经皮穴位电刺激联合阿扎司琼预防开颅术后患者恶心呕吐的临床研究

目的：探讨经皮穴位电刺激（TAES）联合阿扎司琼对开颅患者术后恶心呕吐（PONV）的预防作用。方法：选取2016年1月至2017年1月在大连市中心医院择期行开颅手术的患者80例，按照随机数字表法随机分为观察组和对照组，每组40例。所有患者均行开颅手术，缝合硬脑膜时给予阿扎司琼，观察组待患者清醒后行TAES，对照组在对应穴位贴电极片，但不给予电流穴位刺激。比较2组患者术后临床疗效、不同时间恶心呕吐严重程度及手术前后血浆胃动素（MTL）水平，记录2组患者术后不良反应发生情况。结果：术后观察组总有效率为90.00%，明显高于对照组的72.50%（P<0.05）。术后2～24 h 2组患者恶心、呕吐评分均逐渐降低，且同一时间点观察组明显低于对照组（P<0.05或P<0.01）。与麻醉前比较，观察组术后12 h及对照组术后12、24 h血浆MTL水平均明显升高，但观察组术后12、24 h血浆MTL水平明显低于对照组（P<0.01）；观察组术后24 h及对照组术后48 h血浆MTL水平均恢复至麻醉前状态（P>0.05）。观察组总不良反应发生率明显低于对照组（P<0.05）。结论：TAES联合阿扎司琼对开颅术患者血浆MTL水平影响较小，可有效降低PONV的发生率，改善恶心、呕吐严重程度，临床疗效优于单独使用阿扎司琼。

Clinical Study of Transcutaneous Acupoint Electrical Stimulation Combined with Azasetron in Preventing Nausea and Vomiting in Patients After Craniotomy

To investigate the preventive effect of percutaneous acupoint electrical stimulation (TAES) combined with azasetron on postoperative nausea and vomiting (PONV) in patients with craniotomy.Methods:A total of 80 patients who underwent craniotomy in Dalian Central Hospital from January 2016 to January 2017 were selected and divided into observation group (n=40) and control group (n=40) according to random number table method.All patients underwent craniotomy,azasetron was given when the dura was sutured.The patients in the observation group were treated with transcutaneous acupoint electrical stimulation (TAES) after waking up,the control group was placed on the corresponding acupuncture points,but no current acupoint stimulation.The clinical efficacy,the degree of severity of nausea and vomiting at different time points and the levels of plasma motilin (MTL) before and after surgery were compared between the 2 groups,the postoperative adverse reactions of the 2 groups were recorded.Results:After surgery,the total efficiency of the observation group was 90.00%,which was significantly higher than 72.50% of the control group (P<0.05).The scores of nausea and vomiting significantly decreased from 2 to 24 hours after surgery in the 2 groups,and the observation group was significantly lower than the control group at the same time (P<0.05 or P<0.01).Compared with pre-anesthesia,the levels of plasma MTL significantly increased in 12 hours after surgery in the observation group and 12 and 24 hours postoperation in the control group,and the levels of plasma MTL 12 and 24 hours postoperation in the observation group was significantly lower than that of the control group (P<0.01); the levels of plasma MTL recovered to the pre-anesthesia state 24 hours postoperation in the observation group and 48 hours postoperation in the control group (P>0.05).The incidence of total adverse reactions in the experiment group was significantly lower than that in the control group (P<0.05).Conclusion:TAES combined with azasetron has little effect on the levels of plasma MTL in patients undergoing craniotomy,it can effectively reduce the incidence of PONV,improve the degree of severity of nausea and vomiting,and the clinical efficacy is better than azasetron alone.