经皮穴位电刺激配合全麻行异氟醚控制性降压的可行性研究

Study on the Applicability of Combined Transcutaneous Electrical Acupoint Stimulation and Routine Anesthesia for Cerebral Operation under Isoflurane-Controlled Hypotension

目的:研究经皮穴位电刺激配合全麻行异氟醚控制性降压的临床使用可行性。方法:选择脑瘤择期手术患者4 2例,随机分为对照组和实验组,对照组采用常规全麻,实验组经皮穴位电刺激加常规全麻,各2 1例。术中用HANS电针仪电刺激双侧颧、鱼腰、风池及合谷等穴位,同时加大异氟醚浓度,使平均动脉压(MAP)较麻醉前下降30 %～4 0 %,维持30～4 5min ,观察以下项目:①两组于剪脑膜后降压前、降压30min及血压回升稳定后30min各阶段的血流动力学指标及组织氧代谢、相应血气和动脉乳酸浓度等指标。②两组降压前、中、后呼气末异氟醚浓度的变化。③麻醉苏醒恢复状况。结果:①两组动脉及肺混合静脉血气值各项指标均无明显变化,且均在正常值范围中;两组间同一时相比较,差异无显著性。②与降压前比较,降压期间肺动脉混合静脉血氧饱和度和组织氧供下降,氧摄取率增加,差异均有显著性(P <0 .0 5 ) ;DO2 、VO2 、ERO2 、SvO2 、CO、CI和ABL等指标降压中与降压前增减的百分数,实验组明显低于对照组(P <0 .0 5 )。③Sv、SI和LVSWI等参数绝对值,对照组、实验组之间同一时相比较无明显差异,而降压30min与降压前增减的百分数,实验组明显低于对照组,有显著性差异(P <0 .0 5 )。④与对照组比较,实验组在降压前、中、后呼气末吸入的异氟?

Objective: To study the applicability of combined transcutaneous electrical acupoint stimulation (TEAS) and general anesthesia for cerebral surgical operation under Isoflurane-induced hypotension. Methods: Forty-two patients with brain tumor were randomly divided into Isoflurane anesthesia (control group,n=21) and combined TEAS and general anesthesia (treatment group,n=21). In treatment group, TEAS (2/100 Hz, 8～12 mA) was applied to Quanliao (SI 18), Yuyao (EX-HN 4), Fengchi (GB 20) and Hegu (LI 4) for 20 min following routine anesthesia with intravenous injection of Droperidol (5 mg), Fentanyl (4～6 μg), 2.5% sodium pentothal (5～7 mg/kg) and Pancuronium (0.1～0.15 mg/kg) and inhaling Isoflurane. For patients of control group, only routine general anesthesia was given. During the operation, the concentration of Isoflurane was elevated to reduce mean arterial pressure (MAP) 30～40% for 30～40 min. The main items for observation are 1) changes of hymodynamic parameters, blood gas and arterial blood lactic acid (ABL) concentration before, during and after hypotension; 2) changes of the end tidal Isoflurane concentration before, during and after hypotension; and 3) the restoration state of autonomous respiration and awakening from anesthesia. Results: There were no significant differences between treatment and control groups in arterial blood pH (pHa), partial pressure of arterial oxygen (PaO_2), saturation of O_2 (SaO_2) and partial pressure of CO_2 (PaCO_2), pulmonary mixed venous blood pH (pHv), PvO_2 and PvCO_2, and hemoglobin (Hb) before, during and after lowering blood pressure, and all the values were in the normal range. Compared with pre-hypotension, the dissolved oxygen (DO_2) and SvO_2 decreased significantly (P<0.05), O_2 extraction ratio (ERO_2) and ABL increased obviously (P<0.05) in these two groups. Thirty minutes after lowering blood pressure, the decreased values of stroke volume (SV), stroke index (SI) and left ventricular stroke work index (LVSWI) of treatment group were significantly lower than those of control group (P<0.05). Before and during lowering and elevating blood pressure, the end tidal Isoflurane concentrations (vol%) in treatment group was significantly lower than those in control group (P<0.05). After operation, the time for the restoration state of autonomous respiration and awakening from anesthesia of treatment group was significantly shorter than that of control group (P<0.05). Conclusion: Combined transcutaneous electrical acupoint stimulation with isoflurane induced hypotension for surgical operation can maintain stable oxygenic metabolism, lower physiological interference and reduce the side effects of the inhaled high concentration of Isoflurane, is superior to general anesthesia and thus suitable to be used for neurosurgical anesthesia.