Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China.
Department of Anesthesiology, Beijing Hui-Min Hospital, Beijing 100053, China.
J Integr Med. 2021 May;19(3):211-218. doi: 10.1016/j.joim.2021.01.005. Epub 2021 Jan 13.
Postoperative gastrointestinal dysfunction (PGD) is one of the most common complications in patients undergoing major abdominal surgery. Acupuncture has been used widely in gastrointestinal diseases due to its effectiveness and minimally invasive nature.
This study evaluated the efficacy of using transcutaneous electrical acupoint stimulation (TEAS) during the surgery and postoperative recovery in patients with gastric and colorectal surgery for improving postoperative gastrointestinal function.
DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS: A total of 280 patients undergoing abdominal surgery were stratified by type of surgery (i.e., gastric or colorectal surgery) and randomly allocated into the TEAS group (group T) or the sham group (group S). Patients in group T received TEAS at LI4, PC6, ST36 and ST37. Patients in group S received pseudo-TEAS at sham acupoints. The stimulation was given from 30 min before anesthesia until the end of surgery. The same treatment was performed at 9 am on the 1st, 2nd and 3rd days after surgery, until the recovery of flatus in patients.
The primary outcome was the time to the first bowel motion, as detected by auscultation. The secondary outcomes included the first flatus and ambulation time, changes of perioperative substance P (SP), incidence of PGD, postoperative pain, postoperative nausea and vomiting (PONV) and some economic indicators.
The time to first bowel motion, first flatus and first ambulation in group T was much shorter than that in group S (P < 0.01). In patients undergoing colorectal surgery, the concentration of SP was lower in group T than in group S on the third day after the operation (P < 0.05). The average incidence of PGD in all patients was 25%, and the frequency of PGD was significantly lower in group T than in group S (18.6% vs. 31.4%, respectively; P < 0.05). TEAS treatment (odds ratio = 0.498; 95% confidence interval: 0.232-0.786) and type of surgery were relevant factors for the development of PGD. Postoperative pain score and PONV occurrence were significantly lower in group T (P < 0.01). Postoperative hospitalization days and the resulting cost to patients were greatly reduced in the TEAS group (P < 0.01).
Perioperative TEAS was able to promote the recovery of postoperative gastrointestinal function, reduce the incidence of PGD and PONV. The concentration of SP was decreased by TEAS treatment, which indicates that the brain-gut axis may play a role in how TEAS regulates gastrointestinal function.
Chinese Clinical Trial Registry, ChiCTR1900023263.
术后胃肠功能障碍（PGD）是腹部大手术后患者最常见的并发症之一。由于其有效性和微创性，针灸在胃肠道疾病中得到了广泛应用。
本研究评估了在胃和结直肠手术后，术中及术后使用经皮穴位电刺激（TEAS）对改善术后胃肠功能的效果。
设计、地点、参与者和干预措施：将 280 名接受腹部手术的患者按手术类型（胃或结直肠手术）分层，并随机分为 TEAS 组（组 T）或假刺激组（组 S）。组 T 患者在 LI4、PC6、ST36 和 ST37 接受 TEAS。组 S 患者在假穴位接受伪 TEAS。刺激从麻醉前 30 分钟开始，持续到手术结束。术后第 1、2 和 3 天的 9 点，在患者排气前，给予相同的治疗。
主要观察指标为肠鸣音首次出现的时间。次要观察指标包括首次排气、首次活动时间、围手术期 P 物质（SP）的变化、PGD 的发生率、术后疼痛、术后恶心呕吐（PONV）和一些经济指标。
组 T 的首次排便、首次排气和首次活动时间明显短于组 S（P < 0.01）。在接受结直肠手术的患者中，术后第 3 天，组 T 的 SP 浓度低于组 S（P < 0.05）。所有患者的 PGD 总发生率为 25%，组 T 的 PGD 发生率明显低于组 S（18.6%比 31.4%；P < 0.05）。TEAS 治疗（比值比=0.498；95%置信区间：0.232-0.786）和手术类型是 PGD 发生的相关因素。组 T 的术后疼痛评分和 PONV 发生率明显低于组 S（P < 0.01）。TEAS 组患者的术后住院天数和医疗费用明显减少（P < 0.01）。
围手术期 TEAS 能促进术后胃肠功能恢复，降低 PGD 和 PONV 的发生率。TEAS 治疗可降低 SP 浓度，提示脑-肠轴可能在 TEAS 调节胃肠功能中发挥作用。
中国临床试验注册中心，ChiCTR1900023263。
