电针对实施ERAS术前禁食禁饮策略的肝胆手术患者胃排空的影响

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目的:评价电针对实施加速康复外科(ERAS)术前禁食禁饮策略的肝胆手术患者胃排空的影响。方法:选择2019年1月至2020年12月当日第1台择期腹腔镜肝叶或胆囊切除术患者76例,性别不限,年龄18~75岁,BMI 18~25 kg/mn 2,ASA分级Ⅰ或Ⅱ级。采用随机数字表法分为2组(n n=38):对照组(C组)和电针组(EA组)。2组均采用ERAS术前禁食禁饮策略:术前晚20:00后禁固体食物,20:00至22:00服用12.5%术前口服碳水化合物800 ml,术日晨5:30至6:00服用术前口服碳水化合物400 ml。EA组术日晨7:30行电针刺激双侧足三里、中脘、内关、太冲穴;C组采用假穴位电刺激。所有患者8:00行胃窦部超声检查,测量平卧位和右侧卧位横截面积(CSA),计算胃容量(GV)、胃容积/体重比值(GV/W)、右侧卧位CSA/体重比值(CSA/W),进行Perlas A半定量评级。麻醉诱导后采用酶联免疫吸附法测定食管入口处黏液胃蛋白酶水平,记录阳性表达情况。记录患者麻醉诱导期间恶心、呕吐、误吸等不良反应的发生情况。n 结果:与C组比较,EA组平卧位CSA、右侧卧位CSA、GV、CSA/W、GV/W、Perlas A半定量分级和胃蛋白酶阳性率降低,恶心发生率降低(n P<0.05)。n 结论:电针可促进实施ERAS术前禁食禁饮策略的肝胆手术患者胃排空。“,”Objective:To evaluate the effect of electroacupuncture (EA) on gastric emptying in patients undergoing hepatobiliary surgery with preoperative fasting and drinking under the enhanced recover after surgery (ERAS) protocol.Methods:Seventy-six patients of both sexes, aged 18-75 yr, with body mass index of 18-25 kg/mn 2, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, who underwent elective laparoscopic hepatectomy or cholecystectomy from January 2019 to December 2020, were divided into 2 groups (n n=38 each) using a random number table method: control group (group C) and EA group.Both groups used the ERAS strategy of fasting and drinking before operation.Solid food was forbidden after 20: 00 the night before surgery, and 12.5% preoperative oral carbohydrate drinks 800 ml was taken orally from 20: 00 to 22: 00, and preoperative oral carbohydrate drinks 400 ml was taken orally from 5: 30 to 6: 00 on the morning of surgery.The bilateral Zusanli, Zhongwan, Neiguan, and Taichong were stimulated at 7: 30 in group EA, while sham acupoints were stimulated in group C. All the patients underwent ultrasonography of the gastric antrum at 8: 00 for measurement of the cross-sectional area (CSA) in the supine and right lateral decubitus positions (right-lat CSA), gastric volume (GV), ratio of gastric volume to weight (GV/W), and ratio of right-lat CSA to weight (CSA/W) were measured, and Perlas A semi-quantitative grating was performed.After induction of anesthesia, the level of mucous pepsin at the esophageal entrance was quantitatively determined by enzyme-linked immunosorbent assay, and positive expression was recorded.The adverse reactions such as nausea, vomiting and aspiration during induction of anesthesia were recorded.n Results:Compared with group C, the supine CSA, right-lat CSA, GV, right-lat CSA/W, GV/W, Perlas A semi-quantitative grading, positive rate of pepsin and incidence of nausea were significantly decreased in group EA (n P<0.05).n Conclusions:EA can promote gastric emptying in the patients undergoing hepatobiliary surgery with preoperative fasting and drinking under ERAS protocol.
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