穴位神经电刺激预防乳腺癌患者术后恶心呕吐的临床观察

目的观察乳腺癌仿根术患者超前应用韩氏穴位神经刺激仪(HANS),能否减轻术后恶心、呕吐(PONV)并将其效果与应用昂丹斯琼进行比较。方法拟行乳腺癌根治术的患者90例,随机分为3组,每组30例。A组麻醉前30 min应用HANS,B组手术结束前静脉注射昂丹斯琼,C组为对照组。3组均实行硬膜外麻醉,术后病人采用自控硬膜外镇痛。术后测定2 h、6 h、12 h、24 h、48 h的VRS评分,恶心、呕吐情况,止吐药的需要情况及不良反应。结果A组12 h内的PONV发生率显著低于C组;B组各时段内PONV发生率均显著低于C组。A、B组两组术后各时段恶心的发生率均显著低于C组。A组仅术后6 h内的呕吐发生率显著低于C组;B组各时段内呕吐发生率均显著低于C组。结论应用HANS刺激内关穴可以降低乳腺癌仿根术后患者的12 h内PONV发生率。

Clinical Observation of HANS for the Prevention of Postoperative Nausea and Vomiting after Modified Radical Mastectomy

Objective To evaluate the efficacy of device- Hans Acupoint Nerve stimulator （Hans） on preventing of postoperative nausea and vomiting （PONV） compared with ondansetron and placebo. Methods Ninety patients with ASA Ⅰ- Ⅱ undergoing major breast surgery were randomly divided into three groups （n = 30, each group）. Group A was received active electro - acupoint stimulation 30 min before anesthesia, group B was received ondansetron 8.0 mg before the end of the operation and group C （ sham control group） was placement of electrodes without electro - acupoint stimulation. Tile anesthetic regimen was standardized; all patients received epidural anesthesia combined with postoperative epidural analgesia. VRS scores, nausea, vomiting, and the need for rescue of antiemetic were assessed in three groups at 2, 6, 12, 24 and 48 h. Results The incidence of PONV was significantly lower in the group A compared with the group C within 12 h after surgery. The incidences of PONV were significantly lower in group B compared with the group C all time after surgery. The nausea scores in group A and B were both lower than group C after surgery. The incidence of vomiting was significantly lower in the group A compared with group C within 6 h after surgery, and the incidence of vomiting was significantly lower in the group B compared with group C within 48 h after surgery.Conclusion These results suggest that HANS could reduce the incidence of PONV in the patients undergoing modified radical mastectomy.