针刺联合格拉司琼对妇科腹腔镜术后恶心呕吐的临床观察

发布时间：2018-04-11 23:02

本文选题：针刺 + 格拉司琼　；参考：《辽宁中医药大学》2016年硕士论文

【摘要】：目的:探讨针刺穴位联合格拉司琼对于预防和治疗妇科腹腔镜手术患者术后恶心、呕吐发生的疗效。材料与方法:选择美国麻醉医师协会分级(ASA)为I~Ⅱ级择期全身麻醉下行妇科腹腔镜手术的患者60例,随机分为对照组(A组)、格拉司琼组(B组)、针刺联合格拉司琼组(C组)各20例。三组均采用静吸复合全麻,术后患者均行静脉自控镇痛(PCIA)。格拉司琼组手术结束前30min予盐酸格拉司琼注射液3mg静注;针刺联合格拉司琼组术前1h针刺患者双内关穴、足三里穴、三阴交穴,局部常规75%医用酒精消毒后,采用1.5寸无菌毫针直刺进针,针刺得气后留针二十分钟,期间每隔5分钟捻转提插行针,二十分钟后拔出毫针,手术结束前30min予盐酸格拉司琼注射液3mg静注;对照组采用空白对照。术后随访0~2h(T1)、2~6h(T2)、6~12h(T3)、12~24h(T4)、24~48h(T5)各时间段内恶心、呕吐的发生率及程度。结果:三组行腹腔镜手术的患者一般资料差异无统计学意义(P0.05)。格拉司琼组在术后T1、T2、T3、T4、T5各时段的恶心发生率分别为5%、15%、10%、10%、0;针刺联合格拉司琼组在术后T1、T2、T3、T4、T5各时段恶心发生率分别为0%、5%、5%、0、0;对照组在术后T1、T2、T3、T4、T5时段的恶心发生率分别为10%、25%、25%、20%、5%。术后恶心的发生率格拉司琼组(B组)以及针刺联合格拉司琼组(C组)低于对照组(P0.05);术后24h-48h针刺联合格拉司琼组未新增恶心患者,对照组发生5例恶心患者;术后48h内C组发生呕吐1例,B组发生3例,对照组发生8例,C组与A组差异有统计学意义(P0.05)。术后48h内PONV发生程度针刺联合格拉司琼组优于对照组。结论:针刺联合格拉司琼对于存在多种高危因素的妇科腹腔镜手术患者,24h内PONV的发生率可明显减少。
[Abstract]:Objective: to investigate the effect of acupuncture combined with granisetron on the prevention and treatment of postoperative nausea and vomiting in patients undergoing gynecological laparoscopic surgery.Materials and methods: sixty cases of gynecological laparoscopic surgery under selective general anesthesia were selected from 60 patients with ASAA (American Association of Anesthesiologists).They were randomly divided into control group (n = 20), granisetron group (n = 20), granisetron group (n = 20) and acupuncture combined with granisetron group (n = 20).All the three groups were treated with intravenous analgesia combined with general anesthesia.In the granisetron group, 3mg was injected intravenously with granisetron hydrochloride injection before operation, and Shuangneiguan points, Zusanli points, Sanyinjiao points, local routine 75% medical alcohol disinfection in the acupuncture combined with granisetron group 1 hour before operation.The needle was inserted directly into the needle with 1.5-inch sterile filiform needle. The needle was kept for 20 minutes after the needle was punctured. During the period, the needle was twirled and inserted every 5 minutes. After 20 minutes, the needle was pulled out, and 30min was injected intravenously with granisetron hydrochloride injection 3mg before the operation.The control group was treated with blank control.The incidence and degree of nausea and vomiting were observed during the follow up period of 0 ~ 2 h ~ 2 h, T _ 1, T _ 1, T _ 2, T _ 2, T _ 2, T _ 2, T _ 3, T _ 3, T _ 4, T _ 4, T _ 4 and T _ 5, respectively.Results: there was no significant difference in general data among the three groups of patients undergoing laparoscopic surgery (P 0.05).The incidence of postoperative nausea in granisetron group (B group) and acupuncture combined with granisetron group (C group) was lower than that in control group (P 0.05), postoperative 24h-48h acupuncture combined with granisetron group had no new nausea, and there were 5 cases of nausea in control group.Within 48 hours after operation, 1 case of vomiting occurred in group C, 3 cases in group B, and 8 cases in group C in control group. There was significant difference between group C and group A (P 0.05).The incidence of PONV in combination with granisetron group was better than that in control group within 48 hours after operation.Conclusion: Acupuncture combined with granisetron can significantly reduce the incidence of PONV in gynecological laparoscopic surgery patients with multiple high risk factors within 24 hours.
【学位授予单位】：辽宁中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R614

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