管俊杰;张亮;孟箭;
GUAN Jun-jie;ZHANG Liang;MENG Jian;Xuzhou Central Hospital;

• 1:徐州市中心医院

摘要(Abstract)：

加速康复外科(ERAS)以循证医学证据为基础,优化治疗措施,符合人体在围手术期的应激代谢改变,可降低机体应激反应,达到加速康复的目的。围手术期针刺治疗能缓解患者术前焦虑,缩短术前禁食时间,减少麻醉药物用量,保护器官功能,减轻术后疼痛,减少术后恶心呕吐,加快术后康复。针刺的加入能为ERAS理念的建设提供新方法、新思路。但现阶段,针刺在ERAS中的应用存在缺乏整体性考量和标准化不足等问题。
The concept of enhanced recovery after surgery(ERAS) is based on evidence-based medicine. By optimizing the treatment measures, the stress response of the body is reduced to meet the body's metabolic changes during the perioperative period, so as to achieve the purpose of accelerating recovery. In the perioperative period, acupuncture can relieve patients' preoperative anxiety, shorten fasting time, reduce the amount of anesthetics, protect organ function, reduce postoperative pain, reduce postoperative nausea and vomiting, and speed up postoperative recovery. The addition of acupuncture intervention in ERAS would provide new methods and new ideas for the construction of ERAS. But at present, the application of acupuncture in ERAS has problems such as lacking of overall consideration and insufficient standardization, etc.

关键词(KeyWords)： 加速康复外科;针刺;经皮穴位电刺激;针刺麻醉
Enhanced recovery after surgery;Acupuncture;Transcutaneous electrical acupoint stimulation;Acupuncture anesthesia

Abstract:

Keywords:

基金项目(Foundation): 江苏省卫生计生委科研资助项目(No.H2017080);; 徐州市医学创新(技术攻关)团队项目(No.XWCX201604);; 徐州市科技局重点研发项目(No.KC17196)

作者(Author): 管俊杰;张亮;孟箭;
GUAN Jun-jie;ZHANG Liang;MENG Jian;Xuzhou Central Hospital;

Email:

DOI: 10.13702/j.1000-0607.200423

参考文献(References)：

• [1] KEHLET H.Multimodal approach to control postoperative pathophysiology and rehabilitation[J].Br J Anaesth,1997,78(5):606-617.
• [2] 江志伟，李宁，黎介寿.快速康复外科的概念及临床意义[J].中国实用外科杂志，2007,27(2):131-133.
• [3] 陈凛，陈亚进，董海龙，等.加速康复外科中国专家共识及路径管理指南(2018版)[J].中国实用外科杂志，2018,38(1):1-20.
• [4] 中国加速康复外科专家组.中国加速康复外科围手术期管理专家共识(2016)[J].中华外科杂志，2016,54(6):413-418.
• [5] 中国研究型医院学会肝胆胰外科专业委员会.肝胆胰外科术后加速康复专家共识(2015版)[J].中华消化外科杂志，2016,15(1):1-6.
• [6] 中华医学会肠外肠内营养学分会加速康复外科协作组.结直肠手术应用加速康复外科中国专家共识(2015版)[J].中华消化外科杂志，2015,14(8):606-608.
• [7] GAULTON T G,WUNSCH H,GASKINS L J,et al.Preoperative sedative-hypnotic medication use and adverse postoperative outcomes[J].Ann Surg,2019.doi:10.1097/SLA.0000000000003556.
• [8] STAMENKOVIC D M,RANCIC N K,LATAS M B,et al.Preoperative anxiety and implications on postoperative reco-very:what can we do to change our history?[J].Minerva Anestesiol,2018,84(11):1307-1317.
• [9] 张云霄，李宗超，陈冀衡，等.术前焦虑对胸腔镜肺癌根治术后患者早期预后的影响[J].中国肺癌杂志，2019,22(11):714-718.
• [10] WILES M D,MAMDANI J,PULLMAN M,et al.A randomised controlled trial examining the effect of acupuncture at the EX-HN3 (Yintang) point on pre-operative anxiety levels in neurosurgical patients[J].Anaesthesia,2017,72(3):335-342.
• [11] BRADY M,KINN S,STUART P.Preoperative fasting for adults to prevent perioperative complications[J].Cochrane Database Syst Rev,2003(4):D4423.
• [12] 莫云长，张安琪，郑波，等.经皮穴位电刺激对手术患者胃排空的影响[J].中国针灸，2017,37(12):1261-1264.
• [13] 严洁，常小荣，臧敬跃，等.针刺足阳明经不同部位腧穴对人体胃窦容积变化的动态观察[J].针刺研究，1995,20(1):60-65.
• [14] 任彬彬，余芝，徐斌.针刺对胃肠运动双向调节作用概述[J].中国针灸，2012,32(8):765-768.
• [15] 周嘉.针刺麻醉临床实践60年历程回顾[J].针刺研究，2018,43(10):607-610.
• [16] JIN L,WU J S,CHEN G B,et al.Unforgettable ups and downs of acupuncture anesthesia in China[J].World Neurosurgery,2017,102:623-631.
• [17] 韩济生.针刺麻醉向何处去?由针刺麻醉(AA)到针刺辅助麻醉(AAA)[J].中国疼痛医学杂志，1996,2(1):1-5.
• [18] 王强，熊利泽.针药平衡麻醉促进病人术后康复的新理念[J].中华麻醉学杂志，2015,35(1):6-10.
• [19] 曹小定.针刺复合麻醉的产生和发展[J].针刺研究，1997,22(Z1):9-10.
• [20] GURUSAMY K S,VAUGHAN J,DAVIDSON B R.Low pressure versus standard pressure pneumoperitoneum in laparoscopic cholecystectomy[J].Cochrane Database Syst Rev,2014(3):CD006930.
• [21] ASMUSSEN S,MAYBAUER D M,CHEN J D,et al.Effects of acupuncture in anesthesia for craniotomy:a meta-analysis[J].J Neurosurg Anesthesiol,2017,29(3):219-227.
• [22] ASMUSSEN S,PRZKORA R,MAYBAUER D M,et al.Meta-analysis of electroacupuncture in cardiac anesthesia and intensive care[J].J Intensive Care Med,2019,34(8):652-661.
• [23] 莫云长，陈林碧，王茜茜，等.经皮穴位电刺激对颅脑手术行控制性降压重要脏器功能的保护效应[J].温州医科大学学报，2016,46(8):547-553.
• [24] 袁岚，唐炜，王剑，等.经皮穴位电刺激对全麻髋关节置换术老年患者控制性降压期间脑氧代谢的影响[J].针刺研究，2014,39(1):7-11.
• [25] 傅国强，周嘉，童秋瑜，等.针药复合麻醉在肺切除术中抗应激作用的临床研究[J].针刺研究，2011,36(5):361-365.
• [26] WANG N,OU Y,QING W.Combined acupuncture and general anesthesia on immune and cognitive function in elderly patients following subtotal gastrectomy for gastric cancer[J].Oncol Lett,2018,15(1):189-194.
• [27] 张珏，费智敏，书国伟，等.针药复合麻醉在颅脑功能区手术中的应用[J].针刺研究，2014,39(1):12-15.
• [28] 马正良，易杰.围手术期患者低体温防治专家共识(2017) [J].协和医学杂志，2017,8(6):352-358.
• [29] 梁汉生，李奕楠，冯艺.经皮穴位电刺激的麻醉前预保温作用观察[J].针刺研究，2019,44(10):747-751.
• [30] 韩济生.针麻镇痛研究[J].针刺研究，2016,41(5):377-387.
• [31] QUINLAN J,LOBO D N,LEVY N.Postoperative pain management:time to get back on track[J].Anaesthesia,2020,75(Suppl 1):e10-e13.
• [32] SMALL C,LAYCOCK H.Acute postoperative pain mana-gement[J].Br J Surg,2020,107(2):e70-e80.
• [33] WU M S,CHEN K H,CHEN I F,et al.The efficacy of acupuncture in post-operative pain management:a systematic review and meta-analysis[J].PLoS One,2016,11(3):e150367.
• [34] CIBRIAN K.Nondrug interventions reduce pain and opioid use after total knee arthroplasty[J].Am J Nurs,2017,117(11):62.
• [35] 穴位刺激防治术后恶心呕吐专家指导意见[J].临床麻醉学杂志，2019,35(6):596-599.
• [36] LEE A,CHAN S K,FAN L T.Stimulation of the wrist acupuncture point PC6 for preventing postoperative nausea and vomiting[J].Cochrane Database Syst Rev,2015(11):CD003281.
• [37] SHIN H C,KIM J S,LEE S K,et al.The effect of acupuncture on postoperative nausea and vomiting after pediatric tonsillectomy:a meta-analysis and systematic review[J].Laryngoscope,2016,126(8):1761-1767.
• [38] 黎介寿.肠内营养与肠屏障功能[J].肠外与肠内营养，2016,23(5):257-259.
• [39] CHI Y L,ZHANG W L,YANG F,et al.Transcutaneous electrical acupoint stimulation for improving postoperative recovery,reducing stress and inflammatory responses in elderly patient undergoing knee surgery[J].Am J Chin Med,2019,47(7):1445-1458.
• [40] TU Q,YANG Z,GAN J,et al.Transcutaneous electrical acupoint stimulation improves immunological function during the perioperative period in patients with non-small cell lung cancer undergoing video-assisted thoracic surgical lobectomy[J].Technol Cancer Res Treat,2018,17:1533033818806477.
• [41] 黄卫，余婷玉，龙文飞，等.经皮穴位电刺激复合腹横肌平面阻滞在加速康复外科中的应用[J].针刺研究，2018,43(10):611-615.
• [42] 江群，莫云长，金丹，等.加速康复外科理念下穴位刺激对甲状腺癌根治术患者恢复质量的影响：随机对照研究[J].中国针灸，2019,39(12):1289-1293.