腹腔鏡手術病患接受內關穴位注射可控制早期術後噁心嘔吐

Acupuncture Injections Have Early Effect in Controlling Postoperative Nausea and Vomiting of Patients Receiving Pneumoperitoneal Laparoscopic Surgery

背景及目的：針灸目前已被證實對於懷孕、化學治療及手術後造成的噁心嘔吐有效果﹔對於接受腹腔鏡手術病人來說，噁心嘔吐一直是術後的主要問題之一。術後噁心嘔吐是造成延遲離開恢復室及病患滿意度降低的原因。本實驗目的在探討內開穴位注射對接受腹腔鏡手術病患是否有控制術後噁心嘔吐的效果：並且比較內開穴位注射不同物質的反應。研究設計：選擇150位接受腹腔鏡手術病患，隨機分成5組：1.控制N組（Cn）在雙側非內開穴位注射生理食鹽水1毫升、2.控制L組（Cl）在雙側非內開穴位注射1%lidocaine1毫升、3.實驗N組（En）在雙側內開穴位注射生理食鹽水1毫升、4.實驗L組﹝El）及5.參照組(Rf)。在雙側內開穴位注射1%lidoc也1el毫升。術後採雙官方式，由另一位不知分組的觀察者追蹤24小時內噁心嘔吐的發生率。實驗結果：五組患者的基本資料並沒有統計上差異，術後噁心嘔吐的發生率在參照組、控制N組、控制L組、實驗N組及實驗L組分別為41%（12／30）、36%（11／30）、43%（13／30）、27%（8β0）及33%（10／30），結果顯示實驗N組在術後噁心嘔吐發生率比參照組及控制N、L組有統計上意義地降低、但實驗L組與參照組及控制N、L組之間並沒有統計上的意義差異。研究結論：內開穴位注射生理食鹽水是控制術後早期噁心嘔吐另一種替代、經濟的方式﹔而局部麻醉劑（1%lidocaine）則發現會阻斷此效果。顯示內開穴位的誘發可能與納離子通道有所關連。

Acupuncture is generally accepted that there is clear evidence that acupuncture can be effective for nausea and vomiting associated with pregnancy, chemotherapy, and the postoperative period. Postoperative Nausea and Vomiting(PONV) is one of the dominant postoperative problems of pneumonperitoneal laparoscopic surgery which incidence was reported as high as 45%. Postoperative nausea and vomiting (PONV) is an important cause of delayed discharge from the recovery room and decreased patient satisfaction. Our study is designed to investigate whether P6 acupoint injections is effective as a preventive treatment for postoperative nausea and vomiting of adults receiving laparoscopic pneumonperitoneal surgery. We also examine the response between different sorts of injection agents. We collected 150 patients was randomly divided into 5 groups: (1) Control N group (Cn), bilateral P6 sham point injections with normal saline lml; (2) Control L group (Cl), bilateral P6 sham point injections with 1 % lidocaine lml; (3) Experiment N group (En), bilateral P6 acupoint injection with normal saline lml; (4) Experiment L group(El), bilateral P6 acupoint injection with 1 % lidocaine lml. (5) Reference(Rf), no acupoint injection used. We applied double-blinded method to follow up the events of postoperative nausea and vomiting which were recorded by another observer unknown about 5 groups for 24 hours. Incidence of PONV among Rf, Cn, Cl, En, El were 41 %(12/30), 36%(11/30), 43%(13/30), 27%(8/30) and 33%(10/30). En group was found with significant difference in decreased incidence of PONV compared with other groups. But, no significant difference between El group and other three groups(Rf, Cn and Cl).In conclusion: P6 acupoint injections with normal saline may be an alternative, economic method to prevent early postoperative nausea and vomiting. 1 %Lidocaine can block early antiemetic effect of P6 acupoint.