经皮多穴位电刺激对预防胸腔镜下肺叶切除术患者术后恶心呕吐的影响

目的观察经皮电刺激合谷-内关-后溪-支沟穴对胸腔镜下肺叶切除术患者术后恶心呕吐(PONV)的影响。方法选择择期胸腔镜下肺叶切除术患者64例,年龄18~75岁,采用随机数字表法分为两组,每组32例。麻醉诱导前30min于患者双侧合谷、内关、后溪及支沟穴连接经皮穴位电刺激仪进行电刺激,设置频率为2/100Hz,经皮穴位电刺激(TEAS)组(E组)电刺激强度为引起感觉阈的2倍,经皮穴位假电刺激组(C组)电刺激强度仅为引起感觉阈的强度。E组患者于诱导结束后继续经皮穴位电刺激,强度为30mA,直至手术结束,C组不给予经皮电刺激。术中维持采用血浆靶控输注丙泊酚和瑞芬太尼,两组患者术后均采用静脉自控镇痛(PCIA),术前及手术过程中均不给予止吐药物。术后6、24和48h对患者进行30min经皮电刺激,E组和C组的频率和强度均与麻醉诱导前30min一致。随访患者PONV情况、使用补救止吐药物情况、VAS疼痛评分及镇痛泵舒芬太尼用量。结果与C组比较,E组拔管后即刻、术后6、24、48h恶心发生率均明显降低,术后24h的呕吐发生率明显降低,术后6h及术后24h的VAS评分明显降低,术后48h的镇痛泵舒芬太尼用量明显减少(P0.05)。两组患者术后使用补救止吐药物差异无统计学意义。结论经皮穴位电刺激合谷-内关-后溪-支沟穴对预防PONV有效。

Effect of transcutaneous multi-electrical acupoint stimulation for prevention of PONV in patients under-going thoracoscopic lobectomy

Objective To investigate the effect of transcutaneous electric acupoint stimulation (TEAS)of Hegu-Neiguan-Houxi-Zhigou for preventing postoperative nausea and vomiting (PONV) in patients undergoing thoracoscopic lobectomy.Methods Sixty-four ASA physical status Ⅰ-Ⅲ pa-tients,aged 18-75 years,scheduled for elective thoracoscopic lobectomy were enrolled.Patients were randomly allocated into two groups (n =32):TEAS group (group E)and sham TEAS group (group C).TEAS at Hegu,Neiguan,Houxi and Zhigou was applied to patients before,during and after sur-gery in group E.The frequency was 2/100 Hz and the intensity was 2 times the threshold of sensation before and after surgery,and 30 mA during surgery.While sham TEAS with the intensity of sensory threshold was given to patients before and after surgery in group C.Patients in both groups received sufentanil,propofol and rocuronium for induction of anesthesia.Target controlled infusion of propofol and remifentanil was administered for maintenance of anesthesia.Patient-controlled intravenous anal-gesia (PCIA)was applied in both groups.No antiemetic was given to patients before and during sur-gery.Frequency of nausea or vomiting and any use of antiemetic for remediation were recorded after surgery.The postoperative Visual Analogue Scale (VAS)score and analgesic dosage were also docu-mented.Results Compared to group C,the incidence of nausea immediately after surgery,6 h after surgery,24 h after surgery and 48 h after surgery were significantly lower in group E.The incidence of vomiting 24 h after surgery was significantly lower in group E.The VAS score 6h and 24 h after surgery were significantly lower in group E.The analgesic dosage 48 h after surgery were reduced in group E.There were no significant differences regarding the use of antiemetic for remediation between the two groups.Conclusion TEAS at Hegu-Neiguan-Houxi-Zhigou is effective for preventing PONV in patients undergoing thoracoscopic lobectomy.