| Objective: To investigate the effect and mechanism of transcutaneous electrical acupoint stimulation(TEAS)pretreatment on the recovery of gastrointestinal function in patients underwent laparoscopic colonic carcinomas operation and to provide a non-drug treatment method for accelerated recovery of patients underwent laparoscopic colonic carcinomas operation,TEAS pretreatment was applied on the patients underwent laparoscopic colonic carcinomas operation.Methods: Sixty patients with elective laparoscopic colon cancer surgery in the First Affiliated Hospital of University of Science and Technology of China were selected.Inclusion criteria:(1)18 to 75 years old,no gender limit;(2)Pathological report diagnosed as intestinal malignant tumor and suitable for laparoscopic colon surgery;(3)18≤ BMI≤ 30;(4)American Society of Anesthesiologists ASA graded Ⅰ-Ⅱ;(5)The patients voluntarily participated in this study and signed an informed consent.Exclusion criteria:(1)those who cannot defecate through the anus due to gastrointestinal surgery fistula;(2)those who have undergone surgery on the meridian line or the selected meridian points have skin infections;(3)implanted in the heart Pacemakers;(4)Those who with upper or lower limb nerve damage;(5)Those who have participated in other clinical trials within the past 4 weeks;(6)Pregnant women,parturients,and those who with positive urine pregnancy test;(7)Long-term history of alcohol abuse,Those who are addicted or dependent on opioids;(8)Those who have had severe central nervous system disease and severe mental illness before the operation;(9)Those who are considered unsuitable to participate in this trial by the investigator.Elimination criteria:(1)Subjects who requested to withdraw during the trial;(2)Those who violated the trial protocol and failed to communicate through communication;(3)Those who had serious adverse events during the trial or the subject died;(4)those who were changed to abdominal surgery.All patients were divided into two groups by random number table methods,30 cases in each group: TEAS group and control group.In the TEAS group,the Neiguan and Zusanli acupoints on one side of the patient were connected to the OMRON therapy apparatus current intensity 3m A(for the patient’s comfort situation).The first two days and the day of the operation were stimulated before the operation.These three electrical stimulations were performed at the same time,at the same acupoint,and with the same current intensity for 30 minutes(3 days before operation at 7:30).Control group: All steps were the same as the TEAS group,but no current flows.After the patient entered the operating room,the peripheral vein was opened,and the compound sodium lactate solution was injected to monitor blood pressure,ECG,and Sp O2.30 minutes after acupoint stimulation,anesthesia induction starts,midazolam injection 0.04mg/kg,sufentanil citrate injection 0.2-0.5μg/kg,etomidate 0.3-0.4mg/kg,rocuronium bromide Injection 0.6-1.0mg/kg.After intubation,the patients were mechanically ventilated to monitor end-tidal CO2.Adjust VT6-8ml/kg,RR10-14 beats/min,I:E is 1:2,maintain end-tidal CO2 at 30-40 mm Hg,and intraoperative blood pressure fluctuations were less than 30% of the preoperative level.Maintenance program: propofol 4-6mg·kg-1·h-1 pump injection,sevoflurane 0.8%-2% inhalation,remifentanil citrate injection 6-10μg·kg-1·h-1 pump Note: Intermittent administration of atracurium cisbesilate to maintain the Narcotrend value 40-60 during the operation.After the operation,the analgesic pump was sent to PACU.The formula of the analgesic pump was Sufentanil 2ug/kg+ Kaifen 2mg/kg+ Ondasetron 16 mg plus normal saline to make 100 ml.The background infusion rate of intravenous analgesia pump was 2m L/h.The first dose is 2ml,and the self-controlled dose is 2ml/time,and the lock time is 30 min.Record the time to pull out the tracheal tube,the time the patient was awake,and the pain score when the patient was awake.Steward score greater than 6 points can be transferred to the ward.After the postoperative VAS score is greater than 4 points,tramadol 50 mg intravenously.Ondansetron intravenous injection 4mg will be given to those patients who experience vomiting in PACU or ward after surgery.Main indicators: Record the preoperative,24 and 48 h serum gastrin G17(gastrin 17 is a gastrointestinal hormone secreted by the antrum of the stomach,which can promote the secretion of gastric acid and the growth of gastrointestinal mucosa,reflecting the stomach Recovery of intestinal function.)Concentration;time of first air exhaust from anus;incidence of nausea and vomiting;time of first meal;time of drainage tube removal and postoperative hospital stay.Secondary indicators: observe and compare the visual analogue score(VAS)at 1h(T1),6h(T2),12h(T3),24h(T4)and 48h(T5)after operation;record intraoperative and postoperative opioid use Dose;urine output;infusion volume;bleeding volume;blood transfusion volume;cumulative PCIA compressions;postoperative pain remedial measures(tramadol 50 mg will be given to those whose VAS score greater than 4 points),etc.Results:(1)The two groups of patients had no statistical significance in indicators such as age,gender,weight,operation time,ASA classification,intraoperative access,drainage tube removal time,and hospital stay.(2)The concentration of gastrin G17(2.6±0.6)pmol/L in the TEAS group at 24 hours after surgery was significantly higher than that of the control group(2.0±0.8)(P<0.05);the concentration of gastrin G17 in the TEAS group at 48 hours after surgery(2.9±0.9)pmol/L was significantly higher than the control group(2.4±0.8)pmol/L(P<0.05),with statisticai significance(See Table 2 and Figure 2).(3)Compared with the control group,the time of the first anal exhaust in the TEAS group(61.8±11.3h)was significantly shorter than that of the control group(71.3±8.9h)(P<0.05).The control group(109.1±16.9h)was significantly shorter than that(P<0.05),with statistical significance(See Table 3 and Figure 3).(4)The incidence of postoperative nausea and vomiting in the TEAS group was significantly lower than the control group(P<0.05).Among them,the number of postoperative nausea and vomiting in the TEAS group was 5 cases,with an incidence rate of 17.9%,while there was 15 cases in the control group,and the incidence rate was 46.9%,with statistical significance(See Table 4).(5)The VAS score(5.8±0.7)of the TEAS group at 1 hour after operation was significantly lower than that of the control group(6.7±0.7);The VAS score(5.4±0.8)of the TEAS group was significantly lower than that of the control group(5.8±0.5)at 6 hours after operation;The VAS score(4.6±0.8)of the TEAS group was significantly lower than that of the control group(5.4±0.7)after 12 hours;There was no significant difference between the VAS score(4.6±0.8)in the TEAS group and the control group(4.8±0.6)at 24 hours after surgery;There was no significant difference in the VAS score(4.1±0.6)of the TEAS group at 48 hours after surgery compared with the control group(4.2±0.5);The number of analgesic pump compressions in the TEAS group within 48 hours after surgery(2.2±0.7)was significantly lower than that of the control group(4.6±0.7)(P<0.05).(See Table 5 and Table 6 and Table 7)Conclusion: Pretreatment with percutaneous electrical stimulation at Neiguan and Zusanli points three days before the surgery can improve the quality of postoperative recovery of patients undergoing laparoscopic colon surgery,including speeding up the recovery of gastrointestinal function,relieving postoperative pain,reducing adverse reactions such as nausea and vomiting,and improving patients’ satisfaction. |
