAS group and the 2 Hz/100 Hz TEAS group(all P<0.05). Conclusion Different frequency of TEAS combined with wristband pressing to stimulating Neiguan(PC 6) have certain therapeutic effects on PONV in patients undergoing laparoscopic cholecystectomy. 2 Hz/100 Hz TEAS combined with wristband pressing at Neiguan(PC 6) is more effective in PONV. 2 Hz/100 Hz TEAS and 100 Hz TEAS combined with wristband pressing at Neiguan(PC 6) have postoperative analgesic effect, and 2 Hz/100 Hz TEAS has the better analgesic effect.
Objective To compare the effects of different frequency of transcutaneous electrical acupoint stimulation(TEAS) combined with wristband pressing on Neiguan(PC 6) for nausea and vomiting(PONV) after laparoscopic cholecystectomy, and optimize the TEAS frequency selection for treatment of PONV. Methods Eighty patients undergoing laparoscopic cholecystectomy were randomly divided into a postoperative routine care group, a 2 Hz TEAS combined with wristband pressing group(2 Hz TEAS group), a 100 Hz TEAS combined with combined with wristband pressing group(100 Hz TEAS group) and a 2 Hz/100 Hz TEAS wristband pressing group(2 Hz/100 Hz TEAS group), 20 cases in each group(1 patient dropped off in the postoperative routine care group). All the four groups underwent laparoscopic cholecystectomy, and routine nursing was given after the operation. In the postoperative routine nursing group,only routine nursing was received. In the other three groups, 2 Hz TEAS combined with wristband pressing, 100 Hz TEAS combined with wristband pressing, 2 Hz/100 Hz TEAS combined with wristband pressing to simulate Neiguan(PC 6) were treated on the basis of postoperative routine care after surgery. The treatment was given for 30 min each time for a total of 4 treatments. The incidence of PONV in each group was observed at 0-2 h, 2-8 h, 8-24 h and 24-48 h after operation, and the severity of PONV and postoperative pain were evaluated. Results Compared with the postoperativeroutine care group, the incidence and severity of PONV in the four time periods after surgery were significantly reduced in the 2 Hz/100 Hz TEAS group(all P<0.05), the incidence and severity of PONV in patients at 2 h and 2-8 h after surgery were significantly reduced in the 2 Hz TEAS group and the 100 Hz TEAS group(all P<0.05), the postoperative pain at 8 h and 24 h after surgery was alleviated in the 100 Hz TEAS group and the 2 Hz/100 Hz TEAS group(all P<0.05). Conclusion Different frequency of TEAS combined with wristband pressing to stimulating Neiguan(PC 6) have certain therapeutic effects on PONV in patients undergoing laparoscopic cholecystectomy. 2 Hz/100 Hz TEAS combined with wristband pressing at Neiguan(PC 6) is more effective in PONV. 2 Hz/100 Hz TEAS and 100 Hz TEAS combined with wristband pressing at Neiguan(PC 6) have postoperative analgesic effect, and 2 Hz/100 Hz TEAS has the better analgesic effect.
引文
[1]Gan TJ,Diemunsch P,Habib AS,et al.Consensus guidelines for the management of postoperative nausea and vomiting[J].Anesth Analg,2014,118(1):85-113.
[2]Ryu J,So YM,Hwang J,et al.Ramosetron versus ondansetron for the prevention of postoperative nausea and vomiting after laparoscopic cholecystectomy[J].Surg Endosc,2010,24(4):812-817.
[3]周愚,王蔚,黄宏辉,等.自控经皮穴位电刺激对妇科腹腔镜术后恶心呕吐的影响[J].临床麻醉学杂志,2014,30(6):592-593.
[4]金玮,吕雅,陈双懂,等.内关穴经皮穴位电刺激防治甲状腺肿瘤术后恶心呕吐疗效的临床观察[J].中国中西医结合杂志,2013,33(9):1199-1202.
[5]A DM and A K.Effect of acupressure on post-operative nausea and vomiting in cesarean section:a randomised controlled trial[J].J Clin Diagn Res,2013,7(10):2247-2249.
[6]周璇,王琦.穴位按压腕带缓解术后恶心呕吐随机对照试验的Meta分析[J].护理学杂志,2011,26(6):81-84.
[7]Gan TJ.Mechanisms underlying postoperative nausea and vomiting and neurotransmitter receptor antagonist-based pharmacotherapy[J].Cns Drugs,2007,21(10):813.
[8]蒋平,王国年,孔庆玲,等.手术后恶心呕吐的机制及其防治[J].现代生物医学进展,2012,12(21):4186-4189.
[9]吴新民,罗爱伦,田玉科,等.术后恶心呕吐防治专家意见(2012)[J].临床麻醉学杂志,2012,28(4):413-416.
[10]李宝贵,陶富盛.术后恶心呕吐的中西医认识和临床对策[J].辽宁中医药大学学报,2011,13(2):135-138.
[11]赵东,潘芳,杨拔贤.术后恶心呕吐发生率与预防性用药的意义[J].临床麻醉学杂志,2006(12):912-914.
[12]Cui Y,Wang L,Shi G,et al.Electroacupuncture alleviates cisplatin-induced nausea in rats[J].Acupunct Med,2016,34(2):120-126.
[13]Mckeon C,Smith CA,Gibbons K,et al.EA versus sham acupuncture and no acupuncture for the control of acute and delayed chemotherapy-induced nausea and vomiting:a pilot study[J].Acupunct Med,2015,33(4):277.
[14]欧阳铭文,秦再生,林春水,等.针刺对腹腔镜术后恶心、呕吐的预防作用[J].中国针灸,2009,29(11):915-918.
[15]马婷婷,吴曦,梁繁荣.国外针灸防治手术后恶心呕吐研究现状[J].中国针灸,2010,30(5):407-411.
[16]苗新旗.温针灸疗法对腹腔镜胆囊切除术后胃肠功能紊乱影响的临床观察[D].沈阳:辽宁中医药大学,2012.
[17]Wang SM,Kain ZN.P6 acupoint injections are as effective as droperidol in controlling early postoperative nausea and vomiting in children[J].Anesthesiology,2002,97(2):359-366.
[18]高军龙,李玉兰.浅谈经皮穴位电刺激在围麻醉期的多种作用[J].中国针灸,2015,35(3):269-273.
[19]Lee S,Lee MS,Choi DH,et al.Electroacupuncture on PC6prevents opioid-induced nausea and vomiting after laparoscopic surgery[J].Chin J Integr Med,2013,19(4):277-281.
[20]Huang S,Peng W,Tian X,et al.Effects of transcutaneous electrical acupoint stimulation at different frequencies on perioperative anesthetic dosage,recovery,complications,and prognosis in video-assisted thoracic surgical lobectomy:a randomized,double-blinded,placebo-controlled trial[J].JAnesth,2017,31(1):58-65.
[21]An LX,Chen X,Ren XJ,et al.Electro-acupuncture decreases postoperative pain and improves recovery in patients undergoing a supratentorial craniotomy[J].Am J Chin Med,2014,42(5):1099-1109.
[22]唐炜,马文,傅国强,等.不同频率电针对腹腔镜手术病人术后恶心呕吐的影响[J].中国针灸,2013,33(2):159-162.
[23]Lee A,Chan SK,Fan LT.Stimulation of the wrist acupuncture point PC6 for preventing postoperative nausea and vomiting[J].Cochrane Database Syst Rev,2015(11):Cd003281.
[24]朱丹,吕黄伟.P6刺激对术后恶心呕吐有效性的Meta分析[J].中国循证医学杂志,2010,10(8):923-931.
[25]卢超,邱鹏飞,房军帆,等.内关穴刺激防治手术后恶心呕吐的研究进展[J].临床麻醉学杂志,2017,33(9):929-930.
[26]ASPAN?S evidence-based clinical practice guideline for the prevention and/or management of PONV/PDNV[J].J Perianesth Nurs,2006,21(4):230-250.
[27]Stoicea N,Gan TJ,Joseph N,et al.Alternative Therapies for the Prevention of Postoperative Nausea and Vomiting[J].Front Med(Lausanne),2015,2:87.
[28]贾炜.运用功能磁共振成像(fMRI)技术研究手厥阴心包经内关穴在大脑中的功能定位[D].郑州:河南中医学院,2008.
[29]Huang ST,Chen GY,Lo HM,et al.Increase in the vagal modulation by acupuncture at neiguan point in the healthy subjects[J].Am J Chin Med,2005,33(1):157-164.
[30]郭义,方剑乔.实验针灸学[M].北京:中国中医药出版社,2012.
[2]Ryu J,So YM,Hwang J,et al.Ramosetron versus ondansetron for the prevention of postoperative nausea and vomiting after laparoscopic cholecystectomy[J].Surg Endosc,2010,24(4):812-817.
[3]周愚,王蔚,黄宏辉,等.自控经皮穴位电刺激对妇科腹腔镜术后恶心呕吐的影响[J].临床麻醉学杂志,2014,30(6):592-593.
[4]金玮,吕雅,陈双懂,等.内关穴经皮穴位电刺激防治甲状腺肿瘤术后恶心呕吐疗效的临床观察[J].中国中西医结合杂志,2013,33(9):1199-1202.
[5]A DM and A K.Effect of acupressure on post-operative nausea and vomiting in cesarean section:a randomised controlled trial[J].J Clin Diagn Res,2013,7(10):2247-2249.
[6]周璇,王琦.穴位按压腕带缓解术后恶心呕吐随机对照试验的Meta分析[J].护理学杂志,2011,26(6):81-84.
[7]Gan TJ.Mechanisms underlying postoperative nausea and vomiting and neurotransmitter receptor antagonist-based pharmacotherapy[J].Cns Drugs,2007,21(10):813.
[8]蒋平,王国年,孔庆玲,等.手术后恶心呕吐的机制及其防治[J].现代生物医学进展,2012,12(21):4186-4189.
[9]吴新民,罗爱伦,田玉科,等.术后恶心呕吐防治专家意见(2012)[J].临床麻醉学杂志,2012,28(4):413-416.
[10]李宝贵,陶富盛.术后恶心呕吐的中西医认识和临床对策[J].辽宁中医药大学学报,2011,13(2):135-138.
[11]赵东,潘芳,杨拔贤.术后恶心呕吐发生率与预防性用药的意义[J].临床麻醉学杂志,2006(12):912-914.
[12]Cui Y,Wang L,Shi G,et al.Electroacupuncture alleviates cisplatin-induced nausea in rats[J].Acupunct Med,2016,34(2):120-126.
[13]Mckeon C,Smith CA,Gibbons K,et al.EA versus sham acupuncture and no acupuncture for the control of acute and delayed chemotherapy-induced nausea and vomiting:a pilot study[J].Acupunct Med,2015,33(4):277.
[14]欧阳铭文,秦再生,林春水,等.针刺对腹腔镜术后恶心、呕吐的预防作用[J].中国针灸,2009,29(11):915-918.
[15]马婷婷,吴曦,梁繁荣.国外针灸防治手术后恶心呕吐研究现状[J].中国针灸,2010,30(5):407-411.
[16]苗新旗.温针灸疗法对腹腔镜胆囊切除术后胃肠功能紊乱影响的临床观察[D].沈阳:辽宁中医药大学,2012.
[17]Wang SM,Kain ZN.P6 acupoint injections are as effective as droperidol in controlling early postoperative nausea and vomiting in children[J].Anesthesiology,2002,97(2):359-366.
[18]高军龙,李玉兰.浅谈经皮穴位电刺激在围麻醉期的多种作用[J].中国针灸,2015,35(3):269-273.
[19]Lee S,Lee MS,Choi DH,et al.Electroacupuncture on PC6prevents opioid-induced nausea and vomiting after laparoscopic surgery[J].Chin J Integr Med,2013,19(4):277-281.
[20]Huang S,Peng W,Tian X,et al.Effects of transcutaneous electrical acupoint stimulation at different frequencies on perioperative anesthetic dosage,recovery,complications,and prognosis in video-assisted thoracic surgical lobectomy:a randomized,double-blinded,placebo-controlled trial[J].JAnesth,2017,31(1):58-65.
[21]An LX,Chen X,Ren XJ,et al.Electro-acupuncture decreases postoperative pain and improves recovery in patients undergoing a supratentorial craniotomy[J].Am J Chin Med,2014,42(5):1099-1109.
[22]唐炜,马文,傅国强,等.不同频率电针对腹腔镜手术病人术后恶心呕吐的影响[J].中国针灸,2013,33(2):159-162.
[23]Lee A,Chan SK,Fan LT.Stimulation of the wrist acupuncture point PC6 for preventing postoperative nausea and vomiting[J].Cochrane Database Syst Rev,2015(11):Cd003281.
[24]朱丹,吕黄伟.P6刺激对术后恶心呕吐有效性的Meta分析[J].中国循证医学杂志,2010,10(8):923-931.
[25]卢超,邱鹏飞,房军帆,等.内关穴刺激防治手术后恶心呕吐的研究进展[J].临床麻醉学杂志,2017,33(9):929-930.
[26]ASPAN?S evidence-based clinical practice guideline for the prevention and/or management of PONV/PDNV[J].J Perianesth Nurs,2006,21(4):230-250.
[27]Stoicea N,Gan TJ,Joseph N,et al.Alternative Therapies for the Prevention of Postoperative Nausea and Vomiting[J].Front Med(Lausanne),2015,2:87.
[28]贾炜.运用功能磁共振成像(fMRI)技术研究手厥阴心包经内关穴在大脑中的功能定位[D].郑州:河南中医学院,2008.
[29]Huang ST,Chen GY,Lo HM,et al.Increase in the vagal modulation by acupuncture at neiguan point in the healthy subjects[J].Am J Chin Med,2005,33(1):157-164.
[30]郭义,方剑乔.实验针灸学[M].北京:中国中医药出版社,2012.
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