围术期经皮穴位电刺激对胸腔镜肺切除术中肺顺应性的影响

Effect of perioperative transcutaneous electrical acupoint stimulation on intraoperative lung compliance during thoracoscopic pneumonectomy

目的观察围术期经皮穴位电刺激(TEAS)对胸腔镜肺切除术中肺顺应性的影响。方法选择择期全麻下行胸腔镜肺切除术的患者70例,男31例,女39例,年龄20~64岁,BMI 18~28 kg/m^(2),ASAⅠ或Ⅱ级。采用随机数字表法将患者分为两组:TEAS组和对照组,每组35例。TEAS组在双侧内关穴、曲池穴进行电刺激,频率为2/100 Hz,电刺激从术前30 min开始直至手术结束时停止。对照组仅于双侧内关穴、曲池穴连接电极,不予电刺激。所有患者麻醉方法及用药原则一致。记录机械通气(术前双肺通气时、术中单肺通气时、术后双肺通气时)的肺顺应性和气道峰压。记录术后肺部感染、肺不张、胸腔积液和气胸等肺部并发症的发生情况。记录术后气管导管拔除时间、胸腔引流管拔除时间和术后住院时间。结果与对照组比较,TEAS组术中单肺通气时肺顺应性明显增高,气道峰压明显降低,术后气管导管拔除时间明显缩短(P<0.05)。两组术后肺部感染、肺不张、胸腔积液和气胸的发生率、术后胸腔引流管拔除时间和术后住院时间差异无统计学意义。结论围术期经皮穴位电刺激双侧内关穴和曲池穴可改善胸腔镜肺切除术患者的肺顺应性,降低气道压。

Objective To observe the effect of perioperative transcutaneous electrical acupoint stimulation(TEAS)on intraoperative lung compliance during thoracoscopic pneumonectomy.Methods Seventy patients undergoing elective thoracoscopic pneumonectomy,31 males and 39 females,aged 20-64 years,BMI 18-28 kg/m^(2),ASA physical statusⅠorⅡ,were randomly divided into two groups using the random number table method:TEAS group and control group,35 patients in each group.In the TEAS group,electrical stimulation was performed at bilateral Neiguan acupoint and Quchi acupoint with a frequency of 2/100 Hz.The electrical stimulation started 30 minutes before operation and lasted till the end of the operation.In the control group,the electrodes were only connected to Neiguan acupoint and Quchi acupoint but without electrical stimulation.Routine anesthesia was performed in all the patients.The intraoperative lung compliance and airway peak pressure during mechanical ventilation(preoperative bilateral lungs ventilation,intraoperative one lung ventilation,and postoperative bilateral lungs ventilation)were recorded.Postoperative pulmonary complications(including pulmonary infections,atelectasis,and pleural effusion and pneumothorax)were recorded.Time of extubation,removal of chest drainage tube and length of hospital stay were also recorded.Results Compared with the control group,intraoperative lung compliance was significantly increased,and airway peak pressure was significantly decreased,time of extubation was significantly shortened in the TEAS group during intraoperative one lung ventilation(P<0.05).Occurrences of postoperative pulmonary infections,atelectasis,pleural effusion,and pneumothorax were also similar in the two groups.Removal of chest drainage tube and length of hospital stay were similar between the two groups.Conclusion Perioperative transcutaneous electrical acupoint stimulation at bilateral Neiguan acupoint and Quchi acupoint can significantly improve lung compliance,reduce airway peak pressure during thoracoscopic pneumonectomy.