经皮穴位电刺激超前镇痛对术后芬太尼镇痛效果的影响

Effect of Transcutaneous Electrical Acupoint Stimulation on the Post-operative Analgesic Effect of Fentanyl

目的观察经皮穴位电刺激(TEAS)超前镇痛对术后芬太尼镇痛效果的影响。方法选择美国麻醉医师学会分级Ⅰ或Ⅱ级,择期行腰椎内固定术的患者90例,随机平均分为3组。超前镇痛组(Ⅰ组)手术切皮前30 min行TEAS至手术结束,术中镇痛组(Ⅱ组)手术开始时TEAS至手术结束,Ⅲ组为对照组。术后均采用芬太尼静脉自控镇痛。观察3组患者苏醒时间,拔管时间,拔管后躁动情况,术后2、6、12、24、48 h疼痛视觉模拟评分(VAS评分)、镇静程度评分(Ramsay评分),镇痛泵芬太尼用量及不良反应发生情况。结果Ⅰ组和Ⅱ组VAS和Ramsay评分2 h、6 h低于Ⅲ组(P<0.05),Ⅰ组12 h低于Ⅱ组和Ⅲ组(P<0.05)。与Ⅱ组和Ⅲ组比较,Ⅰ组术后镇痛芬太尼累积消耗量减少,术后头晕、恶心、呕吐发生率降低(P<0.05)。结论经皮穴位电刺激超前镇痛对术后镇痛芬太尼用量有节俭作用。

Objective To observe the effect of transcutaneous electrical acupoint stimulation（TEAS） on the analgesic effect of Fentanyl. Method Ninety patients of degree Ⅰ or Ⅱ according to the American Society of Anesthesiologists（ASA） who were going to receive internal fixation of the lumbar spine were randomized into 3 groups. In the pre-operation analgesia group（group Ⅰ）, TEAS was conducted from 30 min before skin-cutting to the end of the operation; in the intra-operation group（group Ⅱ）, TEAS was conducted from the beginning to the end of the operation; group Ⅲ was a control group. After operation, patients were given controlled intravenous analgesia with Fentanyl. The waking time, extubation time, and irritation after extubation, as well as Visual Analogue Scale（VAS） score and Ramsay score at 2 h, 6 h, 12 h, 24 h, and 48 h after operation, dosage of Fentanyl, and adverse events were observed in the three groups. Result The VAS and Ramsay scores at 2 h and 6 h in group Ⅰ and Ⅱ were significantly lower than those in group Ⅲ（P0.05）, and the scores at 12 h in group Ⅰ were significantly lower than those in group Ⅱ and Ⅲ（P0.05）. The post-operative Fentanyl cost and adverse events including dizziness, nausea, and vomiting in group Ⅰwere markedly lower compared to those in group Ⅱ and Ⅲ（P0.05）. Conclusion Early use of TEAS can reduce the post-operative use of Fentanyl.