电针对依托咪酯复合麻醉患者肾上腺皮质功能的影响

Effect of electroacupuncture on adrenocortical function under etomidate-based anesthesia

目的探讨电针对依托咪酯复合麻醉患者肾上腺皮质功能的影响。方法择期腹部手术患者80例，性别不限，年龄30～64岁，ASA分级I级或Ⅱ级，采用随机数字表法，将其分为4组（n=20）：丙泊酚对照组（P组）、依托咪酯组（E组）、依托咪酯＋电针组（EEA组）和依托咪酯＋假电针组（Es组）。E组、EEA组和Es组采用咪达唑仑．依托咪酯．舒芬太尼-阿曲库铵行麻醉诱导，采用依托咪酯．瑞芬太尼维持麻醉；P组采用咪达唑仑-丙泊酚-舒芬太尼-阿曲库铵行麻醉诱导，采用丙泊酚-瑞芬太尼维持麻醉。EEA组于麻醉诱导前至术毕行电针刺激[疏密波（2／50Hz），波宽300txs，刺激电流由0开始，以0．1mA的梯度逐渐增大，逐渐达到患者能耐受的最大水平]。于麻醉诱导前（T0）、手术开始后2h（T1）、术毕（T2）、术后2h（B）时抽取静脉血样，采用ELISA法测定血清皮质醇、促肾上腺皮质激素（ACTH）、肾上腺素、去甲肾上腺素的浓度。结果与P组比较，E组、EEA组和Es组T1-T3时血清皮质醇浓度降低，T3时血清ACTH浓度升高，EEA组T1、T2时血清肾上腺素浓度、L—L时血清去甲肾上腺素浓度降低（P〈0．05）；与E组比较，EEA组T1-T3时血清皮质醇浓度升高，B时血清ACTH浓度降低，T1、T2时血清肾上腺素浓度、T1—T3时血清去甲肾上腺素浓度降低（P〈0．05），Es组上述指标差异无统计学意义（P〉0．05）。结论电针可减轻依托咪酯复合麻醉对患者肾上腺皮质功能的抑制作用。

Objective To investigate the effect of electro-acupuncture on adrenocortical function under etomidate-based anesthesia in patients. Methods Eighty ASA physical status I or II patients of both sexes, aged 30-64 yr, scheduled for elective abdominal surgery, were randomly divided into 4 groups （ n = 20 each） ： propofol control group （group P）, etomidate group （group E）, etomidate ＋ electro-acupuncture group （group EEA）, and etomidate ＋ sham electro-acupuncture group （group ES）. Anesthesia was induced with midazolam, etomidate, sufentanil and atracurium in E, EEA and ES groups, or with midazolam, propofol, sufentanil and atra- curium in group P. The patients were mechanically ventilated after endotracheal intubation. Anesthesia was main- tained with iv infusion of etomidate and remifentanil and intermittent iv boluses of atraeurium in E, EEA and ES groups, or with iv infusion of propofol and remifentanil and intermittent iv boluses of atracurium in group P. Electro-acupuncture stimulation of Zusanli and Sanyinjiao （frequency 2 Hz /50 Hz, wave length 300μs） was started from the time before induction of anesthesia and continued until the end of surgery in group EEA. Venous blood samples were taken before induction of anesthesia （T0）, at 2 h after beginning of surgery （T1）, at the end of surgery （T2） and at 2 h after surgery （T3） for determination of serum cortisol, adrenoeorticotropic hormone （ACTH）, epinephrine and norepinephrine concentrations. Results Compared with group P, the serum cortisol concentrations were significantly decreased at T 3, the serum ACTH concentration was increased at T3 in groups E, EEA and ES, and the serum epinephrine levels at T1,2 and norepinephrine levels at T1,3 were decreased in group EEA （ P 〈 0.05）. Compared with group E, the serum cortisol concentrations were significantly increased at T1,3 , the serum ACTH concentration was decreased at T3 , and the serum epinephrine levels at T1,2 and norepinephrine levels at Tv3 were decreased in group EEA （P 〈 0.05）, and no significant change was found in the parameters mentioned above in group ES （P 〉 0.05）. Conclusion Electro-acupuncture can mitigate etomidate-based anesthesia-induced inhibition of adrenocortical function in patients.