The Effects Of Different Time Points Electrical Stimulation On Stressresponse And Postoperative Nausea And Vomiting In Patients With Joint Replacement Surgery

Objective: To investigate the effects of different time points electrical stimulation on stress response and postoperative nausea and vomiting in patients with joint replacement surgery.Methods: A total of 100 patients with knee or hip replacement surgery were selected.According to the random number table method,the patients were divided into 5 groups,namely blank control group(A group),conventional drug group(group B),preoperative TEAS group(group C),TEAS group(group D),postoperative TEAS group(E group),20 cases in each group.In a group of patients during perioperative period do not accept other drugs and teas intervention;in group B,30 min prior to surgery,intravenous injection of 3 mg granisetron granisetron;group C in 30 minutes before the induction of anesthesia for teas intervention;group D in the skin incision accept teas intervention;Group E at the end of surgery to accept teas intervention.Neiguan,Hegu,Gou points,Quchi,Zusanli,Sanyinjiao and acupoint selection,through low-frequency electronic pulse therapeutic instrument electrical stimulation,waveform for dilatational wave,sparse wave and dense wave respectively 3 Hz,20 Hz,the peak current of 15 to 30 Ma,electrical stimulation time for 30 minutes.Comparison of patients in each group(T0),cut skin after 30 min(T1),sewing leather finished(T2),postoperative 24h(T3)four time points of mean arterial pressure(MAP),heart rate(HR),cardiac output(CO),Peripheral vascular resistance(SVR),blood flow acceleration index(ACI)changes and serum gas,CORT,blood glucose changes.3 ml venous blood collected at various time points,sent to the laboratory for serum gas,CORT,blood glucose determination of gas using ELISA determination of CORT by electrochemical luminescence method for the determination of and glucose by full automatic biochemical analyzer measured.The incidence and degree of 2h,2-6h,6-12 h,12-24 h time of nausea and vomiting were observed in each group.Results: the level of serum gas in group C in T1,T2 and T3 compared with t0 decreased significantly,the difference is statistically significant(P < 0.05);in other four groups,the serum gastrin level in T2 and T3 compared with t0 gradually increased(P < 0.05);at T2 and T3,the level of serum gas in group C were higher than the other four groups at the same time point were decreased,the difference is statistically significant(P < 0.05).The blood glucose levels in the 5 groups at T1,T2,T3 were gradually increased compared with T0(P<0.05);the average blood glucose level of C group was higher than the other 4 groups at the same time,the difference was statistically significant(P<0.05).In group A,group B,group D,E serum CORT levels in T1,T2 and T3 compared with t0 increased significantly,at T3 reached peak(P < 0.05);group C patients serum CORT levels T2 and T3 compared with t0 increased significantly(P < 0.05),T3 and t0 no statistical difference(P > 0.05).In the C group,the serum CORT levels in T1,T2 and T3 were significantly lower than that in group B,group A,group D and group E at the same time point(P<0.05).A group,B group,D group,E group of patients with T1 in MAP,T2,T3 was significantly higher than T0(P<0.05);C group of patients with T1 in T2,MAP was significantly higher than T0(P<0.05).The C group in T1,T2,MAP,T3 compared with A group,B group at the same time point significantly reduced(P<0.05);in T1,T3,MAP compared with D group,E group of the same time points significantly reduced(P<0.05).A group,B group,D group,E group of patients with T1 in HP,T2,T3 was significantly higher than T0(P<0.05);C group of patients with T1 in HP,T2,T3 was significantly higher than T0(P<0.05).The C group in T1,T2,HP,T3 compared with A group,B group at the same time point significantly reduced(P<0.05);in HP,T3 compared with D group,E group of the same time points significantly reduced(P<0.05).A group,B group,D group,E group of patients with T1 in CO,T2,T3 was significantly lower than T0(P<0.05);C group of patients with T1 in T2,CO was significantly lower than T0(P<0.05),T3 and T0 compared with no statistical difference between.C group in T1,T2,CO T3 compared with A group,B group at the same time points significantly increased(P<0.05);in CO,T3 compared with D group,E group was significantly higher(P<0.05)at the same time point.In group B,group C patients after < 2h,2-6h,6-12 hours,12-24 hours,operation within 24 hours of nausea and vomiting occurred rate had no significant difference(P > 0.05);two groups of patients with postoperative < 2h,postoperative nausea and vomiting within 24 h occurrence rate was significantly lower than that of group a,group B,group C and group D(P < 0.05).There was no significant difference in incidence of postoperative nausea and vomiting(P>0.05)in 2-6h,6-12 h and 12-24 h after operation.There was no significant difference in the degree of postoperative nausea and vomiting(P>0.05).Conclusion:(1)preoperative TEAS can effectively reduce the level of blood CORT,MAP and HR in patients with joint replacement,reduce the degree of CO reduction,and make it as soon as possible after the recovery,reduce the incidence of complications.The effect of TEAS intervention time on the prevention of stress response is also different,the effect of preoperative TEAS is better than that of the skin and the end of the operation.(2)the influence of different time on TEAS in the perioperative period of GAS was different.Preoperative TEAS could reduce the blood GAS,the TEAS level had little effect on the GAS level,and the changes of GAS were closely related to postoperative nausea and vomiting.(3)preoperative TEAS can reduce the incidence of postoperative nausea and vomiting in patients with joint replacement,and the effect of conventional drug prevention is close to,the reason may be related to the decrease of postoperative blood GAS.