穴位电刺激对老年膝关节置换术患者寒战的影响

Efficacy of electrical stimulation at acupoint on shivering in elderly patients with knee arthroplasty

目的:探讨穴位电刺激对老年膝关节置换术患者寒战治疗效果。方法:选择ASA分级Ⅰ~Ⅱ级的80例老年膝关节置换术患者随机分为经皮穴位电刺激(TEAS)辅助麻醉组(T组)和单纯麻醉组(P组)。两组均采用连续腰麻方式进行麻醉,蛛网膜下腔给予0.75盐酸罗哌卡因2mL,控制麻醉阻滞平面高度T10~T8。T组在麻醉前进行穴位电刺激15min,以双侧合谷-曲池、三阴交-足三里穴位配对,波形采用疏密波,刺激频率2Hz/15Hz,强度以患者最大耐受为限。于未麻醉及穴位刺激前(T0)、麻醉成功手术前(T1)、手术开始后(T2)和手术结束(T3)时,分别记录心率(HR)、平均动脉压(MAP)、血氧饱和度(SPO2)和寒战程度。结果:T组寒战发生率低于P组(P <0.05)。T组于T1、T2、T3时间段内比P组寒战发生程度更轻(P <0.05)。T组HR于T1、T2相比于P组变化较小(P <0.05)。两组SPO2变化无差异(P> 0.05)。结论:经皮穴位电刺激能降低老年膝关节置换术患者寒战的发生,并能减轻麻醉手术对心率的影响。

Objective:To investigate the efficacy of electrical stimulation at acupoint on shivering in elderly patients with knee arthroplasty.Methods:80 cases were randomly divided into the electrical stimulation at acupoint and anesthesia group(group T)and anesthesia group(group P).Both groups were anesthetized by continuous lumbar anesthesia,the subarachnoid cavity was given 0.75 ropivacaine hydrochloride for 2mL,the control anesthesia block plane height T10~T8.Group T was given electrical stimulation at acupoint before anesthesia.Heart rate(HR),mean arterial pressure(MAP),blood oxygen saturation(SPO2)and degree of shivering were recorded before anesthesia,electrical stimulation at acupoint(T0)and operation(T1),during operation(T2)and after operation(T3).Results:The incidence of shivering in group T was lower than group P(P<0.05).The degree of shivering at T1,T2 and T3 in the group T were lighter than group P(P<0.05).The change of HR in T1 and T2 in group T was smaller than group P(P<0.05).There was no difference in the SPO2 between two groups(P>0.05).Conclusion:T electrical stimulation at acupoint can reduce the incidence of shivering in elderly patients with knee arthroplasty,and can reduce the effect of anesthesia on heart rate.