Tang Ling,Du Zhen,Zhou Min,et al.Improvements of gastrointestinal function and analgesic outcome after laparoscopy under general anesthesia in children[J].Journal of Clinical Pediatric Surgery,2024,(07):665-671.[doi:10.3760/cma.j.cn101785-202403049-011]
耳穴压豆改善小儿全身麻醉下腹腔镜手术后胃肠道功能及镇痛效果的临床观察
- Title:
- Improvements of gastrointestinal function and analgesic outcome after laparoscopy under general anesthesia in children
- Keywords:
- Pain; Surgical Procedures; Operative; Child
- 摘要:
- 目的 探讨耳穴压豆对小儿全身麻醉下腹腔镜手术后胃肠道功能及镇痛效果的影响。方法 本研究为前瞻性研究,选择2023年10月至2024年2月湖南省儿童医院普外科病房全身麻醉下行腹腔镜手术的60例患儿为研究对象。采用随机数字表法分为耳穴组(O组)及对照组(C组),每组各30例。耳穴组中有1例不配合(术后2 h自行撕脱耳穴贴),另有1例转开腹手术中途剔除;对照组中有1例术后6 h将胶布撕脱,另有1例因术后病情恶化需要转重症监护室,因此每组实际纳入28例。所有患儿术中接受昂丹司琼和地塞米松预防术后恶心、呕吐(postoperative nausea and vomiting,PONV)。O组术前贴压带王不留行籽的耳穴贴,C组术前将0.5 cm×0.5 cm胶布直接固定于双耳相应穴位。记录两组患儿拔气管导管时(t1)、术后0~2 h(t2),术后2~6 h(t3)、术后6~12 h(t4),术后12~24 h(t5)以及术后24~48 h(t6)6个时间段的PONV发生率,恶心、呕吐、干呕分级情况,术后疼痛评分,胃肠功能恢复,不良反应,术后不良事件发生情况及家属满意度。结果 O组和C组恶心呕吐发生率在t1分别为3.6%(1/28)和28.6%(8/28),t2分别为17.9%(5/28)和46.4%(13/28);术后12 h呕吐治疗有效率分别为96.4%(27/28)和78.5%(22/28);两组术后疼痛评分在t1分别为0(0,1)和2(1,3),t2分别为2(1,3)和3(2,3),t3分别为1(0,2)和2(2,2),t4分别为0(0,0)和0(0,1);肛门首次排气时间分别为7(5,8)h和9(8,10)h;术后拔管时间分别为25(20,28)min和28(25,30)min;复苏室停留时间分别为40(31,40)min和48(45,50)min;术后"非常满意"的人数分别为16例(16/28,57.1%)和5例(5/28,17.8%);差异均有统计学意义(P<0.05)。O组和C组恶心呕吐发生人数在t3时间段分别为0例和和5例(5/28,17.8%),术后12 h恶心治疗有效率分别为96.4%(27/28)和82.1%(23/28),干呕治疗有效率分别为96.4%(27/28)和92.8%(26/28),术后总不良反应发生率分别为6(21.4)和9(32.1);上述指标差异均无统计学意义(P>0.05)。两组术后24 h均无一例出现恶心呕吐干呕。结论 耳穴压豆可减轻小儿普外科经腹腔镜手术后胃肠道反应,促进胃肠功能恢复,有效缓解术后疼痛,无明显不良反应,术后不良事件发生率低,且能够获得患儿及家属较高的满意度。
- Abstract:
- Objective To explore the effects of auricular point compression on gastrointestinal function and analgesia after laparoscopy under general anesthesia in children.Methods For this prospective study.60 hospitalized children undergoing laparoscopy under general anesthesia at Department of General Surgery ward were selected as study subjects from October 2023 to February 2024.They were randomized into two groups of aural acupoint compression (O) and control (C) (n=30 each).Ondansetron and dexamethasone were dosed intraoperatively for preventing postoperative nausea and vomiting (PONV).In group O,ear point tape was applied pre-operation.In group C,0.5 cm×0.5 cm tape was directly affixed to bilateral acupoints pre-operation.Time of tracheal catheter withdrawal (t1) and 0-2 h post-operation were recorded.PONV incidence,nausea,vomiting and retching grade,postoperative pain score,gastrointestinal function recovery,adverse reactions,occurrence of adverse events and family satisfaction at 0-2 h (t2),2-6 h (t3),6-12 h (t4),12-24 h (t5) and 24-48 h post-operation (t6).Results The incidence of PONV in groups O and C was 1(3.6) and 8(28.6) at t1 and 5(17.9) and 13(46.4) at t2.Effective rate of anti-vomiting at 12 h post-operation was 96.4%(27/28) and 78.5%(22/28).Postoperative pain score was 0(0,1) and 2(1,3) at t1,2(1,3) and 3(2,3) at t2,1(0,2) and 2(2,2) at t3 and t4 0(0,0) and 0(0,1).Initial anal exhaust time was 7(5,8) and 9(8,10) h and postoperative extubation time 25(20,28) and 28(25,30) min.Duration of resuscitation room was 40(30.5,40) and 48(45,50) min and postoperative satisfaction 16(57.1) and 5(17.8).There was no difference of statistical significance (P<0.05).In groups O and C,the incidence of PONV was 0(0) and 5(17.9) at t3.Effective rates of anti-nausea at 12 h was 96.4%(27/28) and 82.1%(23/28) and effective rates of anti-retching at 12 h post-operation 96.4%(27/28) and 92.8%(26/28).The incidence of postoperative adverse reactions was 6(21.4) and 9(32.1).There was no difference of statistical significance (P>0.05).No nausea,vomiting or retching occurred at 24 h post-operation in neither groups.Conclusions Auricular point compression may alleviate gastrointestinal reactions after laparoscopy,promote the recovery of gastrointestinal function and effectively relieve postoperative pain in children.There are no obvious adverse reactions.With a low incidence of postoperative adverse events,it obtains satisfaction of both children and their families.
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备注/Memo
收稿日期:2024-3-26。
基金项目:湖南省科技厅临床技术创新引导计划项目(2021SK50506);湖南省自然科学基金医卫行业联合基金项目(2024JJ9342)
通讯作者:唐玲,Email:lop3456p@163.com