不同穴组电针对幕上肿瘤切除术患者七氟烷麻醉的影响

Effects of Electroacupuncture of Different Acupoint Groups on Sevoflurane Anesthesia in Patients Undergoing Resection of Supratentorial Tumors

目的:观察电针不同穴组对幕上肿瘤切除术患者七氟烷吸入全麻及其恢复期的影响。方法:择期进行幕上肿瘤切除术患者120例,随机分为七氟烷吸入全麻组(A组)、近端电针+七氟烷全麻组(B组)和远端电针+七氟烷全麻组(C组)。在麻醉诱导开始前,对B组和C组患者进行电针,B组为开颅侧切口近端穴位,风池透天柱连攒竹透鱼腰;C组为开颅侧切口远端穴位,合谷连外关,金门连太冲,足三里连丘墟。电刺激时间为麻醉诱导开始前直至手术结束。A组患者在上述相应穴位上贴导线,不进行电刺激。各组患者在异丙酚2 mg/kg、舒芬太尼0.3μg/kg、维库溴铵0.1 mg/kg诱导下行气管插管,吸入2%七氟烷维持麻醉,术毕停止吸入七氟烷。记录各时间点七氟烷呼出浓度、最低肺泡有效浓度(MAC)及脑电双频指数(BIS)以及麻醉恢复期情况。结果:患者对近端穴组的电刺激敏感度明显大于远端穴组,其平均刺激电流强度为(0.44±0.32)mA,低于远端的3个穴组(P<0.01)。B组和C组的七氟烷呼出浓度和MAC,在开颅期、颅内期各时间点均显著低于A组(P<0.05,P<0.01),B组节省七氟烷用量平均为8.34%,略低于C组(9.62%)。C组在钻骨后、开骨瓣后、剪开硬膜这几个时间点BIS值高于A组(P<0.05),而B组在各时间点BIS值与A组相近。B组和C组的自主呼吸恢复时间、拔管时间、睁眼时间、随意运动恢复时间、定向力恢复时间、离开手术室时间均明显小于A组(P<0.05,P<0.01)。结论:对幕上肿瘤切除术的患者进行不同穴组电针复合七氟烷麻醉,均能够降低七氟烷用量,显著缩短麻醉恢复时间。其中,近端穴组电针敏感度高。

Objective To observe the effect of electroacupuncture（EA） of different acupoint groups on the sevoflurane anesthetic requirement for resection of supratentorial tumors and the speed of post-operation recovery.Methods A total of 120 cases of supratentorial tumor resection patients were randomly and equally allocated into general anesthesia（GA） group,EA-proximal acupoints group（EA-PA group） and EA-distant acupoints group（EA-DA group）.The supratentorial tumor patients were anesthetized with sevoflurane for surgery.Proximal acupoints used were Fengchi（GB 20）,Tianzhu（BL 10）,Cuanzhu（BL 2） and Yuyao（EX-HN 4） that the former 2 acupoints and the latter 2 acupoints were for penetrative needling;and distant acupoints used were Hegu（LI 4）,Waiguan（TE 5）,Jinmen（BL 63）,Taichong（LR 3）,Zusanli（ST 36） and Qiuxu（GB 40） on the craniotomy side,and stimulated with EA（2 Hz/100 Hz,a tolerable electric stimulating strength）,beginning from the anesthesia induction till the end of surgical operation.All patients were anesthetized by inhalation of propofol（2 mg/kg）,sufentanil（0.3 μg/kg） and vecuronium bromide（0.1 mg/kg） and maintained with sevoflurane.The end-tidal sevoflurane concentration,minimum alveolar concentration（MAC）,bispectral index（BIS）,and the speed of recovery were recorded.Results In comparison with the GA group,the end-tidal concentrations during anesthesia maintenance at the time-points of post skull drilling,dura incising,intracra-nial operation in EA-PA group,the time-points of post skull drilling,skull opening,dura incising,and intracranial operation in EA-DA group,and the MAC of sevoflurane at the time-points of skull drilling in EA-DA group,and skull opening,dura incising,intracranial operation and dura suturing in both EA-PA and EA-DA groups were significantly lower（P0.05,P0.01）.Compared to the GA group,the BIS values of EA-DA group at the time-points of skull drilling and opening,and dura incising were significantly higher（P0.05）,while during the recovery stage of anesthesia,in comparison with the GA group,the autonomous respiration recovery time,tracheo-tube removing time,eye-opening time,voluntary motion recovery time,orientation force recovery time,and operating room-departure time of both EA-PA and EA-DA groups were significantly shorter（P0.05,P0.01）.No significant differences were found between the EA-PA and EA-DA groups in the aforementioned indexes（P0.05）.Conclusion EA of both proximal and distant acupoints can reduce the expired concentration and MAC of sevoflurane during anesthesia maintenance,and accelerate the recovery after cease of anesthesia in supratentorial tumor resection patients.