经皮自控电刺激耳神门穴对乳腺癌术后疼痛及恶心、呕吐的影响

目的 观察经皮自控电刺激耳神门穴对乳腺癌术后疼痛及恶心、呕吐发生率的影响。方法 选择2022年10月—2023年3月拟实施择期乳腺癌手术的患者80例。采用随机数字表分为耳神门穴刺激组（transcutaneous auricular Shenmen stimulation， ta-SMS组）和对照组（C组），每组40例。ta-SMS组入手术室后在预麻间行耳神门穴电刺激30 min、进入麻醉恢复室后即刻及回到病房后每隔3 h自控行经皮耳神门穴电刺激30 min。C组除不予耳穴电刺激外，其余处理同ta-SMS组。记录两组患者入室时心率（heart rate， HR）、平均无创血压（mean blood pressure， MBP）、脑电双频指数（bispectral index， BIS）及术后24、48、72 h的恶心、呕吐(post-operative nausea and vomiting， PONV)发生率；比较两组患者术后视觉模拟评分法（visual analogue scale， VAS）疼痛评分变化、镇痛泵按压总次数以及手术前后血清5-羟色胺（5-HT）表达水平。结果 ta-SMS组患者较C组术后72 h内恶心、呕吐发生率显著降低（P<0.05）；两组术后24、48、72 h的VAS评分差异无统计学意义（P>0.05）；ta-SMS组PCIA按压总次数、镇痛复合液总消耗量降低，差异有统计学意义（P<0.05）；两组术前血清5-HT水平差异无统计学意义（P>0.05）；ta-SMS组术后24、48、72 h血清5-HT水平显著低于C组，差异有统计学意义（P<0.05）。结论 多次经皮自控电刺激耳神门穴可降低乳腺癌手术后72 h内恶心、呕吐的发生率，缓解患者疼痛；5-HT的表达下调参与了其过程。

Efficacy of transcutaneous auricular acupoint Shenmen stimulation for relieving pain, nausea and vomiting in breast cancer patients undergoing mastectomy

Objective To observe the efficacy of transcutaneous self-controlled electrical stimulation at auricular acupoint Shenmen for relieving pain, nausea and vomiting in breast cancer patients undergoing mastectomy. Methods Eighty breast cancer patients undergoing surgical treatment in Longhua Hospital between October 2022 and March 2023 were randomly divided into ta-SMS group and control group with 40 cases in each group. Patients in ta-SMS group received 30 min electric stimulation at auricular Shenmen point before anesthesia and after entering the anesthesia recovery room, then every 3 h after returning to the ward. The heart rate(HR), mean blood pressure(MBP) and bispectral index(BIS) were recorded in both groups. The incidence of nausea and vomiting at 24, 48 and 72 h after surgery were recorded in both groups. Postoperative VAS pain score, total number of analgesic pump compression and serum 5-hydroxytryptamine(5-HT) levels before and after operation were compared between the two groups. Results The incidence of nausea and vomiting in ta-SMS group was significantly lower than that in the control group within 72 h after surgery(P<0.05). There was no significant difference in VAS scores at 24, 48 and 72 h between the two groups(P>0.05). The total number of patient-controlled intravenous analgesia(PCIA) compression and the total consumption of analgesics in ta-SMS group were significantly lower than those in the control group(P<0.05). There was no difference in serum 5-HT level between the two groups before operation(P>0.05); while the serum 5-HT levels in ta-SMS group were significantly lower than those in the control group at 24, 48 and 72 h after surgery(P<0.05). Conclusion Transcutaneous electrical stimulation at auricular acupoint Shenmen can reduce the incidence of nausea and vomiting after breast cancer surgery and relieve patients pain, which are associated with the down-regulation of 5-HT.