经皮穴位电刺激联合静吸复合全身麻醉对内镜颅底手术麻醉效果影响的研究

Effect of Inhalation Combined with General Anesthesia Combined with Percutaneous Electrical Acupoint Stimulation on the Anesthetic Effect of Endoscopic Skull Base Surgery

目的 观察经皮穴位电刺激联合静吸复合全身麻醉对内镜颅底手术麻醉效果的影响。方法 选择2019年1月—2021年1月唐山市人民医院收治的76例内镜颅底手术患者为研究对象,根据随机数字表法分为对照组38例和观察组38例。对照组行单纯静吸复合全身麻醉,观察组在静吸复合全身麻醉基础上给予经皮穴位电刺激辅助(麻醉前30 min至手术结束)治疗。观察和比较两组患者术中麻醉药物丙泊酚、舒芬太尼等药物的用量,患者意识恢复时间、自主呼吸恢复时间及患者手术结束到拔除气管插管的时间,术后不同时间段(术后6、24、72 h)视觉模拟评分(VAS),手术结束后即刻、手术结束后6 h、手术结束后24 h患者出现恶心、呕吐、寒战以及躁动等不良反应发生情况。结果 观察组术中麻醉药物丙泊酚(683.82±21.97)mg、舒芬太尼(24.61±1.90)μg、瑞芬太尼(1.24±0.07)mg等药物的用量与对照组[丙泊酚(748.34±23.79)mg、舒芬太尼(29.11±1.45)μg、瑞芬太尼(1.41±0.04)mg]相比明显减少,两组差异均具有统计学意义(P<0.05);观察组患者意识恢复时间(40.05±1.51)min、自主呼吸恢复时间(32.32±2.08)min及手术结束到拔除气管插管的时间(41.71±1.80)min与对照组[(49.05±2.34)、(39.18±2.57)、(50.32±3.01)min]相比明显缩短,两组差异均具有统计学意义(P<0.05);观察组术后不同时间段评估疼痛水平的VAS评分[6 h(3.47±0.65)分、24 h(2.32±0.47)分、72 h(1.29±0.46)分]与对照组[6 h(4.61±0.92)分、24 h(2.79±0.66)分、72 h(1.79±0.62)分]相比明显减少,两组差异均具有统计学意义(P<0.05);观察组不良反应发生率明显低于对照组,差异有统计学意义(P<0.05)。结论 相较于单纯静吸复合全身麻醉,经皮穴位电刺激联合静吸复合全身麻醉更能有效改善内镜颅底手术患者术后疼痛症状,缩短自主呼吸恢复时间、意识恢复时间以及拔除气管插管时间,并能减少术中麻醉药物剂量,从而提高患者舒适度,并能减少不良反应,有利于患者整体康复。

Objective To observe the effect of percutaneous electrical acupoint stimulation combined with intravenous inhalation combined with general anesthesia on the anesthesia effect of endoscopic skull base surgery.Methods A total of 76 patients with endoscopic skull base surgery who were admitted to Tangshan people's hospital from January 2019 to January 2021 were selected as the research objects,and were divided into a control group of thirty-eight cases and an observation group of thirty-eight cases according to the random number table method.The control group received simple intravenous inhalation combined with general anesthesia,the observation group was given percutaneous electrical acupoint stimulation on the basis of intravenous inhalation combined with general anesthesia(30 minutes before the anesthesia to the end of the operation).To observe and compare the intraoperative doses of anesthetics propofol,sufentanil and other drugs between the two groups,the recovery time of the patients consciousness,the recovery time of spontaneous breathing,and the time from the end of the operation to the removal of the tracheal intubation,the visual analogue scale(VAS score)at different time periods after surgery(6 hours,24 hours,72 hours after surgery),immediately after the operation,6 hours after the operation,and 24 hours after the operation,the patient experienced nausea,vomiting,chills and agitation,etc.occurrence of adverse reactions.Results The intraoperative anesthesia drugs propofol(683.82±21.97)mg,sufentanil(24.61±1.90)μg,remifentanil(1.24±0.07)mg in the observation group were significantly different from those in the control group[propofol(748.34±23.79)mg,sufentanil(29.11±1.45)μg and remifentanil(1.41±0.04)mg]were significantly decreased,and the differences between the two groups were statistically significant(P<0.05);The recovery time of consciousness(40.05±1.51)min and spontaneous breathing recovery time(32.32±2.08)min of patients in the observation group,and the time from the end of the operation to the removal of the tracheal intubation(41.71±1.80)min were significantly shortened from those in the control group[(49.05±2.34),(39.18±2.57),(50.32±3.01)min],and the differences between the two groups were statistically significant(P<0.05);The VAS scores of the observation group after operation[6 hours(3.47±0.65)points,24 hours(2.32±0.47)points,72 hours(1.29±0.46)points]and the control group[6 hours(4.61±0.92)points,24 hours(2.79±0.46)points,72 hours(1.79±0.62)points]were significantly reduced,and the differences between the two groups were statistically significant(P<0.05);The incidence of adverse reactions in the observation group was significantly lower than that in the control group,and the difference was statistically significant(P<0.05).Conclusion Compared with simple intravenous inhalation combined with general anesthesia,transcutaneous electrical acupoint stimulation combined with intravenous inhalation combined with general anesthesia can more effectively improve postoperative pain symptoms in patients with endoscopic skull base surgery,shorten the recovery time of spontaneous breathing,the recovery time of consciousness,and the removal of tracheal intubation,and can reduce the intraoperative anesthetic dose,thereby improving patient comfort,and can reduce adverse reactions,which is conducive to the overall recovery of patients.