| With the improvement of medical standards,the population of gynecological laparoscopic patients is increasing obviously,female patients undergoing gynecological laparoscopic surgery were popular.Relevant studies have shown that female and age <50 years are the most reliable specific predictors of postoperative nausea and vomiting.General anesthesia requires large doses of anesthetics and opioid analgesics to maintain anesthesia,so the adverse reactions of nausea and vomiting caused by anesthetics cannot be ignored;laparoscopic pneumoperitoneum and the operation itself can aggravate the chance of nausea and vomiting.Clinical practice and related studies have shown that the application of electrical acupuncture stimulation can reduce the incidence of postoperative nausea and vomiting in patients undergoing endoscopic gastrointestinal surgery and patients undergoing thoracic surgery.This study intends to conduct such related research on young women,a special population.To evaluate the effect of perioperative application of electroacupuncture on postoperative nausea and vomiting under the concept of accelerated rehabilitation surgery.Objective: Based on ERAS theory,to study the effect of acupoint electroacupuncture stimulation on postoperative nausea and vomiting in gynecological endoscopic surgery.Methods: 90 young female patients who underwent endoscopic gynecologic surgery,18-50 years old,BMI<30kg/m2,ASA Ⅰ-Ⅱ,were randomly divided into three groups.Exclusion criteria: Severe organic heart disease;severe liver and kidney dysfunction;previous motion sickness or a history of postoperative nausea and vomiting,previous digestive tract disease or gastrointestinal surgery;electroacupuncture operating near the broken skin or allergies;unable to communicate with each other like deaf-mute or mental disorder;intraoperative change operation patients;intraoperative severe complications,such as intraoperative bleeding and hemodynamic instability;pneumothorax,etc.Those patients was randomly divided into three groups: group A(pre-treatment group)(n=30): bilateral Zusanli and bilateral Neiguan acupoints were electrically stimulated 30 minutes before surgery for 30 minutes,and 0.25 mg palonosetron hydrochloride was intravenously dripping after surgery;Group B(post-treatment group)(n=30):0.25 mg palonosetron hydrochloride was intravenously dropped before the end of surgery.bilateral Zusanli and bilateral Neiguan acupoints were electrically stimulated for 30 minutes after surgery immediately;Group C(control group)(n=30): Palonosetron hydrochloride 0.25 mg was given intravenously before surgery and electroacupuncture stimulation was not performed.Before the operation,fasting for 6-8h and 2h forbidden to drink.Establish a venous fluid circuit in the ward and place a venous indwelling needle.After entering the room,electrocardiogram(ECG),blood oxygen saturation(Sp O2),non-invasive blood pressure,EEG Bispectral Index(BIS),and body temperature are monitored.Group A(pretreatment group): Electrical acupuncture stimulation of the Zusanli and Neiguan points on both sides for 30 minutes before the operation,after which the acupuncture needles were removed,and palonosetron hydrochloride 0.25 mg was injected intravenously after the operation;Group B(post-treatment group): After the operation,intravenous infusion of Palonosetron hydrochloride 0.25 mg immediately after the operation.the bilateral Zusanli and bilateral Neiguan points were stimulated with electrical acupuncture for 30 minutes,and then the acupuncture needles were removed;Group C(control group): Palonosetron hydrochloride 0.25 mg was injected intravenously after the operation,without electroacupuncture stimulation at acupoints.Induction of anesthesia,0.5mg penehyclidine hydrochloride are injected,dexmedetomidine hydrochloride are pumped with speed of 0.4μg/kg/min,midazolam0.03-0.05mg/kg,2-2.5mg/kg propofol,0.2mg/kg cis Atracurium besilate and 0.3-0.5μg/kg sufentanil were given endotracheal intubation.Anesthesia is maintained by 0.6MAC sevoflurane inhalation,propofol3-6mg/kg/h,remifentanil 0.1-0.3μg/kg/min,intermittently supplemented with cis-atracurium besylate to maintain muscle relaxation.Adjust the depth of anesthesia according to the monitoring indicators.Intraoperative BIS>60,a single dose of propofol 0.5mg/kg;when BIS<40,adjust the dosage of propofol and sevoflurane.Give atropine 0.5mg when the heart rate is slower than 50 beats/min.Give rapid rehydration and ephedrine boost when the blood pressure is lower than 30% of the base value.When the peak airway pressure is higher than 30 cm H2O,reduce the tidal volume to 5ml/kg and increase the respiratory rate 2 Times/min.If the intraoperative bleeding exceeds 400 ml,check the arterial blood gas,and inject blood products and supplement electrolytes as needed to maintain a stable internal environment.Use warming blankets,liquid warmers and other measures to actively keep warm.Use warming blankets,liquid warmers and other measures to actively keep warm.Sufentanil 0.1μg/kg and dezocine 0.1mg/kg were given 20 minutes before the operation to relieve the postoperative pain of the patient.The incidence and severity of PONV at the time points of 0-2h,2-6h,6-24 h,and 24-48 h after the operation were recorded and observed,and the time of first exhaust after operation and whether antiemetic drμgs were applied were recorded.Result:1.There was no statistically significant difference in the general data(age,weight,length of operation,intraoperative opioid dosage)between the three groups of patients(P>0.05).2.There was no statistically significant difference in MAP and HR between the three groups of patients at each time point(P>0.05).3.Comparison of the number and incidence of PONV among the three groups of patients:Within 2 hours,the incidence of PONV in group A was significantly lower than that in groups B and C(P<0.05).There was no significant difference in the incidence of PONV among the three groups in the rest of the time period(P>0.05).There was no difference between the two groups B and C(P>0.05).There was no significant difference in the incidence of PONV between group A and group B and C within 24 hours(P>0.05)(Table 4).There was no significant difference in the incidence of PONV among the three groups of patients within 24-48 hours(P>0.05).4.Comparison of the severity of PONV classification in the three groups of patients:Within 0-2h,the severity of postoperative PONV in group A was significantly lower than that in group B and group C(P<0.05),and there was no significant difference in the other comparisons(P>0.05).5.Comparison of the first exhaust time of the three groups of patients:Compared with group B and group C,the time of first exhaust after operation was significantly shorter in group A(P<0.05),and there was no statistical significance in group B and group C(P>0.05).6.Comparison of postoperative antiemetic drμgs in the three groups of patients:Compared with group B and group C,the proportion of postoperative antiemetic drμgs in group A was significantly lower(P<0.05),and group B was not statistically significant compared with group C(P>0.05).7.Comparison of adverse reactions of antiemetic drμgs:There was no statistically significant comparison of antiemetic complications such as dizziness,headache and drowsiness among the three groups of patients(P>0.05).Conclusion: Preoperative application of electric acupuncture to stimulate the bilateral Zusanli and Neiguan points combined with Palonosetron can significantly reduce the incidence and severity of postoperative nausea and vomiting at age <50 gynecologic laparoscopic surgery 0-2h postoperatively,and shorten the time of first exhaust after surgery.Reducing the application of antiemetic drμgs is conducive to the implementation of ERAS. |
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