不同频率连续波针刺辅助麻醉用于甲状腺手术的临床研究

The clinical study of acupuncture-assisted anesthesia with different frequencies continuous waves on thyroid surgery

目的 探讨不同频率连续波针刺辅助麻醉用于甲状腺手术的麻醉效果及对手术引起的应激反应的影响。方法：将80例ASA为Ⅰ～Ⅱ级的择期甲状腺手术患者随机分为四组。分别在不同频率连续波针刺辅助结合颈丛神经阻滞下行甲状腺手术，A．B．C三组分别选用2Hz、15Hz、100Hz连续波刺激，D组为对照组。观察各组患者术前，术中、术毕各时点的心率、血压、呼吸、SpO2的变化以及术中辅助用药的情况，并且评定术中的镇痛效果，同时检测血液中皮质醇（COR）、去甲肾上腺素（NE）的浓度。结果：15Hz组镇痛效果最好，与对照组相比有显著性差异（P〈0．05）。15Hz组患者在牵拉甲状腺时血浆皮质醇含量最低。与对照组相比有显著性差异（P〈0．05）。2Hz、15Hz、100Hz三组患者在牵拉甲状腺时血浆NE含量与对照组比较有显著性差异（P〈0．05）。结论：15Hz连续波针刺辅助麻醉用于甲状腺手术中，麻醉效果更佳．更能抑制手术引起的应激反应。

Objective： To investigate the effects of acupuncture-assisted anesthesia （transcu- taneous electrical nerve stimulation TENS with different frequencies） combined with cervical plexus block（CPB） on the stress reaction and analgesic effect in patients undergoing thyroidectomy. Methods： 80 patients undergoing elective thyroidectomy, ASA Ⅰ-Ⅱ, were randomly divided into four groups. Group A, received CPB plus a low frequency （2Hz） TENS; Group B, received CPB plus middle frequency （15Hz） TENS; Group C, received CPB plus high frequency （100Hz） TENS; Group D, received CPB plus sham TENS （as a controlled group）. Blood pressure （MAP）, heart rate（HR）,respiratory rate （RR）, pulse oxygen saturation （SpO2） and the additional drugs were recorded at 8 time points. At the same time ,the venous blood samples were taken for measurements of cortisone（COR） and norepinephrine（NE）. Result ： The group B （15Hz） is the best in the analgesic effect and the group D is the worst, there is a significance difference between the groups （P〈0.05）. The concentration of COR was significantly lower in group B than in group D at maximum operative trauma time （P〈0.05）. Plasma NE was significantly higher in Group D than in Group A, B and C at maximum operative trauma time （P〈0.05）. Conclusion：Acupuncture-assisted anesthesia by 15Hz continuous waves stimulation has better analgesic effects than 2Hz and 100Hz on thyroid surgery ,and can obviously relieve the system stress reaction because of anesthesia and surgery.