穴位电刺激对剖宫产产妇寒战的影响

Effect of electric acupoint stimulation on shivering in cesarean section

目的：探讨穴位电刺激对剖宫产产妇寒战的治疗效果。方法：选择根据美国麻醉医师协会（ASA）评级为Ⅰ～Ⅱ级的80例剖宫产产妇随机分为经皮穴位电刺激（TEAS）辅助麻醉组（A组）和单纯麻醉组（B组）。两组均行经行硬一腰联合麻醉穿刺，蛛网膜下腔给予0．75％布比卡因8mg，控制麻醉阻滞平面高度T4～T8。A组硬-腰联合麻醉前进行穴位电刺激至手术结束，以同侧合谷-劳宫、三阴交-足三里穴位配对，左右两侧共4对穴位贴上自粘电极片，连接LH402H型韩氏穴位神经刺激仪，采用疏密波，频率2Hz／15Hz，强度10～30mA，以病人能耐受为度。于麻醉前（T0）、麻醉穿刺成功平卧后1min（T1）、胎儿取出后1min（T2）、关腹（T3）和手术结束（T4），分别记录心率（HR）、平均动脉压（MAP）、血氧饱和度（SPO2）和寒战程度。结果：A组寒战发生率为35．0％（14／40），低于B组的67．59／6（27／40，P〈0．05），于手术T2、T3和T4时，A组比B组发生寒战程度轻（均P〈0．01）；与麻醉前（T0）相比，A组在T1和T2时HR增快（均P〈0．05），T3和T4时HR已恢复麻醉前水平（均P〉0．05），B组于手术T1、T2、T3和T4时HR均比麻醉前快（P〈0．05，P〈0．01）；两组在T1和T2时MAP偏低（P〈0．05，P〈0．01），在关腹及手术结束时MAP都恢复至术前水平（均P〉0．05）；两组SPO2差别没有统计学意义（均P〉0．05）。结论：经皮穴位电刺激能降低剖宫产产妇寒战的发生，并具有稳定心率的作用。

Objective To explore the efficacy of electric acupoint stimulation on shivering in cesarean section. Methods Eighty cases of parturients, under the America Society of Anesthesiologists （ASA） physical status Ⅰ -Ⅱ, were randomized into a transcutaneous electrical acupoint stimulation （TEAS） assisted anesthesia group （group A） and an anesthesia group （group B）. Spinal-epidural anesthesia（CSEA） puncture was applied to both groups and 8 mg of 0.75% bubivacaine was given by spinal injection, the block level was T4-T8. In group A, TEAS was applied before CSEA at paired acupoints-ipsilateral Hegu （LI 4）-Laogong （PC 8） and Sanyinjiao （SP 6）-Zusanli （ST 36） till ending the surgery. The 4 pair of bilateral acupoints were fixed with serf-adhesive electrodes and connected with Han＇s acupoint and nerve stimulator （HANS, LH402H）, the frequency was 2 Hz/ 15 Hz, the intensity was 10-30 mA and the form was densedisperse wave within the patients＇ tolarance. The heart rate （HR）, mean arterial pressure （MAP）, oxyhemoglohin saturation （SPO2） and shivering degree were recorded before anesthesia （T0）, 1 min after anesthesia puncture （T1）, 1 min after the delivery （T2）, during abdomen closure （T3） and at the end of surgery （T4）. Results The occurrence rate of shivering was 35.0% （14/40） in group A, which was lower to 67.5% （27/40, P〈0.05） in group B; the degree of shivering was lighter in group A than that in group B at T2, T3 and T4 （all P〈0.01）. In group A, HR was faster at T1 and T2 compared to that at T0 （all P〈0.05）, while at T3 and T4, the HR was the same with that before anesthesia （all P〈0.05）. In group B, the HR was faster at T1, T2, T3 and T4 compared to that at T0 （P〈0. 05, P〈0.01）. In both groups, the MAP was lower at T1, T2 （P〈0.05,P〈0.01） and resumed to that before anesthesia at T3 and T4 （all P〉0.05） ; there was no statistical significance of SPO2 in both groups （all P〈0.05）. Conclusion TEAS can reduce the occurrence rate of shivering and steady the heart rate in cesarean section.