低频电穴位刺激对胃肠手术患者术后镇痛的效果

目的:探讨低频电穴位刺激对胃或直结肠切除术患者的术后镇痛作用并评价其效果。方法:ASAⅠ～Ⅱ级,行胃或直结肠切除术患者60例,随机分为低频电经皮穴位刺激(HANS)+患者静脉自控镇痛(PCIA)组(HANS组)和PCIA组(对照组)各30例,均于手术结束前30min缝合腹膜时给予托烷司琼3mg,曲马多1.5mg/kg静脉注射;在麻醉结束后5min,于复苏室(PACU)中开始使用PCIA镇痛。HANS组同时增加低频电穴位刺激30min。2组均于麻醉前5min、实施镇痛后30min检测血浆β-内啡肽(β-EP)的浓度,记录和评定术后的血压、呼吸、血氧饱和度和疼痛VAS评分,PCIA用量,有效和无效按压次数,镇痛和睡眠满意度,术后恶心呕吐(PONV)发生频率及程度。结果:术后血浆β-EP浓度与术前比较2组均升高,与对照组比较HANS组升高更明显(均P0.05)。术后HANS组0、2、6、14及24h的疼痛VAS评分、PCIA用量、有效及无效按压次数,均明显低于对照组;睡眠和镇痛满意度明显高于对照组(P0.05,0.01)。术后血压、呼吸、血氧饱和度及PONV发生频率和程度2组比较差异无统计学意义。结论:低频电穴位刺激可促进内源性β-EP的分泌,增强胃肠手术患者的术后镇痛效果。

Effect of Low Frequency Current Acupoint Stimulation on Postoperative Analgesia Following Gastrectomy or Proctocolectomy

Objective：To investigate the effect of low frequency current acupoint stimulation on postoperative analgesia following gastrectomy or proctocolectomy. Methods：Sixty ASA class Ⅰ or Ⅱ patients were randomly divided into HANS group and control group. Tropisetron （3 mg） and tramadol 1.5 （mg/kg） were given intravenously before peritoneum suture at the end of operation in both two groups,and then intravenous patient-controlled analgesia （PCIA） was initiated in post-anesthesia care unit. At the same time,patients in HANS group were stimulated with HANS for 30 min. The venous blood samples were obtained 5 min before anesthesia and 30 min after PCIA for detecting the plasma level of β-endorphine （β-EP）. Postoperative VAS,the overall satisfaction to analgesic therapy and somnus scores,the amount of analgesic requirement,the effective/ineffective number of PCIA,BP,HR,SpO2,the rate of postoperative nausea and vomiting （PONV） were recorded. Results：The postoperative plasma level of β-EP,the overall satisfaction to analgesic therapy and somnus scores in HANS group were higher than those in control group （P0.05）. On the postoperative h 0,2,6,14 and 24,VAS,the amount of analgesic requirement,the effective/ineffective number of PCIA in HANS group were lower than those in control group （P0.05 or 0.01）. Conclusion：Postoperative low frequency current acupoint stimulation with HANS enhanced the analgesic effect of PCIA and reduced the requirement of analgesics following gastrectomy or proctocolectomy.