经皮穴位电刺激对腹腔镜胆囊切除术患者术后早期恢复质量的影响
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摘要
目的探讨经皮穴位电刺激在提高腹腔镜胆囊切除术(LC)患者术后早期恢复质量的临床效果。方法选取2016年1月～2018年10月首都医科大学附属北京中医医院收治的LC患者93例为研究对象,根据随机数字表法分为对照组(46例)和研究组(47例)。对照组行LC术时给予右美托咪定,研究组行LC术时给予经皮穴位电刺激联合右美托咪定,比较两组麻醉前(T_1)、插管5 min后(T_2)、气腹建立5 min后(T_3)、气腹建立15 min后(T_4)、术毕(T_5)时的心率(HR)、平均动脉压(MAP);比较两组患者T1_、T_5、术后1 d(T_6)的白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、神经元特异性烯醇化酶(NSE)以及超氧化物歧化酶(SOD)水平;比较两组术后谵妄分级量表评分、镇静评分、视觉模拟评分(VAS)以及舒适度评分,记录两组治疗期间不良反应发生情况。结果对照组HR、MAP在T_2～T_5均高于T_1(P<0.05),研究组HR、MAP在T_2～T_5与T_1比较差异无统计学意义(P>0.05),研究组HR、MAP在T_2～T_5显著低于同期对照组(P<0.05)。两组SOD水平在T_5较治疗前降低,但研究组高于对照组(P<0.05),NSE较治疗前升高,但研究组低于对照组(P<0.05)。两组IL-6、TNF-α在T_5、T_6浓度均较T_1升高,但研究组低于对照组(P<0.05)。两组患者术后VAS、舒适度评分比较差异无统计学意义(P> 0.05),研究组术后谵妄分级量表评分低于对照组,镇静评分高于对照组(P<0.05)。两组患者不良反应总发生率比较差异无统计学意义(P>0.05)。结论 LC术中应用经皮穴位电刺激,可维持血流动力学稳定,改善血清SOD、NSE、IL-6、TNF-α水平,且不增加不良反应发生率,有效改善患者早期恢复效果。
Objective To explore the clinical application of transcutaneous acupoint electrical stimulation in improving the early recovery quality of patients after laparoscopic cholecystectomy(LC). Methods A total of 93 patients with LC admitted to Beijing Traditional Chinese Medicine Hospital Affiliated to Capital Medical University from January 2016 to October 2018 were selected as the study objects. They were divided into control group(46 cases) and research group(47 cases) according to random number table method. The control group was given Dexmedetomidine during LC, and the research group received transcutaneous acupoint electrical stimulation combined with Dexmedetomidine during LC.Heart rate(HR) and mean arterial pressure(MAP) were compared at before anesthesia(T_1), 5 min after intubation(T_2),5 min after establishment of pneumoperitoneum(T_3), 15 min after establishment of pneumoperitoneum(T_4), and 5 min after operation(T_5). The level of interleukin-6(IL-6),tumor necrosis factor-α(TNF-α), neuron specific enolation(NSE) and superoxide dismutase(SOD) at T_1, T_5 and postoperative 1 day(T_6) were compared between the two groups.The postoperative delirium rating scale score, sedation score, visual analogue score(VAS) and comfort score were compared between the two groups. The occurrence of adverse reactions during treatment was recorded. Results The HR and MAP of control group at T_2-T_5 time point were higher than those at T_1 time point(P < 0.05). There was no significant difference in HR and MAP between the time points of T_2-T_5 and T_1 in the research group(P > 0.05). HR and MAP of the research group at T_2-T_5 time points were significantly lower than those in the control group at the same time point(P < 0.05). The SOD of the two groups at T_5 time point was lower than that before treatment, but the SOD of the research group was higher than that of the control group; NSE was higher than before treatment, but lower in the research group than in the control group(P <0.05). The levels of IL-6 and TNF-α at T_5 and T_6 time points in both groups were higher than those at T_1 time point,but the levels of IL-6 and TNF-a in the research group were lower than those in the control group(P < 0.05). There were no significant differences in VAS score and comfort score between the two groups(P > 0.05). Postoperative delirium rating scale score in the research group was lower than that in the control group, and sedation score was higher than that in the control group(P < 0.05). There was no significant difference in the total incidence of adverse reactions between the two groups(P > 0.05). Conclusion The application of transcutaneous acupoint electrical stimulation in LC can maintain hemodynamic stability, improve the level of serum SOD, NSE, IL-6 and TNF-α, without increasing the incidence of adverse reactions, and effectively improve the early recovery quality of patients.
Objective To explore the clinical application of transcutaneous acupoint electrical stimulation in improving the early recovery quality of patients after laparoscopic cholecystectomy(LC). Methods A total of 93 patients with LC admitted to Beijing Traditional Chinese Medicine Hospital Affiliated to Capital Medical University from January 2016 to October 2018 were selected as the study objects. They were divided into control group(46 cases) and research group(47 cases) according to random number table method. The control group was given Dexmedetomidine during LC, and the research group received transcutaneous acupoint electrical stimulation combined with Dexmedetomidine during LC.Heart rate(HR) and mean arterial pressure(MAP) were compared at before anesthesia(T_1), 5 min after intubation(T_2),5 min after establishment of pneumoperitoneum(T_3), 15 min after establishment of pneumoperitoneum(T_4), and 5 min after operation(T_5). The level of interleukin-6(IL-6),tumor necrosis factor-α(TNF-α), neuron specific enolation(NSE) and superoxide dismutase(SOD) at T_1, T_5 and postoperative 1 day(T_6) were compared between the two groups.The postoperative delirium rating scale score, sedation score, visual analogue score(VAS) and comfort score were compared between the two groups. The occurrence of adverse reactions during treatment was recorded. Results The HR and MAP of control group at T_2-T_5 time point were higher than those at T_1 time point(P < 0.05). There was no significant difference in HR and MAP between the time points of T_2-T_5 and T_1 in the research group(P > 0.05). HR and MAP of the research group at T_2-T_5 time points were significantly lower than those in the control group at the same time point(P < 0.05). The SOD of the two groups at T_5 time point was lower than that before treatment, but the SOD of the research group was higher than that of the control group; NSE was higher than before treatment, but lower in the research group than in the control group(P <0.05). The levels of IL-6 and TNF-α at T_5 and T_6 time points in both groups were higher than those at T_1 time point,but the levels of IL-6 and TNF-a in the research group were lower than those in the control group(P < 0.05). There were no significant differences in VAS score and comfort score between the two groups(P > 0.05). Postoperative delirium rating scale score in the research group was lower than that in the control group, and sedation score was higher than that in the control group(P < 0.05). There was no significant difference in the total incidence of adverse reactions between the two groups(P > 0.05). Conclusion The application of transcutaneous acupoint electrical stimulation in LC can maintain hemodynamic stability, improve the level of serum SOD, NSE, IL-6 and TNF-α, without increasing the incidence of adverse reactions, and effectively improve the early recovery quality of patients.
引文
[1]邹卫华.腹腔镜胆囊切除术对老年急性胆囊炎患者治疗的疗效及预后分析[J].肝胆外科杂志,2016,24(6):452-454.
[2]杨军,黄鹏.腹腔镜胆囊切除术治疗高龄急性化脓性胆囊炎临床效果研究[J].肝胆外科杂志,2016,24(6):464-465.
[3]任德旺,梁阔,刘家峰,等.心脏移植患者腹腔镜胆囊切除术1例报告[J].腹腔镜外科杂志,2018,23(11):878-880.
[4]杨晓玲,周述芝.右美托咪定、咪达唑仑对腹腔镜胆囊切除术全麻患者气管插管拔管期心血管应激反应的影响[J].山东医药,2013,53(3):50-52.
[5]范薇,孙勇,张钧,等.右美托咪定对腹腔镜胆囊切除术中CO2气腹不同压力水平下老年患者术后认知功能的影响[J].实用医学杂志,2015,31(21):3577-3580.
[6]唐朝正,李春燕,张晓莉,等.低频经皮穴位电刺激对软瘫期脑卒中患者手和上肢功能的影响[J].中国康复理论与实践,2015,31(3):252-255.
[7]陈金仙,郭迎霞,顾晓霞,等.术前鼻内喷雾右美托咪定对妇科腹腔镜手术患者术前镇静和焦虑情绪的影响[J].广东医学,2013,34(24):3798-3801.
[8]沈健,陈家伟,缪长虹,等.不同剂量右旋美托咪定对术后谵妄和镇痛的影响[J].中国临床医学,2013,20(3):340-342.
[9]严广斌.视觉模拟评分法[J].中华关节外科杂志:电子版,2014,8(2):34.
[10]刘洁.舒适护理在腹腔镜胆囊摘除术中的应用[J].中国现代药物应用,2013,7(9):174-175.
[11]李帅.腹腔镜下胆囊切除术后护理[J].实用临床护理学电子杂志,2018,3(47):80.
[12]马雪,胡占升.腹腔镜胆囊切除术与开腹胆囊切除术治疗老年急性胆囊炎的疗效比较[J].实用医学杂志,2015,31(6):931-933.
[13]王福刚,彭毅,王学然.右美托咪定在肠道手术患者麻醉中的效果及对炎性反应影响[J].临床误诊误治,2018,31(12):27-31.
[14]Coelho JCU,Dalledone GO,Domingos MF,et al.Results of laparoscopic cholecystectomy in the elderly[J].Rev Col Bras Cir,2018,45(5):e2020.
[15]高军龙,李玉兰.浅谈经皮穴位电刺激在围麻醉期的多种作用[J].中国针灸,2015,35(3):269-273.
[16]赵津津,吴敬彰,史双友,等.右美托咪定复合依托咪酯对老年胃肠道疾病手术患者血流动力学稳定性及术后炎症反应的影响[J].广东医学,2016,37(18):2817-2820.
[17]陈瑶,田婧,谢蓓菁,等.经皮穴位电刺激在脑卒中后手功能障碍康复中的应用[J].中国康复医学杂志,2015,30(5):454-457.
[18]刘延莉,王明山,李秋杰,等.经皮穴位电刺激治疗剖宫产产妇恶心呕吐及对血浆5-HT浓度的影响[J].中国针灸,2015,35(10):1039-1043.
[19]彭源,张瑾,苏常春,等.经皮穴位电刺激对脑卒中患者上肢功能及运动诱发电位的影响[J].中国康复医学杂志,2015,30(6):547-550,571.
[20]朱俊超,滕秀飞,杨延超,等.经皮穴位电刺激与右美托咪定对腹腔镜手术患者术后早期认知功能的影响[J]中国医科大学学报,2016,45(4):345-348.
[2]杨军,黄鹏.腹腔镜胆囊切除术治疗高龄急性化脓性胆囊炎临床效果研究[J].肝胆外科杂志,2016,24(6):464-465.
[3]任德旺,梁阔,刘家峰,等.心脏移植患者腹腔镜胆囊切除术1例报告[J].腹腔镜外科杂志,2018,23(11):878-880.
[4]杨晓玲,周述芝.右美托咪定、咪达唑仑对腹腔镜胆囊切除术全麻患者气管插管拔管期心血管应激反应的影响[J].山东医药,2013,53(3):50-52.
[5]范薇,孙勇,张钧,等.右美托咪定对腹腔镜胆囊切除术中CO2气腹不同压力水平下老年患者术后认知功能的影响[J].实用医学杂志,2015,31(21):3577-3580.
[6]唐朝正,李春燕,张晓莉,等.低频经皮穴位电刺激对软瘫期脑卒中患者手和上肢功能的影响[J].中国康复理论与实践,2015,31(3):252-255.
[7]陈金仙,郭迎霞,顾晓霞,等.术前鼻内喷雾右美托咪定对妇科腹腔镜手术患者术前镇静和焦虑情绪的影响[J].广东医学,2013,34(24):3798-3801.
[8]沈健,陈家伟,缪长虹,等.不同剂量右旋美托咪定对术后谵妄和镇痛的影响[J].中国临床医学,2013,20(3):340-342.
[9]严广斌.视觉模拟评分法[J].中华关节外科杂志:电子版,2014,8(2):34.
[10]刘洁.舒适护理在腹腔镜胆囊摘除术中的应用[J].中国现代药物应用,2013,7(9):174-175.
[11]李帅.腹腔镜下胆囊切除术后护理[J].实用临床护理学电子杂志,2018,3(47):80.
[12]马雪,胡占升.腹腔镜胆囊切除术与开腹胆囊切除术治疗老年急性胆囊炎的疗效比较[J].实用医学杂志,2015,31(6):931-933.
[13]王福刚,彭毅,王学然.右美托咪定在肠道手术患者麻醉中的效果及对炎性反应影响[J].临床误诊误治,2018,31(12):27-31.
[14]Coelho JCU,Dalledone GO,Domingos MF,et al.Results of laparoscopic cholecystectomy in the elderly[J].Rev Col Bras Cir,2018,45(5):e2020.
[15]高军龙,李玉兰.浅谈经皮穴位电刺激在围麻醉期的多种作用[J].中国针灸,2015,35(3):269-273.
[16]赵津津,吴敬彰,史双友,等.右美托咪定复合依托咪酯对老年胃肠道疾病手术患者血流动力学稳定性及术后炎症反应的影响[J].广东医学,2016,37(18):2817-2820.
[17]陈瑶,田婧,谢蓓菁,等.经皮穴位电刺激在脑卒中后手功能障碍康复中的应用[J].中国康复医学杂志,2015,30(5):454-457.
[18]刘延莉,王明山,李秋杰,等.经皮穴位电刺激治疗剖宫产产妇恶心呕吐及对血浆5-HT浓度的影响[J].中国针灸,2015,35(10):1039-1043.
[19]彭源,张瑾,苏常春,等.经皮穴位电刺激对脑卒中患者上肢功能及运动诱发电位的影响[J].中国康复医学杂志,2015,30(6):547-550,571.
[20]朱俊超,滕秀飞,杨延超,等.经皮穴位电刺激与右美托咪定对腹腔镜手术患者术后早期认知功能的影响[J]中国医科大学学报,2016,45(4):345-348.