双侧内关穴注射葡萄糖联合低呼气末二氧化碳对宫腹腔镜手术术后恶心呕吐的影响
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R246

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金华市中医药科学技术研究项目(2023KY02)


Effect of Injection with Glucose at Bilateral Neiguan (PC6) Point Combined with Low End Tidal Carbon Dioxide on Postoperative Nausea and Vomiting After Hysteroscopy- Laparoscopy Surgery laparoscopic Surgery in Gynecological Gynecology
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    目的:研究双侧内关穴注射50%葡萄糖注射液联合低呼气末二氧化碳(LEtCO2) 对宫腹腔镜手术 术后恶心呕吐(PONV) 的影响。方法:选取2023年1—4月在浙江大学医学院附属金华医院行宫腹腔镜手术 患者90例,按随机数字表法分为昂丹司琼组、穴位注射组、联合组各30例。昂丹司琼组在手术开始时,予以 一次性静脉注射盐酸昂丹司琼注射液,采用控制性通气模式。穴位注射组予双侧内关穴注射50%葡萄糖注射 液,采用控制性通气模式。联合组予双侧内关穴注射50%葡萄糖注射液联合LEtCO2。比较3组的PONV发生 率、恶心呕吐严重程度及额外止吐药使用情况、脑氧饱和度(rSO2)、视觉模拟评分法(VAS) 评分、住院时 长、首次进食时间、首次排气或排便时间。结果:术后<2 h,联合组PONV 发生率低于昂丹司琼组(P< 0.05)。联合组术后2~4 h、5~24 h的PONV发生率及术后24 h内的额外止吐药使用者占比均低于昂丹司琼 组、穴位注射组(P<0.05)。术后24 h,联合组Ⅰ级、Ⅲ级恶心呕吐患者的占比高于昂丹司琼组、穴位注射 组(P<0.05)。联合组住院时长均短于昂丹司琼组、穴位注射组(P<0.05)。联合组首次进食时间、首次排气 或排便时间均早于昂丹司琼组、穴位注射组(P<0.05)。麻醉气管插管后5 min(T1)、特伦德伦伯卧位复位 前(T2)、恢复截石体位后5 min(T3),3组rSO2均较麻醉实施前(T0) 升高(P<0.05);T2、T3,联合组rSO2 均 低于同期昂丹司琼组及穴位注射组(P<0.05)。术后2 h (T4)、4 h (T5)、12 h (T6)、24 h (T7),3组 VAS评分同期比较,差异均无统计学意义(P>0.05)。结论:双侧内关穴注射葡萄糖联合LEtCO2可减少宫腹腔 镜手术PONV的发生及减轻严重程度,减少PONV对围手术期康复的不利影响。

    Abstract:

    Abstract: Objective: To study the effect of the therapy of injection with 50% glucose at Neiguan (PC6) point combined with low end tidal carbon dioxide (LEtCO2) on postoperative nausea and vomiting (PONV) after gynecological hysteroscopy-laparoscopy. Methods:A total of 90 female patients undergoing hysteroscopy and laparoscopy in Jinhua Central Hospital Affiliated to Zhejiang University School of Medicine from January 2023 to April 2023 were included and divided into the Ondansetron group, the acupoint injection group and the combination group according to the random number table method, with 30 cases in each group. The Ondansetron group was treated with a single intravenous injection of Ondansetron Hydrochloride, and controlled ventilation mode was used at the beginning of surgery. The acupoint injection group was treated with 50% glucose injection at the bilateral Neiguan (PC6) points,and controlled ventilation mode was used. In the combination group, 50% glucose injection at bilateral Neiguan (PC6) points was combined with LEtCO2 for treatment. The incidence of PONV,severity of nausea and vomiting,use of remedial drugs, regional cerebral oxygen saturation (rSO2), Visual Analogue Scale (VAS) scores, total hospitalization time, first feeding time,and first exhaustion or defecation time were compared among the three groups. Results:The incidence of PONV during the first 2 hours in the combination group was lower than that in the Ondansetron group (P<0.05). The incidence of PONV during the 2 to 4 hours,and the 5 to 24 hours after operation and the proportion of patients using additional antiemetic medicines respectively in the combination group were lower than those in the Ondansetron group and the point injection group( P<0.05). The percentage of patients with grade Ⅰand Ⅲ nausea and vomiting during the first 24 hours after operation in the combination group was higher than that in the Ondansetron group and the point injection group (P<0.05). The length of hospital stay in the combination group was shorter than that in the Ondansetron group and the point injection group, respectively (P<0.05). Time of first food intake, and time of first exhaust or defecation in the combination group were earlier than those in the Ondansetron group and the point injection group (P< 0.05). When compared with that before anesthesia implementation (T0), rSO2 levels were increased 5 minutes after intubation during anesthesia (T1),before the return to the Trendellenberg position (T2),and 5 minutes after the return to the lithotomy position (T3) in all three groups (P<0.05); the rSO2 levels at T2 and T3 in the combination group were lower than those in the Ondansetron group and the point injection group during the same period (P < 0.05). At 2 hours (T4),4 hours (T5),12 hours (T6),and 24 hours (T7) after operation,there was no significant difference in VAS scores among the three groups at the same time points (P>0.05). Conclusion:The therapy of injection with 50% glucose at Neiguan( PC6) point combined with LEtCO2 can reduce the incidence and severity of PONV in the early stage of hysteroscopy and laparoscopy and the adverse effects of PONV on perioperative rehabilitation.

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柴华,杜宇龙,崔大伟,金霞云.双侧内关穴注射葡萄糖联合低呼气末二氧化碳对宫腹腔镜手术术后恶心呕吐的影响[J].新中医,2025,57(1):132-136

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  • 在线发布日期: 2025-01-14
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