经皮穴位电刺激辅助全身麻醉减少镇痛药及其副作用的随机对照研究

Effect of TEAS-assisted General Anesthesia on Consumption of Anesthetics and side-effects: A Randomized Controlled Study

目的:1.为了明确经皮穴位电刺激是否可以减少择期乳腺癌根治术麻醉药的用量,产生针刺镇痛效应,并且缩短患者苏醒和拔管时间;2.经皮穴位电刺激是否可以明显的减少术后恶心呕吐、眩晕及皮肤瘙痒等麻醉相关并发症的发生;3.探讨电针镇痛效应是否与患者体内β-内啡肽、游离皮质醇有关。方法:选择60例进行择期乳腺癌根治术的患者,随机分为对照组(CON组)、经皮穴位电刺激组(TEAS组),每组30人。入手术室后TEAS组选择双侧合谷穴(LI4),内关穴(PC6)和足三里(ST36)作为穴位刺激30分钟,刺激频率为疏密波2/30 Hz,强度以患者所能承受为限(6-8 m A),对照组患者则仅将电极贴片贴于穴位,不给予电刺激。术中行Narcotrend脑电监测仪监测麻醉深度,记录术中血流动力学参数,采集外周静脉血行皮质醇和β-内啡肽检测。首要观察指标是术中瑞芬太尼用量,次要观察指标是麻醉苏醒质量和麻醉相关副作用。结果:TEAS组瑞芬太尼用量(0.063±0.026μg·kg-1·min-1)相比对照组(0.091±0.032μg·kg-1·min-1)减少了30%。两组间术中血流动力学和血浆β-内啡肽、皮质醇水平无显著差异(P>0.05)。然而,拔管和苏醒时间在对照组分别为17(5)和14(8)min显著长于TEAS组(P<0.05),TEAS组术后24小时眩晕和皮肤瘙痒发生率显著低于对照组(P<0.05)。结论:经皮穴位电刺激确实产生了针刺镇痛效应,大大减少了全麻术中瑞芬太尼用量并降低术后麻醉相关并发症的发生率,是一种值得推广的辅助麻醉方法。

Objective： 1.To determine whether the TEAS can reduce the consumption of the anesthetics undergoing modified radical mastectomy, resulting in the throes of acupuncture effects, and shorten the patient regain consciousness and extubation time. 2.To assess whether the TEAS can significantly reduce postoperative nausea and vomiting, dizziness and pruritus and alleviate the post-operative side effects. 3.To investigate whether the effect of electrical acupoint stimulation is closely related to beta-endorphin and cortisol. Methods： Sixty patients undergoing modified radical mastectomy were randomly assigned to control group（CON group） and transcutaneous electrical acupoint stimulation group（TEAS group）. Before operation, TEAS consisted of 30 min of electrical stimulation（6-8 m A,2/30 Hz） on the Hegu（LI4）,Neiguan（PC6） and Zusanli（ST36） before anesthesia. The patients in the control group had the electrodes applied, but received no stimulation. Narcotrend EEG monitor was used to monitor the depth of anesthesia. Perioperative haemodynamics were recorded, and peripheral blood samples were collected to measure the levels of cortisol and beta-endorphin. The primary end point was intraoperative remifentanil consumption and the secondary endpoints were recovery quality and anesthesia-related side-effects. Results： Patients in the TEAS group required 30% less remifentanil during surgery than controls [0.091（SD 0.032） μg·kg^-1·min^-1vs 0.063（0.026） μg·kg^-1·min^-1]. There were no differences in intra-operative haemodynamics or beta-endorphin and cortisol between the groups. However, the time to extubation and regain in the control group was 17（5） min and 14（8） min, respectively,significantly longer than that in the TEAS group（P〈0.05）. TEAS also decreased the incidence of dizziness and pruritus within the first 24 h after surgery（P〈0.05）. Conclusions： TEAS produced acupuncture analgesia, greatly reduced intra-operative remifentanil consumption and alleviated the post-operative side effects, suggesting that the TEAS-assisted anesthesia was worthy of wide application and being generalized.