经皮穴位电刺激联合羟考酮对妇科腹腔镜手术患者术后恶心呕吐的影响

Effect of transcutaneous electrical acupoint stimulation combined with oxycodone on postoperative nausea and vomiting in patients undergoing gynecologic laparoscopic surgery

中文关键词: 经皮穴位电刺激  羟考酮  术后恶心呕吐  内脏痛  恢复质量

英文关键词: Transcutaneous electrical acupoint stimulation  Oxycodone  Postoperative nausea and vomiting  Visceral pain  Quality of recovery

中文摘要:

      
目的：探讨经皮穴位电刺激（TEAS）联合羟考酮对妇科腹腔镜手术患者术后恶心呕吐（PONV）的影响。
方法：选择择期在全麻下行妇科腹腔镜手术的患者96例，年龄18～64岁，BMI 18.5～30.0 kg/m²，ASA Ⅰ或Ⅱ级。采用随机数表法将患者分为三组：TEAS联合羟考酮组（TO组，n=31）、羟考酮组（O组，n=32）和对照组（C组，n=30）。TO组患者取双侧内关穴、足三里穴、三阴交穴行TEAS，刺激30 min后行麻醉诱导。O组、C组仅在相应穴位上粘贴电极片，但不予刺激。TO组、O组于手术结束前20 min静脉推注羟考酮0.1 mg/kg，C组于相同时点静脉推注等容量生理盐水。记录术后48 h内恶心呕吐发生情况以及追加止吐药的情况。记录术后30 min、6、24、48 h的切口痛和内脏痛VAS评分。记录术后48 h内补救镇痛的情况。记录术前24 h、术后24、48 h QoR-15评分。
结果：与O组比较，TO组术后48 h内PONV发生率明显降低（P＜0.05）。与C组比较，TO组术后6、24 h切口痛、内脏痛VAS评分明显降低（P＜0.05），O组术后24 h切口痛VAS评分明显降低，术后6、24 h内脏痛VAS评分明显降低（P＜0. 05）。与TO组比较，O组和C组术后24 h QoR-15评分明显降低（P＜0.05）。三组术后48 h追加止吐药比例、补救镇痛率差异无统计学意义。
结论：TEAS联合羟考酮可显著降低妇科腹腔镜患者PONV发生率，减轻术后疼痛，提高术后恢复质量。

英文摘要:

      
Objective: To investigate the effect of transcutaneous electrical acupoint stimulation (TEAS) combined with oxycodone on postoperative nausea and vomiting (PONV) in patients undergoing gynecologic laparoscopic surgery.
Methods: Ninety-six patients scheduled for elective gynecologic laparoscopic surgery under general anesthesia, aged 18-64 years, BMI 18.5-30.0 kg/m², ASA physical status Ⅰ or Ⅱ, were randomly divided into three groups: TEAS combined with oxycodone group (group TO, n = 31), oxycodone group (group O, n = 32), and control group (group C, n = 30). In group TO, TEAS was applied to bilateral Neiguan, Zusanli, and Sanyinjiao acupoints for 30 minutes before anesthesia induction. Groups O and C had electrodes placed at the same acupoints without stimulation. Groups TO and O received intravenous oxycodone 0.1 mg/kg 20 minutes before the end of surgery, while group C received an equivalent volume of saline at the same time. The incidence of PONV and rescue antiemetic requirements were recorded within 48 hours postoperatively. Incisional pain and visceral pain VAS scores were assessed 30 minutes, 6, 24, and 48 hours after surgery. Rescue analgesia usage within 48 hours and 15-item quality of recovery (QoR-15) scale 24 hours before surgery and 24, 48 hours after surgery were documented.
Results: Compared with group O, the incidence of PONV within 48 hours after surgery in group TO was significantly reduced (P < 0.05). Compared with group C, incisional pain and visceral pain VAS scores at 6 and 24 hours postoperatively in group TO were significantly decreased (P < 0.05), incisional pain at 24 hours postoperatively in group O was significantly decreased, visceral pain VAS scores at 6 and 24 hours postoperatively was significantly decreased (P < 0.05). Compared with group TO, groups O and C had significantly lower QoR-15 scores 24 hours after surgery (P < 0.05). There were no significant differences in the rates of additional antiemetic use or rescue analgesia among the three groups 48 hours after surgery.
Conclusion: TEAS combined with oxycodone reduces PONV incidence, alleviates postoperative pain, and improves recovery quality in gynecologic laparoscopic patients.