吕建琴;冯睿智;潘慧;李宁;
Lü Jian-qin,FENG Rui-zhi,PAN Hui,LI Ning(Department of Integrated Chinese and Western Medicine,West China Hospital of Sichuan University,Chengdu 610041,China)

• 1:四川大学华西医院中西医结合科

摘要(Abstract)：

目的:探讨针刺内关穴对开颅术后恶心呕吐的预防与治疗作用。方法:将60例拟行择期开颅手术的患者随机分为针刺组30例及对照组30例。针刺组在由手术间转至苏醒室后,即刻针刺内关穴,留针20min后起针,其间行针1次。观察两组患者术后2、6、24h发生事实呕吐的人数,比较两组恶心程度评分。结果:针刺组各时段术后呕吐发生人数及恶心程度评分均较对照组低(P<0.05)。结论:针刺内关穴对开颅术后恶心呕吐具有预防与治疗作用。
Objective To observe whether acupuncture stimulation of Neiguan(PC 6) can prevent postoperative nausea and vomiting(PONV) in patients undergoing craniotomy.Methods A total of 60 patients scheduled for craniotomy were randomly assigned to acupuncture group(n=30) and control group(n=30).When regaining consciousness from the surgical anesthesia,patients of the acupuncture group received immediate acupuncture stimulation of bilateral Neiguan(PC 6).After insertion,the filiform needles were manipulated with uniform reinforcing-reducing method for about 1 min(re-manipulated once again 10 min later),followed by retaining it for 20 min.Patients of the control group received no treatment.Vomiting or retching(having vomitus) was considered as an emetic episode.Nausea was assessed by a four-point verbal rating scale(none,mild,moderate,severe).Results Following the treatment,in the acupuncture group,1 patient had a vomiting from 0 to 2 h,and 1 patient had a vomiting from 2 to 6 h after the operation,and no patients had this symptom 6 h after the operation.While in the control group,the vomiting occurred in 11 patients from 0 to 2 h,8 cases from 2 to 6 h,and other 8 cases from 6 to 24 h after the operation.Comparison between two groups showed that the nausea scores in the 3 time-stages were significantly lower in the acupuncture group than in the control group(P<0.05).Conclusion Acupuncture stimulation of PC 6 is effective in preventing and treating PONV in patients undergonig craniotomy.

关键词(KeyWords)： 针刺疗法;开颅术;恶心呕吐;内关;随机对照临床研究
Acupuncture therapy;Craniotomy;Nausea and vomiting;Neiguan(P 6);Randomized controlled cli-nical trial

Abstract:

Keywords:

基金项目(Foundation):

作者(Authors): 吕建琴;冯睿智;潘慧;李宁;
Lü Jian-qin,FENG Rui-zhi,PAN Hui,LI Ning(Department of Integrated Chinese and Western Medicine,West China Hospital of Sichuan University,Chengdu 610041,China)

DOI: 10.13702/j.1000-0607.2013.03.012

参考文献(References)：

• [1]暨玲,叶百亮,屠金夫,等.内关穴位按摩预防胆囊切除术后疼痛及恶心呕吐[J].浙江中医药大学学报,2010,34(5):745-746.Ji L,Ye B L,Tu J F,et al.Neiguan massaged to prevent acheand nausea and vomit after laparoscopic cholecystectomy—arandomized controlled clinical trial[J].Zhejiang Zhong Yi YaoDa Xue Xue Bao(J Zhejiang Univ Trad Chin Med,Chin),2010,34(5):745-746.
• [2]欧阳铭文,秦再生,林春水,等.针刺对腹腔镜术后恶心、呕吐的预防作用[J].中国针灸,2009,29(11):915-918.Ouyang M W,Qin Z S,Lin C S,et al.Prophylactic effect ofacupuncture on nausea and vomiting after laparoscopic opera-tion[J].Zhongguo Zhen Jiu(Chin Acu-moxi,Chin),2009,29(11):915-918.
• [3]郑冬明,邹建玲,张海峰.针灸预防围手术期恶心呕吐[J].浙江中西医结合杂志,2003,13(7):453.Zheng D M,Zou J L,Zhang H F.Acupuncture preventionpostoperative nausea and vomiting[J].Zhejiang Zhong Xi YiJie He Za Zhi(Zhejiang J Integr Trad Chin Med,Chin),2003,13(7):453.
• [4]冯璐,王君.针药结合治疗术后恶心呕吐疗效观察[J].天津中医药,2008,25(2):108-110.Feng L,Wang J.Clinical observation on treating postoperativenausea and vomiting with integrating of acupuncture and medi-cine[J].Tianjin Zhong Yi Yao(Tianjin J Trad Chin Med,Chin),2008,25(2):108-110.
• [5]Habib A S,Gan T J.Evidence-based management of posto-perative nausea and vomiting:a review[J].Can J Anaesth,2004,51(4):326-341.
• [6]张学中,谭学瑞,潘红星.临床试验所需样本量之管见[J].世界华人消化杂志,2006,14(14):1339-1340.Zhang X Z,Tan X R,Pan H X.Clinical trial have need ofsample size and mistakes[J].Shi Jie Hua Ren Xiao Hua Za Zhi(World Chin J Digest,Chin),2006,14(14):1339-1340.
• [7]Streitberger K,Diefenbacher M,Bauer A,et al.Acupuncturecompared to placebo-acupuncture for postoperative nausea andvomiting prophylaxis:a randomised placebo-controlled patientand observer blind trial[J].Anaesthesia,2004,59(2):142-149.
• [8]兰培丽,裴凌.9136例PACU患者术后并发症的发生原因及分析[J].中国医科大学学报,2011,40(4):349-351.Lan P L,Pei L.Causes of postoperative complications of 9136patients in the post-anaesthesia care unit[J].Zhongguo Yi KeDa Xue Xue Bao(J Chin Med Univ,Chin),2011,40(4):349-351.
• [9]陈光强,王谦,郑一.神经外科开颅术后患者呕吐及预防用药的临床回顾[J].中国医院用药评价与分析,2009,9(5):375-376.Chen G Q,Wang Q,Zheng Y.Preventive medication for pos-toperative vomiting in patients undergoing neurosurgery cra-niotomy:a retrospect study[J].Zhongguo Yi Yuan Yong YaoPing Jia Yu Fen Xi(Evaluat Anal Drug-use Hospital Chin,Chin),2009,9(5):375-376.
• [10]Gan T J,Meyer T,Apfel C C,et al.Consensus guidelinesfor managing postoperative nausea and vomiting[J].AnesthAnalg,2003,97(1):62-71.
• [11]Fabling J M,Gan T J,El-Moalem H E,et al.A rando-mized,double-blinded comparison of ondansetron,droperi-dol,and placebo for prevention of postoperative nausea andvomiting after supratentorial craniotomy[J].Anesth Analg,2000,91(2):358-361.
• [12]李学斌,王会文,张雪梅,等.颅脑手术麻醉后恢复室常见并发症[J].中国康复理论与实践,2010,16(5):489-491.Li X B,Wang H W,Zhang X M,et al.Postoperative compli-cations after intracranial neurosurgery in the postanesthesiacare unit[J].Zhongguo Kang Fu Li Lun Yu Shi Jian(Chin JRehabil Theory Pract,Chin),2010,16(5):489-491.
• [13]Kim Y H,Kim K S,Lee H J,et al.The efficacy of severalneuromuscular monitoring modes at the P 6acupuncture pointin preventing postoperative nausea and vomiting[J].AnesthAnalg,2011,112(4):819-823.
• [14]Wang S M,Kain Z N.P 6acupoint injections are as effectiveas droperidol in controlling early postoperative nausea andvomiting in children[J].Anesthesiology,2002,97(2):359-366.
• [15]White P F,O’Hara J F,Roberson C R,et al.ASPAN’S evi-dence-based clinical practice guideline for the prevention and/or management of PONV/PDNV[J].J Perianesth Nurs,2006,21(4):230-250.
• [16]Streitberger K,Ezzo J,Schneider A.Acupuncture for nauseaand vomiting:an update of clinical and experimental studies[J].Auton Neurosci,2006,129(1/2):107-117.
• [17]Butkovic D,Toljan S,Matolic M,et al.Comparison of laseracupuncture and metoclopramide in PONV prevention in chil-dren[J].Paediatr Anaesth,2005,15(1):37-40.
• [18]Xu M,Zhou S J,Jiang C C,et al.The effects of P 6electri-cal acustimulation on postoperative nausea and vomiting in pa-tients after infratentorial craniotomy[J].J Neurosurg Ane-sthesiol,2012,24(4):312-316.