合谷穴和内关穴经皮穴位电刺激对甲状腺腺叶切除术后咽喉痛的防治作用

发布时间：2018-04-28 15:22

本文选题：经皮穴位电刺激 + 甲状腺腺叶切除术　；参考：《浙江大学》2016年硕士论文

【摘要】：目的：探讨合谷穴和内关穴经皮穴位电刺激(TEAS)防治甲状腺腺叶切除术后咽喉痛(POST)的临床疗效。方法：将美国麻醉医师协会(ASA)病情分级Ⅰ～Ⅱ级、择期甲状腺腺叶切除的120例患者纳入本研究中,采用随机数表法分为对照组和TEAS组(各60例)。两组患者均选择气管插管全身麻醉,其中TEAS组患者麻醉诱导前30min至术毕加用合谷穴和内关穴经皮穴位电刺激进行干预(2～100Hz的疏密波、电流强度介于8-12mA),对照组也以相同的装置在患者的双侧合谷穴和内关穴但并不做电刺激,分别记录两组患者术中瑞芬太尼使用量,拔管后1、6、12、24h各时点POST发生率、严重程度及疼痛视觉模拟评分(VAS),术后24h内恶心呕吐(PONV)发生率、严重程度,以及手术切口VAS评分。结果：TEAS组术中瑞芬太尼使用量为601.4±143.8μg,对照组术中瑞芬太尼使用量为803.5±190.8μg,两组间的差异具有统计学意义(P0.05)；TEAS组24h内POST发生率为21.4%,显著低于对照组的40.7%,差异具有统计学意义(P0.05)；TEAS组拔管后1、6、12、24h各时点POST发生率分别为10.71%、21.43%、17.86%、14.29%,均显著低于相应时间点对照组POST发生率(分别为25.93%、40.74%、35.19%、31.48%),差异具有统计学意义(P0.05)；拔管后1、6、12、24h各时点POST的严重程度相比,TEAS组低于对照组,差异具有统计学意义(P0.05)；拔管后1、6、12h POST的VAS评分,TEAS组低于对照组(P0.05),拔管后24h POST的VAS评分,两组差异并无统计学意义(P0.05)；TEAS组术后24h内PONV发生率为12.5%,显著低于对照组的27.78%(P0.05),且TEAS组PONV严重程度低于对照组(P0.05)；TEAS组术后24h手术切口VAS评分为2.1±0.3,低于对照组的2.3±0.5,差异具有统计学意义(P0.05)。结论：甲状腺腺叶切除术中进行合谷穴和内关穴经皮穴位电刺激干预,可有效降低POST发生率及严重程度,此外,该方法可加强镇痛效应以及更有效预防PONV发生。
[Abstract]:Objective: to investigate the clinical effect of Hegu and Neiguan acupoints on prevention and treatment of laryngalgia after thyroidectomy. Methods: 120 patients with selective thyroidectomy were divided into two groups: control group and TEAS group (n = 60 each), which were divided into two groups: control group (n = 60) and TEAS group (n = 60), which were divided into two groups: control group (n = 60) and TEAS group (n = 60). The patients in TEAS group were treated with Hegu point and Neiguan acupoint electric stimulation before anesthesia induction. The electric current intensity ranged from 8 to 12 mAg. The control group was also treated with the same device at the bilateral Hegu and Neiguan points without electrical stimulation. The amount of remifentanil used during the operation and the incidence of POST at each time point of 1 612h 24 hours after extubation were recorded respectively in the two groups. The severity and pain visual analogue score (VAS), the incidence of nausea and vomiting within 24 hours after operation, the severity, and the surgical incision VAS score. Results the dosage of remifentanil during operation was 601.4 卤143.8 渭 g in the 1: TEAS group and 803.5 卤190.8 渭 g in the control group. There was a significant difference between the two groups in the incidence of POST in 24 hours, which was significantly lower than that in the control group (40.7 渭 g). The incidence of POST at each time point was 10.71and 21.430.4317.86and 14.29, respectively, which was significantly lower than that in the control group at the corresponding time points (25.930.7445.195.The difference was statistically significant (P0.05A); the severity of POST in the tea group was lower than that in the control group at 24 hours after extubation (P 0.05), and the severity of POST in the tea group was lower than that in the control group at 24 hours after extubation (P < 0.05), and the severity of POST in the tea group was significantly lower than that in the control group at 24 h after extubation (P < 0.05), which was significantly lower than that in the control group (P < 0.05). The difference was statistically significant (P 0.05), the VAS score of POST was lower in the tea group than that in the control group at 1: 6 and 12 h after extubation, and the VAS score of the POST at 24 hours after extubation was lower in the tea group than in the control group. There was no significant difference between the two groups in the incidence of PONV within 24 hours after operation in the P0.05TEAS group, which was significantly lower than that in the control group (27.78g / P 0.05), and the severity of PONV in the TEAS group was lower than that in the control group (2.1 卤0.3) and in the control group (2.1 卤0.3), which was significantly lower than that in the control group (2.3 卤0.5). Conclusion: electric stimulation at Hegu point and Neiguan point during thyroidectomy can effectively reduce the incidence and severity of POST. In addition, this method can enhance the analgesic effect and prevent the occurrence of PONV.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R614

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