内关穴电刺激在年龄相关性白内障术中的应用

张李向; 王立芳; 董萍; 李芳

doi:10.16766/j.cnki.issn.1674-4152.003674

内关穴电刺激在年龄相关性白内障术中的应用

doi: 10.16766/j.cnki.issn.1674-4152.003674

张李向¹,
王立芳²,
董萍³,
李芳^2, ,

1.
河北省第一荣军优抚医院综合内科，河北邢台 054000
2.
河北省眼科医院麻醉科，河北邢台 054001
3.
河北省眼科医院针灸康复科

基金项目:

河北省卫生健康委科研基金项目 20191053

河北省中医药管理局科研计划项目 2020554

详细信息

通讯作者:
李芳，E-mail：lifangxt@163.com

中图分类号: R776.1
计量
- 文章访问数: 20
- HTML全文浏览量: 13
- PDF下载量: 2
- 被引次数: 0
出版历程
- 收稿日期: 2024-02-06

The application of electrical stimulation of Neiguan acupoint in age-related cataract surgery

1.
General Internal Medicine Department of the First Rongjun Youfu Hospital in Hebei Province, Xingtai, Hebei 054000, China

摘要

摘要: 目的探讨内关穴电刺激在年龄相关性白内障(ARC)术中的应用效果，为临床防范术后恶心呕吐(PONV)提供更多选择。方法选取2021年8月—2023年10月于河北省眼科医院、河北省第一荣军优抚医院接受超声乳化(Phaco)联合人工晶体植入术(IOL)治疗的ARC患者103例，采用随机数字表法将患者分为试验组(52例)和基线组(51例)。2组均给予丙美卡因表面麻醉，基线组进行常规宣教及药物干预，试验组在基线组的基础上进行内关穴电刺激干预。统计2组术后PONV发生情况，比较2组术后中文版恶心呕吐干呕症状量表(INVR)评分，手术前后眼压、血清胃动素(MTL)、胃泌素(GAS)水平，患者满意度。结果试验组术后6 h内、术后6~24 h恶心发生率及恶心和呕吐的总发生率均低于基线组(P＜0.05)；术后6、24 h试验组眼压均低于基线组(P＜0.05)；术后6、12、24 h试验组INVR评分均低于基线组(P＜0.05)；2组术后12 h MTL、GAS均低于同组术前，但试验组均高于基线组(P＜0.05)；试验组患者满意度(98.08%，51/52)高于基线组(84.31%，43/51，P＜0.05)。结论内关穴电刺激有助于稳定ARC患者的眼压及胃肠功能，降低PONV发生风险，提升患者满意度。
- 年龄相关性白内障 /
- 内关穴电刺激 /
- 术后恶心呕吐 /
- 超声乳化 /
- 人工晶体植入术
Abstract: Objective To explore the application of electrical stimulation on Neiguan acupoint in age-related cataract (ARC) surgery to provide more options for preventing postoperative nausea and vomiting (PONV) in clinical settings. Methods A total of 103 ARC patients who underwent phacoemulsification (Phaco) combined with intraocular lens implantation (IOL) surgery at the Ophthalmology Hospital of Hebei Province and the First Rongjun Youfu Hospital of Hebei Province from August 2021 to October 2023 were selected. The patients were randomly divided into an experimental group (n=52) and a baseline group (n=51) using a random number table method. All patients were given promecaine surface anesthesia, the baseline group received routine education and drug intervention, and the experimental group received the intervention of electrical stimulation of Neiguan acupoint on the basis of the baseline group. The incidence of PONV was analyzed in the two groups. Index of nausea and vomiting and retching (INVR) score, intraocular pressure, levels of serum motilin (MTL) and gastrin (GAS) before and after surgery, and patient satisfaction were compared between the two groups. Results The incidence of nausea and the total incidence of nausea and vomiting in the experimental group were lower than those in the baseline group within 6 hour and 6-24 hour after surgery (P < 0.05). At 6 hours and 24 hours after surgery, the intraocular pressure of the experimental group was lower than that of the baseline group (P < 0.05). The INVR score of the experimental group was found to be significantly lower compared to the baseline group at the 6 hour, 12 hour, and 24 hour time points following the operation (P < 0.05). The levels of MTL and GAS at 12 hour after the operation showed a decrease in both groups compared to pre-operation levels. However, the experimental group exhibited higher levels compared to the baseline group (P < 0.05). The level of satisfaction in the experimental group was 98.08% (51/52), which was significantly higher than the 84.31% (43/51) satisfaction level in the baseline group (P < 0.05). Conclusion The electrical stimulation of Neiguan acupoint can help stabilize intraocular pressure and gastrointestinal function in ARC patients, reduce the risk of PONV occurrence, and improve patient satisfaction.
- Age-related cataract /
- Electrical stimulation of Neiguan acupoint /
- Postoperative nausea and vomiting /
- Phacoemulsification /
- Intraocular lens implantation
利益冲突 无

HTML全文

表 1 2组ARC患者术后不同时间PONV发生情况比较[例(%)]

Table 1. Comparison of postoperative PONV occurrences at different times between the two groups of ARC patients[cases(%)]

组别	例数	术后6 h内		术后6~24 h		术后24~48 h		总发生
组别	例数	恶心	呕吐	恶心	呕吐	恶心	呕吐	恶心	呕吐
试验组	52	2(3.85)	1(1.92)	1(1.92)	0	0	0	3(5.77)	1(1.92)
基线组	51	10(19.61)	4(7.84)	8(15.69)	3(5.88)	1(1.96)	1(1.96)	19(37.25)	8(15.69)
χ²值		4.471	0.882	4.512	1.414			15.196	4.512
P值		0.035	0.348	0.034	0.234	0.495^a	0.495^a	＜0.001	0.034
注：^a为采用Fisher精确检验。1 mmHg=0.133 kPa。

下载: 导出CSV

表 2 2组ARC患者手术前后眼压比较(x±s, mmHg)

Table 2. Comparison of IOP before and after operation between two groups of ARC patients (x±s, mmHg)

组别	例数	术前	术后6 h	术后24 h	术后48 h
试验组	52	16.35±2.43	19.71±1.59^a	17.42±2.03^ab	16.88±2.54
基线组	51	16.18±2.25	20.33±1.46^a	18.35±2.14^ab	17.06±2.37
F值		1.475	19.466	19.823	0.372
P值		0.141	＜0.001	＜0.001	0.711
注：与同组术前比较，^aP＜0.05；与同组术后6 h比较，^bP＜0.05。1 mmHg=0.133 kPa。

下载: 导出CSV

表 3 2组ARC患者术后不同时间INVR评分比较(x±s，分)

Table 3. Comparison of INVR scores between the two groups of ARC patients at different time after surgery(x±s, points)

组别	例数	术后6 h	术后12 h	术后24 h	术后48 h
试验组	52	7.23±2.58	8.35±2.73^a	5.06±2.04^ab	2.50±0.83^abc
基线组	51	8.51±2.66	9.78±2.81^a	6.10±2.11^ab	2.78±0.91^abc
F值		13.489	17.289	15.781	1.291
P值		＜0.001	＜0.001	＜0.001	0.198
注：与同组术后6 h比较，^aP＜0.05；与同组术后12 h比较，^bP＜0.05；与同组术后24 h比较，^cP＜0.05。

下载: 导出CSV

表 4 2组ARC患者手术前后MTL、GAS比较(x±s，ng/L)

Table 4. Comparison of MTL and GAS before and after operation between two groups of ARC patients at different time(x±s, ng/L)

组别	例数	MTL			GAS
组别	例数	术前	术后12 h	术后48 h	术前	术后12 h	术后48 h
试验组	52	256.34±28.31	186.39±22.37^a	251.56±30.27^b	150.64±15.59	119.65±11.36^a	148.32±16.57^b
基线组	51	250.19±32.15	174.88±24.01^a	247.69±27.83^b	146.06±14.53	112.88±12.20^a	144.71±17.28^b
F值		1.689	12.687	1.665	1.792	11.846	1.882
P值		0.092	＜0.001	0.097	0.180	＜0.001	0.174
注：与同组术前比较，^aP＜0.05；与同组术后12 h比较，^bP＜0.05。

下载: 导出CSV

表 5 2组ARC患者总满意度比较[例(%)]

Table 5. Comparison of ARC patients' satisfaction with intervention treatment between the two groups[cases(%)]

组别	例数	非常满意	满意	不满意	总满意度
试验组	52	30(57.69)	21(40.38)	1(1.92)	51(98.08)
基线组	51	20(39.22)	23(45.10)	8(15.69)	43(84.31)
注：2组总满意度比较，χ²=4.512，P=0.034。

下载: 导出CSV

参考文献(20)

[1]	SCHLESINGER T, MEYBOHM P, KRANKE P. Postoperative nausea and vomiting: risk factors, prediction tools, and algorithms[J]. Curr Opin Anaesthesiol, 2023, 36(1): 117-123. doi: 10.1097/ACO.0000000000001220
[2]	RAJAN N, JOSHI G P. Management of postoperative nausea and vomiting in adults: current controversies[J]. Curr Opin Anaesthesiol, 2021, 34(6): 695-702. doi: 10.1097/ACO.0000000000001063
[3]	SCHLESINGER T, WEIBEL S, MEYBOHM P, et al. Drugs in anesthesia: preventing postoperative nausea and vomiting[J]. Curr Opin Anaesthesiol, 2021, 34(4): 421-427. doi: 10.1097/ACO.0000000000001010
[4]	吴新民, 薛张纲, 马虹, 等. 右美托咪定临床应用专家共识(2018)[J]. 临床麻醉学杂志, 2018, 34(8): 820-823. WU X M, XUE Z G, MA H, et al. Expert Consensus on Clinical Application of Dexmedetomidine (2018)[J]. Journal of Clinical Anesthesiology, 2018, 34(8): 820-823.
[5]	邱宇飞, 王建刚, 岳隆基, 等. 经皮穴位电刺激联合托烷司琼、地塞米松预防日间甲状腺切除术后恶心呕吐40例[J]. 安徽医药, 2021, 25(11): 2277-2281. doi: 10.3969/j.issn.1009-6469.2021.11.036 QIU Y F, WANG J G, YUE L J, et al. Transcutaneous acupoint electrical stimulation combined with tropisetron and dexametha-sone to prevent PONV after day thyroidectomy: 40 cases[J]. Anhui Medical and Pharmaceutical Journal, 2021, 25(11): 2277-2281. doi: 10.3969/j.issn.1009-6469.2021.11.036
[6]	周敏, 蔡懿婷, 庞文璟. 穴位贴敷联合经皮穴位电刺激对腹腔镜术后胃肠蠕动功能的影响[J]. 中国医学物理学杂志, 2021, 38(3): 350-354. doi: 10.3969/j.issn.1005-202X.2021.03.016 ZHOU M, CAI Y T, PANG W J. Effects of acupoint application combined with transcutaneous acupoint electrical stimulation on gastrointestinal peristalsis after laparoscopic surgery[J]. Chinese Journal of Medical Physics, 2021, 38(3): 350-354. doi: 10.3969/j.issn.1005-202X.2021.03.016
[7]	张铭连, 王莉菲, 吴彦超, 等. 新编临床眼科学[M]. 北京: 人民卫生出版社, 2019: 189. ZHANG M L, WANG L F, WU Y C, et al. New edition of clinical ophthalmology[M]. Beijing: People's Medical Publishing House, 2019: 189.
[8]	HOU Y, LIANG H, FAN C, et al. Association of intraocular pressure and postoperative nausea and vomiting after microvascular decompression: a prospective cohort study[J]. BMC Anesthesiol, 2022, 22(1): 132. DOI: 10.1186/s12871-022-01665-x.
[9]	XIAO M, YAO D, FIELDS K G, et al. Postoperative and postdischarge nausea and vomiting following ambulatory eye, head, and neck surgeries: a retrospective cohort study comparing incidence and associated factors[J]. Perioper Med(Lond), 2024, 13(1): 3. DOI: 10.1186/s13741-024-00360-4.
[10]	初丽艳, 王月, 王珊珊, 等. 右美托咪定滴鼻对斜视儿童全身麻醉术前焦虑和配合度的影响[J]. 中国医刊, 2021, 56(7): 748-751. doi: 10.3969/j.issn.1008-1070.2021.07.016 CHU L Y, WANG Y, WANG S S, et al. Effect of dexmedetomidine administered intranasally on preoperative anxiety and compliance of children undergoing strabismus surgery by general anesthesia[J]. Chinese Journal of Medicine, 2021, 56(7): 748-751. doi: 10.3969/j.issn.1008-1070.2021.07.016
[11]	刘洋, 吴浩, 谭雷. 内关穴按压联合右美托咪定在预防小儿斜视矫正术后恶心呕吐的临床观察[J]. 中国医药导报, 2022, 19(10): 115-118. LIU Y, WU H, TAN L. Clinical observation of nèiguān point pressing combined with Dexmedetomidine in preventing nausea and vomiting after strabismus correction surgery in children[J]. China Medical Herald, 2022, 19(10): 115-118.
[12]	雷学恒, 施媛, 杨镭镭, 等. 针刺对急性胆囊炎患者腹腔镜切除术后恶心呕吐、胃肠功能的影响[J]. 中国中医急症, 2023, 32(8): 1392-1395. doi: 10.3969/j.issn.1004-745X.2023.08.018 LEI X H, SHI Y, YANG L L, et al. Effect of Acupuncture on PONV and Gastrointestinal Function in Patients with Acute Cholecystitis after Laparoscopic Cholecystectomy[J]. Journal of Emergency in Traditional Chinese Medicine, 2023, 32(8): 1392-1395. doi: 10.3969/j.issn.1004-745X.2023.08.018
[13]	刘洋, 吴浩, 谭雷. 内关穴按压联合右美托咪定在预防小儿斜视矫正术后恶心呕吐的临床观察[J]. 中国医药导报, 2022, 19(10): 115-118. LIU Y, WU H, TAN L. Clinical observation of nèiguān point pressing combined with Dexmedetomidine in preventing nausea and vomiting after strabismus correction surgery in children[J]. China Medical Herald, 2022, 19(10): 115-118.
[14]	郑栋煜, 龚明, 李永华. 国产穿戴式经皮穴位电刺激手环预防航海晕船反应的效果[J]. 海军军医大学学报, 2023, 44(6): 749-753. ZHENG D Y, GONG M, LI Y H. Effects of a domestic wearable transcutaneous acupoint electrical stimulation bracelet on preventing seasickness[J]. Academic Journal of Naval Medical University, 2023, 44(6): 749-753.
[15]	王烨, 冯晓, 康春博, 等. 经皮穴位电刺激装置对腹部手术患者胃肠道功能康复的作用研究[J]. 中国医学装备, 2023, 20(11): 103-107. doi: 10.3969/J.ISSN.1672-8270.2023.11.023 WANG Y, FENG X, KANG C B, et al. Study on the effect of transcutaneous acupoint electrical stimulation device on the rehabilitation of gastrointestinal function of patients undergoing abdominal surgery[J]. China Medical Equipment, 2023, 20(11): 103-107. doi: 10.3969/J.ISSN.1672-8270.2023.11.023
[16]	展立芬, 邢博文, 覃思敏, 等. 电针内关、公孙穴对功能性消化不良大鼠胃肠动力和心率变异性的影响[J]. 河北中医, 2022, 44(7): 1153-1158. doi: 10.3969/j.issn.1002-2619.2022.07.022 ZHAN L F, XING B W, QIN S M, et al. Effects of double acupoints electroacupuncture for gastrointestinal motility and heart rate variability of functional dyspepsia rats[J]. Hebei Journal of Traditional Chinese Medicine, 2022, 44(7): 1153-1158. doi: 10.3969/j.issn.1002-2619.2022.07.022
[17]	郜宗斌, 杨光, 施舟, 等. 阿芬太尼对腰-硬联合麻醉剖宫产术中牵拉痛及寒战的影响[J]. 中华全科医学, 2023, 21(11): 1865-1867, 1887. doi: 10.16766/j.cnki.issn.1674-4152.003244 GAO Z B, YANG G, SHI Z, et al. Effects of alfentanil on traction pain and shivering during combined spina-epidural anesthesial for cesarean section[J]. Chinese Journal of General Practice, 2023, 21(11): 1865-1867, 1887 doi: 10.16766/j.cnki.issn.1674-4152.003244
[18]	LIU L, YUAN X, YANG L, et al. Effect of acupuncture on hormone level in patients with gastrointestinal dysfunction after general anesthesia: a study protocol for a randomized controlled trial[J]. Medicine(Baltimore), 2020, 99(14): e19610-e19618.
[19]	吴文春, 董敏, 陈莹昊, 等. 姜辣素穴位敷贴对全麻患者术后恶心呕吐的作用及机制[J]. 贵州医科大学学报, 2023, 48(11): 1406-1410, 1416. WU W C, DONG M, CHEN Y H, et al. Effect of gingerol acupoint application on postoperative nausea and vomiting in patients with general anesthesia and its mechanism[J]. Journal of Guizhou Medical University, 2023, 48(11): 1406-1410, 1416.
[20]	牛晓丽, 杨毅猛, 蒋文军, 等. 帕洛诺司琼静脉注射联合地塞米松足三里穴位注射预防术后恶心呕吐的效果[J]. 临床麻醉学杂志, 2020, 36(8): 737-740. NIU X L, YANG Y M, JIANG W J, et al. Effect of palonosetron intravenous injection combined with dexamethasone Zusanli acupoint injection on preventing postoperative nausea and vomiting[J]. Journal of Clinical Anesthesiology, 2020, 36(8): 737-740.