经皮穴位电刺激及电针对幕上肿瘤切除术患者术后恢复及镇痛的影响

EFFECTS OF TRANSCUTANEOUS ELECTRICAL ACUPOINT STIMULATION AND ELECTRO-ACUPUNCTURE ON RECOVERY AND POST-OPERATIVE PAIN AFTER RESECTION OF SUPRATENTORIAL TUMORS

目的:观察电针及经皮穴位电刺激复合七氟烷麻醉在神经外科手术中的应用及其对麻醉恢复期以及术后镇痛的影响。方法:择期进行幕上肿瘤切除术的患者120例,随机分为电针+七氟烷全麻组(A组)、经皮穴位电刺激+七氟烷全麻组(T组)和七氟烷吸入全麻组(S组)。在麻醉诱导开始前,对A组患者进行针刺;与开颅侧同侧,合谷连外关,金门连太冲,足三里连丘墟;频率2/100 Hz,刺激强度以患者最大耐受程度为宜。电刺激时间为麻醉诱导开始前直至手术结束。对T组患者,穴位选择、频率、强度调整等各个参数均等同A组。只是在相应穴位贴上皮肤自粘电极(直径3 cm),用两根导线分别连接韩氏穴位神经刺激仪。S组患者在上述相应穴位上贴上导线,不进行刺激。3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,连接术后镇痛泵。记录麻醉恢复期情况及术后48 h内疼痛视觉模拟评分(visual analogue scale,VAS)。结果:麻醉恢复期情况表明,A组和T组患者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,均显著小于S组(P<0.01)。A组和T组患者术后4 h内VAS评分和镇痛泵有效按压次数显著小于S组(P<0.01)。术后6 h直至术后48 h,3组间镇痛效果差别不大。结论:经皮穴位电刺激和电针一样,在复合七氟烷麻醉应用于神经外科手术,能够显著缩短麻醉后恢复时间,辅助术后早期的镇痛,提高患者麻醉后恢复质量,是一种值得推广的麻醉方法。

Objective： We performed this sham-controlled, randomized study to investigate the effects of transcutaneous acupoint electrical stimulation （TEAS） or electro-acupuncture （EA） combined with sevoflurane anesthesia on the recovery and post-operative pain following neurosurgery. Methods： 120 cases of supratentorial tumor resection were anesthetized with sevoflurane and randomly assigned into EA group （Group A）, TEAS group （Group T） and sham treatment group （Group S）. Han＇s acupoint nerve stimulator （HANS） with 2/100 Hz frequency was used to stimulate the acupoints. The patients in Group A received EA at acupoints of Hegu （LI4） and Waiguan （TE5）, Jinmen （BL63） and Taichong （LV3）, Zusanli （ST36） and Qiuxu （GB40） at the same side of the craniotomy before the induction of anesthesia. The patients in Group T received TEAS at the same acupoints through self-adhesive skin electrodes. In group T and group A, stimulations were continued until the end of the operation. All patients were induced with 2 mg/kg propofol, 0.3 μg/kg sufentanyl and 0.1 mg/kg vecuronium and maintained with sevoflurane. For postoperative analgesia, patient controlled intravenous analgesia （PCIA） was used, which contained 1.5 μg/kg sufentanyl and 16 mg ondansetron with normal saline, for a total of 100 ml. The speed of recovery after operation and the data of post-operative pain scores （visual analogue scale, VAS） were analyzed in the three groups. Results： The times to recovery of spontaneous respiration, extubation, opening eyes, voluntary movements and discharge from the recovery room were significantly shorter in Group A and T than in Group S （P 〈 0.01）. Dysphoria, nausea and vomiting occurred in fewer patients in Group A and group T, compared to group S. In the early stages, the VAS scores were much lower in group T and group A. The mean total bolus and effective bolus times of PCIA in the first 4 h after operation were lower in group T and group A than that in the group S （P 〈 0.05）. Conclusion： EA or TEAS combined with sevoflurane used in neurosurgery can speed the recovery of anesthesia and improve the post operation recovery in neurosurgical patients. Both TEAS and EA may help in the post-operative pain control, and this effect mainly occurs in the early stage of post-operative period.