微创医学

目的探讨揿针联合耳穴贴压治疗对胸腰椎后路内固定术后患者恶心呕吐（PONV）及胃肠激素水平的影响。方法选取90例胸腰椎后路内固定术后患者为研究对象，将其随机分为揿针组、耳穴组、揿针+耳穴组，每组30例。术后30 min，给予揿针组患者双侧足三里、内关揿针埋针；给予耳穴组患者单耳埋豆，耳豆采用王不留行籽贴；给予揿针+耳穴组患者双侧足三里、内关揿针埋针，同时采用单耳埋豆。比较3组患者术后0～4 h、5～12 h及13～24 h PONV的视觉模拟量表（VAS）评分，术前、术后血清胃动素（MTL）、胃泌素（GAS）和血管活性肠肽（VIP）水平及术后3 d不良反应发生情况。结果术后0～4 h、5～12 h及13～24 h，揿针+耳穴组患者PONV的VAS评分均低于揿针组和耳穴组患者（均P<0.05）。术后各组患者血清MTL、GAS和VIP水平均较术前明显改善，且揿针+耳穴组患者较揿针组和耳穴组改善更明显，差异均有统计学意义（均P<0.05）。术后各组患者取穴部位不良反应的发生率差异无统计学意义（P>0.05）。结论揿针联合耳穴贴压应用于胸腰椎后路术后患者，可明显减轻患者术后发生PONV的严重程度，改善血清MTL、GAS和VIP的分泌水平，有利于患者术后恢复，值得临床推广。

Objective To explore the effect of press-needle combined with auricular point sticking on postoperative nausea and vomiting (PONV), and gastrointestinal hormone level in patients after thoracolumbar posterior internal fixation. Methods A total of 90 cases with thoracolumbar posterior internal fixation were selected as research objects and randomly divided into press-needle group, auricular point group, press-needle + auricular point group, with 30 cases in each group. Thirty minutes after operation, patients in the press-needle group were treated with press-needle embedding at bilateral Zusanli and Neiguan; patients in the auricular point group were given single ear bean embedding, by using cowherb seed as the ear bean; patients in the press-needle + auricular point group were treated with press-needle embedding at bilateral Zusanli and Neiguan, while single ear bean embedding was used at the same time. The Visual Analogue Scale (VAS) scores of PONV at 0-4 h, 5-12 h and 13-24 h after operation, the levels of serum motilin (MTL), gastrin (GAS) and vasoactive intestinal peptide (VIP) before and after operation, and the occurrence of adverse reactions at 3 days after operation were compared among the three groups. Results The VAS scores of PONV in the press-needle + auricular point group were lower than those in the press-needle group and the auricular point group at 0-4 h, 5-12 h and 13-24 h after operation (all P<0.05). After operation, the serum MTL, GAS and VIP levels of patients in each group were significantly improved as compared with those before operation, and the improvement was more obvious in the press-needle + auricular point group than in the press-needle group and auricular point group, with statistically significant differences (all P<0.05). There was no statistically significant difference in the incidence of adverse reactions at location of point selection among all groups (P>0.05). Conclusion The application of press-needle combined with auricular point sticking in patients with thoracolumbar posterior surgery can obviously alleviate the severity of postoperative PONV, improve the secretion level of MTL, GAS and VIP, and is beneficial to the recovery of patients after operation, and worthy of clinical promotion.