Effect Of Acupoint Stimulation Guided By The Concept Of Accelerated Rehabilitation Surgery On The Quality Of Recovery After Gynecological Laparoscopic Surgery

Objective:With the deepening promotion of diagnosis and treatment concepts and models of integrated Chinese and western medicine,TCM has been gradually applied to accelerate the clinical practice of rehabilitation surgery,and has accumulated rich experience.Therefore,this study combined with the acupuncture point stimulation treatment of traditional Chinese medicine,guided by the surgical concept of promoting patients’ rapid recovery,observed the postoperative recovery quality of patients undergoing gynecological laparoscopic surgery after applying acupuncture point stimulation,and provided a more effective clinical reference for the application of acupuncture point stimulation from the three stages of preoperative,intraoperative and postoperative perioperative period.Method:A total of 74 patients who planned to undergo elective gynecological laparoscopic surgery were included in this study.All patients were divided into the stimulation group and the control group according to a computer-generated random sequence,with 37 cases in each group.In the stimulation group,30 min before anesthesia induction,magnetic beads were applied at Shuanger Shenmen point and pressed with thumb and indicator finger(lasting 3 ～ 5min).Percutaneous electrical stimulation with density waves of 2 Hz/100 Hz was performed at both Neiguan(PC6),Zusanli(ST36)and Hegu(LI4)points until the end of anesthesia.The control group pasted the tape without magnetic beads at Shenmen point without pressing;Electrodes were pasted at Neiguan,Zusanli and Hegu points without corresponding stimulation.Visual analog scores of anxiety before anesthesia induction were recorded in both groups.The changes of mean arterial pressure(MAP)and heart rate(HR)before and after intubation,skin resection,pneumoperitoneum establishment 5min and extubation were observed,and were expressed in the form of rate.Blood glucose was measured30 min after peeling.Numerical pain scores(NRS),total number of compressions and effective number of compressions used for postoperative patient-controlled intravenous analgesia(PCIA)were recorded at 2h,6h,12 h,24h and 48 h.The incidence of nausea and vomiting(PONV)was analyzed at 0 ～ 2h,2 ～ 6h,6 ～ 12 h and 12 ～ 24 h after operation.The time from the operation to the recovery of the first bowel sound,anal exhaust and getting out of bed was recorded.The 40-item Recovery Scale score(QoR-40)was recorded 24 hours after surgery to evaluate the postoperative recovery of the two groups.Results:A total of 74 patients were included in this study,with 1 patient excluded from each group.In the end,a total of 72 subjects were enrolled in this study.Compared with the general data of the two groups of experimental patients,the difference showed no statistical significance.The visual analog score of anxiety after stimulation was 2.2±1.0in the stimulation group,which was significantly lower than 3.6±1.5 in the control group(P=0.004).The blood glucose level in the stimulation group was 5.5±0.5mmol/ml at 30 min after peeling,which was significantly lower than that in the control group(5.9±0.4mmol/ml)(P=0.045).The change rate of MAP in the stimulation group was significantly lower than that in the control group(P<0.05).The change rate of HR before and after intubation,pneumoperitoneum establishment and extubation was significantly lower than that of control group(P<0.05).The consumption of remifentanil in the stimulation group was 233.1.3±29.6ug,which was significantly lower than that in the control group(289.5±37.9ug)(P=0.031).At 2h,6h and 12 h after surgery,NRS scores were lower in the stimulation group,with statistical significance(P<0.05),but there was no significant difference between the two groups at 24 h and 48 h after surgery(P>0.05).The total number of PCIA press in the stimulation group was5.3±2.5 times,and the effective number of PCIA press was 5.1±1.3 times,which were significantly lower than 12.6±3.9 times and 6.5±1.7 times in the control group(P<0.05).The total incidence of PONV and the incidence of PONV in all time periods were decreased(P<0.05).After the operation,the recovery time of the first bowel sound,anal exhaust and getting out of bed were significantly advanced(P<0.05).The score of QoR-40 was higher 24 h after surgery(P<0.001).There were no significant differences in the dosage of propofol and sevoflurane,anesthesia time,recovery time and PACU residence time during operation(P>0.05).Conclusion:Acupoint stimulation can reduce preoperative anxiety in gynecological laparoscopic surgery patients,inhibit intraoperative stress response,improve postoperative pain,reduce perioperative opioid consumption,significantly reduce postoperative nausea and vomiting,greatly shorten the time of gastrointestinal function recovery,and improve the quality of postoperative rehabilitation of patients.