仿生物电刺激对腹腔镜子宫肌瘤剔除术后胃肠功能恢复的影响

Effects of biomimetic electrical stimulation on gastrointestinal function recovery after laparoscopic myomectomy

摘要

目的 探讨仿生物电刺激对腹腔镜子宫肌瘤剔除术(LM)后胃肠功能恢复的影响。方法 采用临床随机对照试验研究方法,选取2021年5月至2022年11月于十堰市太和医院妇科诊断为子宫肌瘤的68患者为研究对象,随机分为对照组[加速康复外科(ERAS)术后护理]、电刺激组(ERAS术后护理加用仿生物电刺激治疗)各34例。结果 两组患者一般资料、术中情况差异均无统计学意义(P＞0.05);与对照组相比,电刺激组术后肠鸣音恢复时间、首次排气时间、首次排便时间均较短,差异有统计学意义(χ²/t/Z值分别为12.845、-5.841、-4.893,P＜0.05);电刺激组腹胀评分低于对照组,差异有统计学意义(Z＝-3.121,P＜0.05);两组恶心呕吐评分差异无统计学意义(P＞0.05);电刺激组术后第2天视觉模拟评分(VAS)低于对照组,差异有统计学意义(Z＝-6.151,P＜0.05),但两组患者术后第1天及第3天疼痛评分无明显差异(P＞0.05);两组患者术后拔除尿管、腹腔引流管时间差异均无统计学意义(P＞0.05);研究期间两组患者均未发生严重不良反应。结论 仿生物电刺激治疗对LM后胃肠功能的早期恢复有促进作用.

Abstract

Objective To explore effect of biomimetic electrical stimulation on recovery of gastrointestinal function of patients following laparoscopic myomectomy (LM). Methods In clinical randomized controlled trial research method, 68 patients who were diagnosed as hysteromyoma in Department of Gynecology of Shiyan Taihe Hospital from May 2021 to November 2022 were selected as study subjects, and were randomly divided into control group [enhanced recovery after surgery (ERAS) postoperative care group, n=34] and electrical stimulation group (ERAS postoperative care plus biomimetic electrical stimulation treatment group, n=34). Results There were no statistically significant differences in general information and intraoperative conditions between the two groups (all P＞0.05). Compared with the control group, the postoperative recovery time of bowel sounds, the first postoperative exhaust time, and the first postoperative defecation time of the patients in the electrical stimulation group were all shorter, and the differences were statistically significant (χ²/t/Z=12.845, -5.841 and -4.893 respectively, all P＜0.05). The bloating score of the patients in the electrical stimulation group was lower than that in the control group, and the difference was statistically significant (Z=-3.121, P＜0.05). There were no statistically significant differences in nausea and vomiting scores between the two groups (both P＞0.05). The visual analogue scale (VAS) of the patients in the electrical stimulation group was lower than that in the control group at the 2nd day after operation, and the difference was statistically significant (Z=-6.151, P＜0.05), however, there was no statistically significant difference in pain scores of the patients in the 1st and 3rd days after operation between the two groups (both P＞0.05). There were no significant differences in the urinary catheter removing time and abdominal drainage tube removing time between the two groups (both P＞0.05). No serious adverse reactions occurred in the two groups during the study period. Conclusion Biomimetic electrical stimulation therapy promotes early recovery of gastrointestinal function after LM.

关键词

仿生物电刺激 / 腹腔镜子宫肌瘤剔除术 / 胃肠功能 / 加速康复外科

Key words

biomimetic electrical stimulation / laparoscopic myomectomy / gastrointestinal function / enhanced recovery after surgery

参考文献

[1] Yang Q, Ciebiera M, Bariani M V, et al. Comprehensive review of uterine fibroids: developmental origin, pathogenesis and treatment[J]. Endocr Rev, 2022, 43(4): 678-719.

[2] Rodriguez-Triana V M, Kwan L, Kelly M, et al. Quality of life after laparoscopic and open abdominal myomectomy[J]. J Minim Invasive Gynecol, 2021, 28(4): 817-823.

[3] Mazzotta E, Villalobos-Hernandez E C, Fiorda-Diaz J, et al. Postoperative ileus and postoperative gastrointestinal tract dysfunction: pathogenic mechanisms and novel treatment strategies beyond colorectal enhanced recovery after surgery protocols[J]. Front Pharmacol, 2020, 11: 583422.

[4] Kehlet H. Enhanced postoperative recovery: good from afar, but far from good?[J]. Anaesthesia, 2020, 75(S1): e54-e61.

[5] Wang H, Bhavsar M, Han Z, et al. Effects of electrical stimulation on stem cells[J]. Curr Stem Cell Res Ther, 2020, 15(5): 441-448.

[6] Gan T J, Belani K G, Bergese S, et al. Fourth consensus guidelines for the management of postoperative nausea and vomiting[J]. Anesth Analg, 2020, 131: 411-448.

[7] Wells C I, Milne T, Seo S, et al. Post-operative ileus: definitions, mechanisms and controversies[J]. ANZ J Surg, 2022, 92(1-2): 62-68.

[8] 中华医学会妇产科学分会加速康复外科协作组. 妇科手术加速康复的中国专家共识[J]. 中华妇产科杂志, 2019, 54(2): 73-79.

[9] 李杨, 陈冬梅, 荣慧. “益气通腑汤”治疗妇科腹腔镜术后气虚血瘀型胃肠功能障碍40例临床研究[J]. 江苏中医药, 2022, 54(10): 45-48.

[10] 陈浩然, 方霜霜, 林新锋. 足三里穴位注射治疗术后胃肠功能障碍疗效与安全性的Meta分析[J]. 广州中医药大学学报, 2022, 39(10): 2450-2458.

[11] Miller S, Peters K, Ptok M. Review of the effectiveness of neuromuscular electrical stimulation in the treatment of dysphagia-an update[J]. Ger Med Sci, 2022, 20: Doc08.

[12] Foong D, Zhou J, Zarrouk A, et al. Understanding the Biology of Human Interstitial Cells of Cajal in Gastrointestinal Motility[J]. Int J Mol Sci, 2020, 21(12): 4540.

[13] 曹玲丽, 冯丽嫦, 黄兰英. 仿生物电刺激对妇科恶性肿瘤患者术后肠功能恢复的影响[J]. 世界临床医学, 2017, 11(23): 98-99.

[14] Robinson A J, Snyder-Mackler L. Clinical electrophysiology: electrotherapy and electrophysiologic testing 3rd ed.[M]. Baltimore: Lippincott Williams and Wilkins, 2008: 151.

[15] Balas S, Yilmaz K B, Tokgöz S, et al. Effects of transcutaneous electrical nerve stimulation on rats with postoperative ileus[J]. Ulus Travma Acil Cerrahi Derg, 2022, 28(10): 1382-1388.

[16] Stakenborg N, Wolthuis A M, Gomez-Pinilla P J, et al. Abdominal vagus nerve stimulation as a new therapeutic approach to prevent postoperative ileus[J]. Neurogastroenterol Motil, 2017, 29(9): e13075- e13075.

[17] Zhang S, Guo W, Jiao Y, et al. Systematic review and meta-analysis of the effect of transcutaneous electrical acupoint stimulation on gastrointestinal function after laparoscopic surgery[J]. Ann Palliat Med, 2021, 10(11): 11840-11848.

[18] Wang D, Shi H, Yang Z, et al. Efficacy and safety of transcutaneous electrical acupoint stimulation for postoperative pain: a meta-analysis of randomized controlled trials[J]. Pain Res Manag, 2022, 2022: 7570533.

基金资助

湖北省卫生健康委员会科研项目(WJ2019F056)