经皮穴位电刺激对乳腺癌改良根治术患者全麻围拔管期应激反应的影响

Preventive Effect of Transcutaneous Electro-acupuncture on the Intratracheal Extubation Stress Response in General Anesthesia of Patients with Breast Cancer Undergoing Modified Radical Mastectomy

目的观察经皮穴位电刺激处理对全身麻醉围拔管期应激反应的调控作用。方法将60例择期行乳房癌改良根治术的患者按入院次序编号,凡偶数组为治疗组,奇数组为对照组,每组30例。治疗组在行全麻前电针刺激患侧合谷、内关穴20min,术中刺激双侧合谷、内关、尺泽、列缺,于手术结束前30min停止刺激尺泽、列缺,开始刺激气舍、水突穴。观察围拔管期心率、血压及血中儿茶酚胺和皮质醇浓度的变化及气道反应。对照组不作任何处理,麻醉方法两组相同。结果两组在拔管后心率、血压、血浆儿茶酚胺及皮质醇浓度均较本组手术结束时升高(P<0·05)。组间比较,治疗组在围拔管期血浆儿茶酚胺浓度、皮质醇浓度、心率、血压的升高幅度明显低于对照组(P<0·05),气道不良反应也轻于对照组(P<0·05)。结论经皮穴位电刺激可减轻全麻围拔管期的应激反应,减轻呼吸道不良反应,具有一定的临床应用价值。

Objective To observe the regulatory effect of transcutaneous electro-acupuncture （TCEA） for preventing intratracheal extubation stress response （IESR） in general anesthesia. Methods Sixty patients with breast cancer scheduled to receive mastectomy were numbered according to their sequence of hospitalization, patients of odd number were assigned to the control group and those of even number to the treated group, 30 in each group. They were anesthetized by the same anesthesia approach, but TCEA was applied on patients in the treated group in the narcotic process by stimulating at Hegu （LI4） and Neiguan （PC6） of the diseased side for 20 min before induction ; then on bilateral points of Hegu, Neiguan, Chize （LU5） and Lieque （LU7） all through the whole course of operation, but at time of 30 min before ending operation, stimulus at Chize and Lieque points stopped and turned to bilateral Shuitu （ST10） and Qishe （ST11） points. No management other than conventional anesthesia was applied on patients in the control group. Changes of blood pressure （MAP）, heart rate （HR）, plasma catecholamine and cortisol as well as the respiratory tract response occurred after extubation were observed and compared. Results HR, MAP, plasma levels of catecholamine and cortisol increased after extubation in both groups （ P 〈 0.05）, but the changes were more obvious in the control group than in the treated group （P 〈0.05）. Besides, the adverse reaction of respiratory tract occurred in the treated group was milder （P 〈0.05）. Conclusions TCEA can alleviate the IESR to attenuate the adverse reaction of respiratory tract. It is definitely valuable in clinical practice.