经皮穴位电刺激对甲状腺手术后围拔管期应激反应的影响

Effect of Transcutaneous Electrical Acupoint Stimulation on Stress Response during Extubation of General Anesthesia after Thyroidectomy

目的:观察经皮穴位电刺激对行甲状腺手术的患者全麻围拔管期应激反应的影响。方法:选择择期行甲状腺手术的患者60例,随机分为经皮穴位电刺激(T)组和假电刺激(C)组,T组麻醉诱导前30分钟给予电刺激,C组患者仅将电极片贴附在相同穴位但不给予电刺激。记录两组在入室(T0)、手术结束时(T1),拔管后即刻(T2),拔管后5 min(T3),拔管后10 min(T4)的血压(NIBP)、平均动脉压(MAP)、心率(HR)以及静脉血中的肾上腺素(E)、去甲肾上腺素(NE)、皮质醇(Cor)的浓度;记录两组的拔管质量评分以及Ricker镇静-躁动评分。结果:T组在T2~T4时的NIBP、MAP、HR以及E、NE、Cor的浓度均较C组显著降低(P<0.05);与C组比较,T组的拔管质量评分以及Ricker镇静-躁动评分降低(P<0.05)。结论:经皮穴位电刺激能够减轻行甲状腺手术患者全麻围拔管期的应激反应,有利于维持血流动力学稳定。

Objective： To investigate the effects of transcutaneous electrical acupoint stimulation（TEAS） on stress response during extubation of general anesthesia in patients undergoing thyroidectomy. Methods： Sixty patients, ASA I ~II, undergoing thyroidectomy under general anesthesia were randomly divided into 2 groups（n=30 each） using a random number table： transcutaneous electrical acupoint stimulation group（T group） and Sham stimulation group（C group）. 30 mins prior to the induction of anesthesia, patients in T group were given electrical stimulation, patients in C group had the electrodes applied, but received no stimulation. Baseline（T0）, at the end of operation（T1）, immediately after extubation（T2）, and at 5, 10 min after extubation（T3, T4） noninvasive arterial blood pressure（NIBP）,mean arterial pressure（MAP） and heart rate（HR） were recorded. Blood samples were taken from the vein artery at T0~T4 to record the concentration of Epinephrine（E）, Norepinephrine（NE） and Cortisone（Cor）. The extubation quality score, Ricker sedation-agitation scale, were also recorded and analyzed. Results： Compared with the baseline value at T0, NIBP, MAP, HR were significantly increased at T2~T4 in both groups（P〈0.05）; The NIBP, MAP, HR and concentrations of E, NE, Cor in T group were lower than those in C group at T2~T4（P〈0.05）; Compared with C group, the extubation quality score and the Ricker sedation-agitation scale was lower（P〈0.05）. Conclusions： Transcutaneous electrical acupoint stimulation could restrain the stress response during extubation of general anesthesia in patients undergoing thyroidectomy, and be conducive to maintain the hemodynamics stability.