针刺辅助局麻对颈动脉支架置入患者脑血流及神经功能的影响

Effects of transcutaneous electrical acupoint stimulation and electro-acupuncture combined with local anesthesia on cerebral blood flow and brain function in CAS patients

目的观察针刺辅助局麻对颈动脉支架置入术(carotid artery stenting,CAS)患者脑血流及神经功能的影响。方法 CAS手术患者80例,男65例,女15例,年龄18~80岁,ASAⅠ~Ⅲ级,根据随机数字表法分为电针(electro-acupuncture,EA)组(A组)、经皮穴位电刺激(transcutaneous electrical acupoint stimulation,TEAS)组(T组)和假电针对照组(C组)。A组进行针刺;T组进行TEAS;C组采用假电针。测定术前、术后30min、术后1d的术侧大脑中动脉平均脑血流速度(Vm)。记录术后30min、术后1d高灌注的发生情况。记录术后1周、1个月和3个月的美国国立卫生研究院卒中量表(NIHSS)、总体评估量表(GES)评分。结果术后30min A组和T组Vm明显慢于C组(P<0.05)。术后30min C组出现高灌注患者有7例(25.0%),明显高于A组的1例(3.7%)和T组的0例(P<0.05)。术后1周、1个月和3个月A组和T组NIHSS评分均明显低于C组(P<0.05)。术后1周A组和T组GES评分明显改善人数明显多于C组(P<0.05)。结论针刺及TEAS复合局麻应用于CAS手术,可减少CAS患者术后脑血流一过性增加,降低术后30 min高灌注发生率,明显改善患者术后1周的神经功能评分。

Objective To investigate the effects of transcutaneous electrical acupoint stimulation（TEAS）and electro-acupuncture（EA）combined with local anesthesia on cerebral blood flow（CBF）and Brain function in CAS patients.Methods Eighty cases of CAS were randomly assigned into EA group（group A）,TEAS group（group T）and sham group（group C）.Patients in group A received EA at acupoints of Shuigou（GV26）and Baihui（GV20）,Hegu（L14）and Waiguan（TE5）at the same side of the stenting before 30 min of operation.Patients in group T received TEAS at the same acupoints through self-adhesive skin electrodes.In group T and group A,stimulations were continued until the end of the operation.The patients in group C did not received EA or TEAS.Blood pressure（BP）and heart rate（HR）were maintained at＋10%-20% of baseline.Preoperative and postoperative average Vm,PI,RI of middle cerebral artery were measured.The occurrence of hyperperfusion and preoperative and postoperative scores at 1 week,1 month,3 months National Institute of Health Stroke Scale and Global Assessment Scale were recorded.Results The Vm of groups A and T was significantly less than group C（P0.05）.The incidence of hyperperfusion of groups A and T were 3.7%,0% and 25.0% respectively（P0.05）.NIHSS score of group A and group T were lower than those of group C during postoperative 1 week,1 month,3 month（P〈0.05）,while the difference between groups A and T had no statistical significance.GES score of group A and group T during postoperative 1 week improved significantly than that of group C（P0.05）.Conclusion Both TEAS and EA combined with local anesthesia in CAS operation could reduce the increase of postoperative cerebral blood flow and the incidence of postoperative hyperperfusion,and obviously improve brain function during postoperative 1 week.Both TEAS and EA combined with local anesthesia could be a worthwhile anesthesia method in CAS patients.