经皮穴位电刺激对介入治疗脑损伤的保护作用观察

Protection of Transcutaneous Acupoint Electrical Stimulation for Brain Injury Undergoing Intervention:a Clinical Observation

目的观察穴位经皮电刺激联合右美托咪定对颅内动脉瘤性蛛网膜下腔出血患者介入治疗血流动力学的影响及脑损伤的保护作用。方法将行介入治疗的108例颅内动脉瘤性蛛网膜下腔出血患者按随机数字表分为电针组和对照组,每组54例。两组均给予右美托咪定麻醉,电针组以电针刺激患者双侧＂内关＂、＂列缺＂、＂云门＂穴,参数设定：疏密波,频率1.5Hz,强度2-4 mA,30 min。比较两组患者入室（T0）、给药（T1）、插管（T2）、苏醒（T3）、拔管（T4）、出室（T5）SBP、DBP、平均动脉血压（mean arterial pressure,MAP）、HR。比较入室（T0）、术毕即刻（T6）、术后6 h（T7）、术后12h（T8）和术后24 h（T9）的血清S100β蛋白（S100βprotein,S100β）和神经元特异性烯醇化酶（neuron specific enolase,NSE）水平。结果与本组T0比较,两组T1-T5 SBP、DBP、MAP、HR降低（P〈0.05）,T6-T9血清S100β及NSE升高（P〈0.05）。与对照组同期比较,电针组T1-T5SBP、DBP、MAP、HR降低（P〈0.05）,T6-T9血清S100β及NSE降低（P〈0.05）。结论经皮穴位电刺激联合右美托咪啶能有效维持颅内动脉瘤性蛛网膜下腔出血患者介入治疗术中血流动力学的稳定性,调节患者血清S100β和NSE水平。

Objective To observe the effect of transcutaneous acupoint electrical stimulation （TAES） combined dexmedetomidine on hemodynamic of intracranial aneurysmal subarachnoid hemorrhage patients undergoing intervention, and their protection for brain Injury. Methods Totally 108 intracranial aneurysmal subarachnoid hemorrhage patients undergoing intervention were randomly assigned to the electroacupuncture （EA） group and the control group according to random digit table, 54 in each group. All patients were anesthetized with dexmedetomidine. Patients in the EA group were needled at bilateral Neiguan （PC6）, Lieque （LU7）, and Yunmen （LU2）. Parameter setting was as follows： The dilatational wave at 1.5 Hz, strength 2-4 mA, 30 min. Systolic blood pressure （SBP）, diastolic blood pressure （DBP）, mean arterial pressure （MAP）, and heart rate （HR） were compared between the two groups immediately after entry into the room （T0）, after administration （T1）, intubating （T2）, resuscitation （T3）, extubation （T4）, and leaving the operating room （T5）. Levels of S100β protein （S100β） and neuron specific enolase （NSE） were compared between the two groups at To, immediately after surgery （T6）, 6 h after operation （T7）, 12 h after operation （T8）, and 24 h after operation （T9）. Results Compared with the same group at To, SBP, DBP, MAP, and HR were significantly reduced in the two groups at T1 -T5（P 〈0.05）, serum levels of S100β and NSE in the two groups were significantly increased at T6 -T9 （P〈0.05）. Compared with the control group at T1 -T5, SBP, DBP, MAP, and HR decreased in the EA group （P 〈0.05）. Compared with the control group at T6 -T9, serum levels of S100 βand NSE decreased in the EA group （P 〈 0.05）. Conclusion TAES combined dexmedetomidine could effectively maintain stable hemodynamics of intracranial aneurysmal subarachnoid hemorrhage patients undergoing intervention, and regulate their serum levels of S100β and NSE.