针刺疗法防治术后恶心呕吐的临床研究进展

Clinical Research Progress on Acupuncture Therapy for the Prevention and Treatment of Postoperative Nausea and Vomiting

摘要: 术后恶心呕吐(Postoperative Nausea and Vomiting, PONV)是麻醉手术后常见并发症，发生率高，严重影响患者恢复并增加医疗负担。本文系统回顾了针刺疗法防治PONV的临床研究进展。PONV的发生受患者因素(性别、吸烟史、既往史、年龄、体重指数等)和术中因素(手术类型、麻醉方式、阿片类药物使用、呼气末二氧化碳水平等)共同影响。其机制涉及中枢与外周通路，通过多种神经递质受体系统介导。针刺疗法可通过局部、神经体液及远隔效应发挥作用。现有研究证实，传统针刺、撳针、穴位注射、经皮穴位电刺激、颊针、穴位埋线及中药热奄包、穴位贴敷等外治疗法均能有效降低PONV发生率和严重程度，促进胃肠功能恢复，减少止吐药物使用，且安全性好。不同针刺方法的作用机制可能与调节胃肠激素、5-羟色胺水平、炎症因子及自主神经功能有关。目前研究仍存在样本量小、方案不统一等局限，未来需开展高质量多中心随机对照试验，以标准化干预方案并深入探索生物学机制，为针刺疗法在围术期的推广应用提供循证依据。

Abstract: Postoperative nausea and vomiting (PONV) is a common complication after anesthesia and surgery, with a high incidence rate that seriously affects patient recovery and increases the medical burden. This article systematically reviews the clinical research progress on acupuncture therapy for the prevention and treatment of PONV. The occurrence of PONV is jointly influenced by patient-related factors (sex, smoking history, medical history, age, body mass index, etc.) and intraoperative factors (type of surgery, anesthesia method, opioid use, end-tidal carbon dioxide levels, etc.). Its mechanisms involve central and peripheral pathways, mediated by multiple neurotransmitter receptor systems. Acupuncture therapy exerts its effects through local, neurohumoral, and distant mechanisms. Existing studies have confirmed that traditional acupuncture, thumbtack needle (pressed needle), acupoint injection, transcutaneous electrical acupoint stimulation, buccal acupuncture, acupoint catgut embedding, as well as external therapies such as herbal hot compress packs and acupoint application patches, can all effectively reduce the incidence and severity of PONV, promote gastrointestinal functional recovery, decrease the use of antiemetic drugs, and demonstrate good safety profiles. The mechanisms of different acupuncture methods may be related to the regulation of gastrointestinal hormones, serotonin (5-HT) levels, inflammatory factors, and autonomic nervous function. Current research still has limitations such as small sample sizes and inconsistent protocols. Future high-quality multicenter randomized controlled trials are needed to standardize intervention protocols and further explore the biological mechanisms, thereby providing evidence-based support for the promotion and application of acupuncture therapy in the perioperative period.