不同经皮穴位电刺激方式用于腹腔镜下胃癌根治术后镇痛效果及胃肠功能恢复的比较

目的 比较不同经皮穴位电刺激(TEAS)方式用于腹腔镜下胃癌根治术后患者镇痛及胃肠功能恢复的效果。 方法 选取180例择期行腹腔镜下胃癌根治术的患者,均经胃镜病理确诊,按年龄分层后,随机分为对照组、短TEAS组、长TEAS组(n=60)。3组均常规诱导,其中短TEAS组从麻醉诱导开始至手术结束持续TEAS; 长TEAS组从麻醉诱导前1 h开始至手术结束后30 min持续TEAS,并于术后2 d内,每隔8 h间断行TEAS 30 min。刺激部位为双侧足三里与内关。术后患者均行静脉自控镇痛(PCIA)。观察并记录3组患者术后4 h(T1)、8 h(T2)、16 h(T3)、24 h(T4)、36 h(T5)镇痛泵用量、疼痛视觉模拟评分(VAS)、镇静评分(Ramsay)及术后恶心呕吐(PONV)发生率; 记录患者术后首次肠鸣音出现的时间、术后首次肛门排气时间、排便时间。 结果 短TEAS组、长TEAS组术后4,8 h镇痛泵用量明显少于对照组(P<0.05),且长TEAS组术后4 h镇痛泵用量明显少于短TEAS组(P<0.05); 长TEAS组术后4,8 h VAS评分较对照组显著降低(P<0.05); 短TEAS组及长TEAS组首次肠鸣音时间与对照组比较,均显著缩短(P<0.05); 长TEAS组与其他2组比较,排便时间显著缩短(P<0.05),且与对照组比较,PONV发生率显著下降(P<0.05)。 结论 TEAS复合全麻能减少阿片类镇痛药的使用剂量,缩短胃癌根治术后首次肠鸣音出现的时间。围术期TEAS可较术中TEAS更有效地减少术后初期疼痛,减少PONV的发生率,缩短术后首次排便时间,更有效地促进胃肠功能恢复。

Comparison of Analgesic Effect and Gastrointestinal Function Recovery afterLaparoscopic Radical Gastrectomy with Different TEAS Methods

ABSTRACT: Objective To compare the effects of different transcutaneous electrical acupoint stimulation(TEAS)on the analgesia and gastrointestinal function recovery after laparoscopic radical gastrectomy for gastric cancer. Methods One hundred and eighty patients with gastric cancer confirmed by gastroscopy undergoing laparoscopic radical gastrectomy were stratified based on age, and then randomly divided into control group, short TEAS group, and long TEAS group averagely. All 3 groups were routinely induced. In the short TEAS group, TEAS was maintained from anesthetic induction to the end of the operation. In the long TEAS group, TEAS was maintained from 1 hour before anesthetic induction to 30 min after the operation, and TEAS was performed for 30 min per 8 h within 2 d after the operation. Stimulation sites included bilateral Zusanli(ST 36)and Neiguan(PC 6). Postoperatively, patients received patient controlled intravenous analgesia(PCIA). The consumption of analgesics, visual analogue scale(VAS),sedation score(Ramsay)and incidence of postoperative nausea and vomiting(PONV)at 4 h(T1), 8 h(T2), 16 h(T3), 24 h(T4)and 36 h(T5)after the operation in the 3 groups were observed and recorded. The times of first bowel sounds, anus exhaust, and defecation after the operation were recorded. Results The consumption of analgesics at 4 h and 8 h after operation in the short TEAS group and the long TEAS group was significantly lower than that in the control group(P<0.05). The consumption of analgesics at 4 h after operation in the long TEAS group was significantly lower than that in the short TEAS group(P<0.05). VAS at 4 h and 8 h after operation in the long TEAS group reduced evidently as compared with the control group(P<0.05). The post-operative first bowel sounds in the short TEAS group and the long TEAS group was shortened apparently compared with the control group(P<0.05). Compared with other 2 groups, the post-operative defecation in the long TEAS group was significantly shorter(P<0.05), and the incidence of PONV in the long TEAS group was significantly lower than that in the control group(P<0.05). Conclusion TEAS combined with general anesthesia can reduce the consumption of analgesics, and shorten the duration of first bowel sounds after radical gastrectomy for gastric cancer. Compared with intraoperative TEAS, perioperative TEAS can more effectively reduce early postoperative pain, reduce the incidence of PONV, shorten the duration of first defecation after the operation, and more effectively promote the recovery of gastrointestinal function.