经皮穴位电刺激对经蝶垂体瘤切除患者围术期静脉全麻的影响

Effect of transcutaneous acupoint electric stimulation on perioperative intravenous anesthesia in patients of transsphenoidal pituitary tumor resection

目的:观察经皮穴位电刺激对经蝶入路垂体瘤切除术患者围术期血流动力学、麻醉用药及相关并发症的影响。方法:选取择期进行经蝶入路垂体瘤切除术的患者90例,随机分为经皮穴位电刺激组(T组)、假穴位组(S组)以及对照组(C组),每组30例。T组行经皮穴位电刺激,穴取合谷、外关、金门、太冲、足三里、丘墟;S组在非穴处行经皮电刺激;C组取穴同T组,只在相关穴位贴皮肤自粘电极,不通电。电刺激时间为麻醉诱导开始前直至手术结束。3组患者均在异丙酚、芬太尼、维库溴铵诱导下行气管插管,术中应用异丙酚、瑞芬太尼维持至手术结束,记录各时间点血压、心率、脑电双频指数(BIS)值、麻醉用药以及术后恢复情况。结果:各组均能够维持稳定的血流动力学。T组在插管后1min、拔管及定向力恢复时的平均动脉压小于其余两组(均P<0.05)。T组术中暴露鞍区和取瘤阶段瑞芬太尼效应室浓度较其余两组低(均P<0.05),术后定向力恢复时异丙酚效应室浓度较其余两组低(均P<0.05)。术后24h内C组2例发生恶心呕吐,其余各组均无相关并发症发生。结论:应用经皮穴位电刺激可以提高围术期血流动力学的稳定程度,降低术中阿片类药物的用量,提高麻醉恢复质量。

Objective To observe the impacts of transcutaneous acupoint electric stimulation on hemodynamics, anes- thetic and relevant complications in patients of transsphenoidal pituitary tumor resection （TPTR）. Methods Ninety cases of the selective TPTR were randomized into a transcutaneous acupoint electric stimulation group （group T）, a sham-acu- point group （group S） and a control group （group C） ; 30 cases in each one. In group T, the transcutaneous acupoint e- lectric stimulation at Hegu （LI 4）, Waiguan （TE 5）, Jinmen （BL 63）, Taichong （LR 3）, Zusanli （ST 36） and Qiuxu （GB 40）. In group S, the transcutaneous acupoint electric stimulation was applied to the sham-acupoints. In group C, the acupoints selected were same as those in group T, but the electrode pads were just attached on the related points with no- electric stimulation. The electric stimulation lasted from analgesic induction till the end of the operation. The endotracheaI intubation was done under the induction by propofol, fentanyl and vecuronium bromide. Propofol and remifentanil were maintained till the end of operation. Blood pressure, heart rate, bispectral index （BIS） value, anesthetic and postoperative recovery situation were recorded. Results The hemodynamics maintained stably in each group. In group T, the mean ar- terial pressure 1 min after intubation, after extubation and during directional force recovery was all lower than the other two groups respectively （all P%0. 05）. In group T, the effect-site concentration of fentaryl in the exposure saddle area and tumor removal stage was lower than the other two groups （all P〈0. 05）. In 24 h after operation, 2 cases presented nausea and vomiting in group C. There were no relevant complications in the rest groups. Conclusion The transcutaneous acupoint electric stimulation improves the stability of hemodynamics in perioperative stage, reduces the intraoperative opi- oids dosages and improves the quality of anesthetic recovery.