经皮穴位电刺激联合丙泊酚靶控输注对开颅术围手术期应激反应的影响

Effect of Transcutaneous Acupoint Electrical Stimulation on Stress in Brain Surgery with Propofol Target Controlled Infusion General Anesthesia

目的 观察开颅手术行经皮穴位电刺激（transcutaneous acupoint electrical stimulation，TAES）联合丙泊酚靶控输注对围手术期应激反应的影响。方法 选择择期开颅手术患者40例，ASA分级Ⅰ~Ⅱ级，分层随机分为对照组和观察组，每组20例。两组术中麻醉维持均采用丙泊酚靶控输注，观察组采用TAES干预，对照组仅在相应穴位贴附电极，不做电刺激。两组分别在穴位电刺激诱导前（T0）、麻醉前（T1）、切皮前（T2）、颅内操作60 min（T3）、切口缝合完毕后（T4）、拔除气管导管约10 min（T5）6个时间点采动脉血测β－内啡肽（β-EP）、皮质醇（COR）、肾上腺素（E）、血糖（Glu），并记录以上各时间点心率（HR）、平均动脉压（MAP）；记录两组麻醉时间、手术时间、总输液量、失血量、尿量。结果 与本组T0时间点比较，两组T2时间点HR、MAP、COR、E降低（P〈0.05），对照组T2时间点β-EP降低（P〈0.05），T3时间点HR、MAP、COR升高（P〈0.05），T4、T5时间点HR、MAP、E、Glu升高（P〈0.05）；观察组T1、T3时间点β-EP升高（P〈0.05），T4、T5时间点HR、COR、E、Glu、β-EP升高（P〈0.05）。与对照组同时间点比较，观察组T2时间点MAP、COR、E较T0变化幅度小（P〈0.05），T3时间点HR、MAP、COR较T0变化幅度小， T4、T5时间点HR、MAP、COR、E、Glu较T0变化幅度小（P〈0.05），T1、T3、T4、T5各时间点β-EP较T0变化幅度大，差异有统计学意义（P〈0.05）。结论 TAES联合丙泊酚靶控输注用于开颅手术可降低围手术期应激反应。

Objective To study the effect of transcutaneous acupoint electrical stimulation （TAES） on stress who received propofol target controlled infusion （TCI） general anesthesia in brain surgery. Methods Totally 40 neurosurgical patients of I- II grade （ASA grading） in our hospital were randomly divided into the TAES group （T group） and the control group （C group）, 20 in each group. All patients received intravenous anesthesia by propofol TCI. The TAES intervention was adopted in those of C group. Electrodes were only applied to corresponding acupoints without electric stimulation. The arterial blood was withdrawn before TAES （T0）, before anesthesia （T1）, before cutting （T2）, at 60 min after encephalic incision （T3）, immediately after incisions suture （T4）, at about 10 min after removing tracheal catheters （T5） to detect β-endorphin （β-EP）, cortisol （COR）, adrenalin （E）, blood sugar （Glu）. The heart rate （HR） and mean arterial pressure （MAP） were recorded. The total time of surgery, anesthesia, total infusion amount, blood lost amount, and urine amount were recorded. Results In both groups, HR, MAP, COR, and E at T2 were lower than at T0significantly （P 〈0.05）. β-EP in group C at T2 was lower than at T0significantly （P 〈 0.05）. HR, MAP, COR in group C at Tswere higher than at T0significantly （P 〈0.05）. HR, MAP, E, and Glu in group C at T4and Tswere higher than at T0significantly （P 〈0.05）. β-EP in group T at Tland Ts were higher than at T0significantly （P 〈0.05）. HR, COR, E, Glu, and β-EP in group T at T4and Tswere higher than at To significantly （P 〈 0.05）. Between groups, comparing with the time point To, the amplitude of variation of MAP, COR, and E at T2in group C were significantly less （P 〈0.05） ; the amplitude of variation of HR, MAP, and COR at T3in group C were less significantly, when compared with the time point T0（P 〈0.05） ; the amplitude of variation of HR, MAP, COR, E, and Glu at T4and T5 in group C were less significantly, when compared with the time point To （P 〈0.05）. When comparing the two groups, the amplitude of variation of β- EP at time points of T1 ,T3,T4,and T5 in group T were larger than at To in group C （P 〈0.05）. Conclusion TAES could reduce stress and stabilize the internal environment when used in brain surgery with propofol TCI general anesthesia.