电针治疗对老年人腹腔镜肠道手术快速康复的影响
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摘要
目的探讨电针治疗对老年人腹腔镜肠道手术后快速康复(ERAS)进程的影响。方法全麻下行腹腔镜肠道手术老年患者随机分为针疗组(P组)和对照组(C组),P组患者在入室后给予电针治疗至手术结束。所有患者术后使用芬太尼静脉输注自控镇痛泵。比较两组术中切皮前后血流动力学改变、术中麻醉药物用量、拔管时间、下床活动时间、术后3、6、12、24、30和48 h芬太尼用量、视觉模拟(VAS)评分及切皮时和术后3 h血浆β-内啡肽浓度。结果切皮后C组患者血流动力学指标较之前增高;切皮时与术后3 h,P组的β-内啡肽浓度高于C组;手术用药比较,P组的麻醉和镇痛药用量显著少于C组;P组患者的拔管、下床时间短于C组;术后3、6 h,P组的芬太尼用量少于C组;术后3、6 h时,P组的安静和咳嗽时VAS评分低于C组,以上差异均有统计学意义(P <0.05)。结论电针促进老年患者术后康复,可作为ERAS的推荐内容。
Objective To discuss the effects of electric acupuncture treatment on intestinal laparoscopy in elderly with enhanced recovery after surgery. Methods 72 old patients undergoing intestinal laparoscopy under general anesthesia were allocated randomly to receive electric acupuncture treatment during the operation(group P)or sham therapy(group C). Hemodynamic parameters during skin incision,peri-operative analgesic requirements,the amount of postoperative fentanyl,the time of extubation and ambulation and the concentration of β-endorphin(EP)during skin incision and 3 h after operation in both groups were recorded. Pain was evaluated postoperatively while coughing and at rest by visual analogue scale at 3,6,12,24,30,48 h after operation. Results Hemodynamic parameters in group C were increased more significantly during skin incision than before(P < 0.05). The concentrations of β-EP in group P were higher than those in group C during skin incision and 3 h after operation(P < 0.05). The time of extubation and ambulation were faster in group P than in group C(P < 0.01 and P < 0.05).The usage of remifentanyl and propofol in group P were fewer than those in groupC(P < 0.01). Fentanyl requirement and pain scores were lower in group P than in group C at 3,6 h postoperation(P < 0.05). Conclusion Our results suggest that electric acupuncture treatment can be recommended to be involved into the program of enhanced recovery after surgery for effectively promoting recovery.
Objective To discuss the effects of electric acupuncture treatment on intestinal laparoscopy in elderly with enhanced recovery after surgery. Methods 72 old patients undergoing intestinal laparoscopy under general anesthesia were allocated randomly to receive electric acupuncture treatment during the operation(group P)or sham therapy(group C). Hemodynamic parameters during skin incision,peri-operative analgesic requirements,the amount of postoperative fentanyl,the time of extubation and ambulation and the concentration of β-endorphin(EP)during skin incision and 3 h after operation in both groups were recorded. Pain was evaluated postoperatively while coughing and at rest by visual analogue scale at 3,6,12,24,30,48 h after operation. Results Hemodynamic parameters in group C were increased more significantly during skin incision than before(P < 0.05). The concentrations of β-EP in group P were higher than those in group C during skin incision and 3 h after operation(P < 0.05). The time of extubation and ambulation were faster in group P than in group C(P < 0.01 and P < 0.05).The usage of remifentanyl and propofol in group P were fewer than those in groupC(P < 0.01). Fentanyl requirement and pain scores were lower in group P than in group C at 3,6 h postoperation(P < 0.05). Conclusion Our results suggest that electric acupuncture treatment can be recommended to be involved into the program of enhanced recovery after surgery for effectively promoting recovery.
引文
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[12]黄小珍,粟胜勇,覃忠亮,等.电针治疗神经根型颈椎病机制的研究进展[J].辽宁中医杂志,2018,44(11):2458-2460.
[13]耿艳霞,陈栋,周海琪,等.电针治疗缓解胃肠外科术后应激反应的临床研究[J].针刺研究,2018,43(12):793-796.
[14]陈晓燕.电针复合药物全麻在老年患者围术期腹腔镜胆囊切除术中的应用[J].中国中医急症,2015,24(12):2266-2268.
[15]吴大庆,邹小华,章放香,等.电针刺激对心脏瓣膜置换术中丙泊酚及咪达唑仑用量的影响[J].贵州医学大学学报,2018,43(9):1060-1064.2019-02-25
[2]SUN Y,ZhANG D W,LI H F,et al.Influence of transversus abdominis plane onintraoperative and postoperative analgesia at different time points in the abdomen laparoscopy operations[J].Int J Anesth Resus,2017,38(6):535-539.
[3]LJUNGQVIST O,SCOTT M,FEARON K C.Enhanced recovery after surgery:A review[J].JAMA Surg,2017,152(3):292-298.
[4]杨锐,陈杨旸,唐俊明,等.快速康复外科在腹腔镜下肝切除的安全性和有效性的Meta分析[J].实用医学杂志,2016,32(16):2729-2733.
[5]PADURARU M,PONCHIETTI L,CASAS I M,et al.Enhanced recovery fater surgery-the evidence in geriatric emergency surgery:a systematic review[J].Chirurgia(Bucur),2017,112(5):546-557.
[6]刘宇,贺海东,王兰,等.超声评估电针改善重症患者胃动力功能的临床研究[J].临床急诊杂志,2017,18(12):902-906.
[7]尹芳.全麻诱导前电针刺激对胃大部切除术患者血流动力学和麻醉效果的影响[J].现代中西医结合杂志,2016,25(2):199-201.
[8]CUI L,DING M.Progress of researches on central mechanism of electroacupuncture tolerance[J].zhen Ci Yan Jiu,2016,41(6):550-555.
[9]潘卫星.针灸的神经生物学机理[J].中华中医药杂志,2018,33(10):4281-4298.
[10]韩济生.针麻镇痛研究[J].针刺研究,2016,41(5):377-387.
[11]姜慧丽,陈利海,王丹丹,等.电针对老年全麻手术患者术后早期认知功能障碍的影响[J].中国中医急症,2017,26(6):1083-1086.
[12]黄小珍,粟胜勇,覃忠亮,等.电针治疗神经根型颈椎病机制的研究进展[J].辽宁中医杂志,2018,44(11):2458-2460.
[13]耿艳霞,陈栋,周海琪,等.电针治疗缓解胃肠外科术后应激反应的临床研究[J].针刺研究,2018,43(12):793-796.
[14]陈晓燕.电针复合药物全麻在老年患者围术期腹腔镜胆囊切除术中的应用[J].中国中医急症,2015,24(12):2266-2268.
[15]吴大庆,邹小华,章放香,等.电针刺激对心脏瓣膜置换术中丙泊酚及咪达唑仑用量的影响[J].贵州医学大学学报,2018,43(9):1060-1064.2019-02-25