Department of Anesthesia and Perioperative Medicine, Division of Pediatric Anesthesia, Oregon Health & Science University, Portland, Oregon.
Spectrum Research, Inc, Tacoma, Washington.
Acta Anaesthesiol Scand. 2019 Mar;63(3):292-297. doi: 10.1111/aas.13288. Epub 2018 Nov 6.
Postoperative nausea and vomiting (PONV) is common after tonsillectomy in children. There is evidence that perioperative acupuncture at the pericardium 6 (P6) point is effective for preventing PONV in adults. Our goal was to determine if intraoperative acupuncture at the P6 point, in addition to usual antiemetics, is more effective than antiemetics alone in preventing PONV in children.
In a randomized double-blind trial, 161 children age 3 through 9 years undergoing tonsillectomy with or without adenoidectomy were randomized to either bilateral acupuncture at P6 plus antiemetics (n = 86) or antiemetics only (n = 75). All participants received ondansetron 0.15 mg/kg and dexamethasone 0.25 mg/kg, up to 10 mg. The presence of nausea, retching, emesis and administration of additional antiemetics were recorded during phases I and II of PACU recovery. Follow-up calls occurred on postoperative day 1 (POD 1).
During phase I and II recovery, the incidence of PONV was significantly less with acupuncture than without (7.0% vs 34.7%, RR: 0.2, 95% CI: 0.09-0.46; P < 0.001). The difference in PONV was driven by less nausea in the acupuncture group (5.0% vs 24.0%), with no difference in vomiting between the two groups. In the first 24 hours, PONV occurred in 36.1% with acupuncture and 49.3% without; these values did not differ significantly (P = 0.09).
Children receiving acupuncture plus antiemetic therapy had less risk of developing nausea during phase I and II recovery, but there was no difference in PONV on POD 1. Acupuncture may reduce nausea in the PACU, even when combined with antiemetics.
扁桃体切除术后儿童常发生术后恶心和呕吐（PONV）。有证据表明，围手术期针刺心包经 6 穴（P6）对预防成人 PONV 有效。我们的目标是确定在常规止吐药物治疗的基础上加用术中 P6 点针刺是否比单独使用止吐药物更能有效预防儿童 PONV。
在一项随机双盲试验中，161 名年龄在 3 至 9 岁之间接受扁桃体切除术和/或腺样体切除术的儿童被随机分为双侧 P6 针刺加止吐药组（n=86）或仅用止吐药组（n=75）。所有患者均接受昂丹司琼 0.15mg/kg 和地塞米松 0.25mg/kg，最大剂量为 10mg。在 PACU 恢复的 I 期和 II 期记录恶心、呕吐、呕吐的发生情况和额外使用止吐药物的情况。术后第 1 天（POD 1）进行随访。
在 I 期和 II 期恢复期间，针刺组的 PONV 发生率明显低于无针刺组（7.0% vs 34.7%，RR：0.2，95%CI：0.09-0.46；P<0.001）。针刺组 PONV 发生率较低主要是由于恶心发生率较低（5.0% vs 24.0%），两组呕吐发生率无差异。在 24 小时内，针刺组有 36.1%的患者发生 PONV，无针刺组有 49.3%的患者发生 PONV；两组差异无统计学意义（P=0.09）。
接受针刺加止吐药物治疗的儿童在 I 期和 II 期恢复期间发生恶心的风险较低，但在 POD 1 时 PONV 发生率无差异。针刺结合止吐药物治疗可能会减少 PACU 中的恶心，即使在使用止吐药物的情况下也是如此。
