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| 颊针疗法对老年患者腹腔镜胃癌根治术后镇痛的影响 |
| Effect of buccal acupuncture on postoperative analgesia in elderly patients undergoing laparoscopic radical gastrectomy |
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| DOI：10.12089/jca.2025.01.005 |
| 中文关键词: 颊针 老年 腹腔镜下胃癌根治术 术后镇痛 |
| 英文关键词: Buccal acupuncture Aged Laparoscopic radical gastrectomy Postoperative analgesia |
| 基金项目:南京市江宁区科技惠民计划（2023078S） |
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| 中文摘要: |
目的：观察麻醉诱导前颊针疗法对行腹腔镜胃癌根治术的老年患者术后镇痛效果与安全性的影响。
方法：选择择期行腹腔镜胃癌根治术的老年患者87例，男48例，女39例，年龄65～85岁，BMI 22～30 kg/m2，ASA Ⅱ或Ⅲ级。采用随机数字表法将患者分为两组：颊针组（n=44）和对照组（n=43）。颊针组于麻醉诱导前行颊针疗法，留置30 min；对照组直接进行麻醉诱导。手术结束后行患者自控静脉镇痛，镇痛配方：舒芬太尼2.0 μg/kg、帕洛诺司琼0.25 mg加入生理盐水150 ml，负荷量5 ml，背景量2 ml/h，单次剂量1.5 ml。记录术中丙泊酚、瑞芬太尼和血管活性药物用量、术后苏醒时间、拔管时间和术后住院时间。记录术后2、6、24、48 h静息时VAS疼痛评分。记录术后48 h内镇痛泵总按压次数、有效按压次数、舒芬太尼用量以及术后补救镇痛情况。记录术后48 h术后恶心呕吐（PONV）、嗜睡、呼吸抑制和皮肤瘙痒等不良反应的发生情况。
结果： 与对照组比较，颊针组术中丙泊酚、瑞芬太尼和血管活性药物用量明显减少（P<0.05），术后苏醒时间、拔管时间和术后住院时间明显缩短（P<0.05），术后2、6、24 h的静息时VAS疼痛评分明显降低（P＜0.05），术后48 h内镇痛泵总按压次数、有效按压次数、舒芬太尼使用量、补救镇痛率和PONV发生率明显降低（P＜0.05）。两组术后48 h嗜睡、呼吸抑制和皮肤瘙痒的发生率差异无统计学意义。
结论：在老年患者腹腔镜下胃癌根治术麻醉诱导前行颊针疗法，可以降低术中麻醉药物和血管活性药物的用量，改善术后疼痛，减少术后镇痛药需求以及PONV的发生率，有助于术后康复。 |
| 英文摘要: |
Objective: To investigate the effect of buccal acupuncture before induction anesthesia on postoperative analgesic effect and safety in elderly patients undergoing laparoscopic radical gastrectomy.
Methods: Eighty-seven elderly patients undergoing elective laparoscopic radical gastrectomy were selected, 48 males and 39 females, aged 65-85 years, BMI 22-30 kg/m2, ASA physical status Ⅱ or Ⅲ. All patients were divided into two groups: buccal acupuncture group (n = 44) and control group (n = 43), according to the method of random number table. The buccal acupuncture were adopted before the anesthesia induction in buccal acupuncture group and remained for 30 minutes, while no interventions were administrated in control group. After the surgery, patient-controlled intravenous analgesia was administered to both groups, consisting of sufentanil 2.0 μg/kg and palonosetron 0.25 mg, diluted with 150 ml saline with 5 ml load capacity, 2 ml/h background dose and 1.5 ml bolus. The amount of propofol, remifentanil and vasoactive drugs, time of postoperative awakening, extubation, and hospitalization were recorded. The VAS pain scores at rest were recorded 2, 6, 24, and 48 hours after surgery. The pressing frequency of patient-controlled analgesia (PCA), the pressing frequency of effective PCA, the use of rescue pain relief medication, and the amount of sufentanil used within 48 hours after surgery were also recorded. Adverse reactions, such as postoperative nausea and vomiting (PONV), drowsiness, respiratory depression, and skin itching, were also recorded within 48 hours after surgery.
Results: Compared with control group, the intraoperative usage of propofol, remifentanil and vasoactive drugs were significantly decreased in the buccal acupuncture group (P < 0.05), the time of postoperative awakening, extubation and hospitalization were significantly shorten in the buccal acupuncture group (P < 0.05), VAS pain scores at rest 2, 6 and 24 hours after surgery was significantly decreased in the buccal acupuncture group (P < 0.05), in the pressing frequency of PCA, effective PCA, sufentanil consumption, and rescue analgesia rate and the incidence of PONV within 48 hours after surgery were significantly decreased in the buccal acupuncture group (P < 0.05). There were no significantly differences on the incidence of drowsiness, respiratory depression, and skin itching in two groups.
Conclusion: The utilization of buccal acupuncture laparoscopic radical gastrectomy in elderly patients can effectively decrease the quantity of anesthetic and vasoactive drugs administered during the operation, enhance the efficacy of pain relief after surgery, reduce the requirement for postoperative analgesic medication and the occurrence of postoperative nausea and vomiting. All of these benefits contribute positively to the recovery of patients after surgery. |
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