经皮穴位电刺激对咪达唑仑镇静作用的影响

Effect of Transcutaneous Acupoint Electrical Stimulation on Conscious Sedation of Midazolam

目的:探讨经皮穴位电刺激对咪达唑仑镇静作用的影响。方法:选择在我院择期椎管内麻醉行骨科下肢手术患者80例,随机分为两组:经皮穴位电刺激组和对照组,每组均40例。经皮穴位电刺激组在完成椎管内麻醉后开始给予经皮穴位电刺激,刺激参数频率2/100 Hz,波宽0.2~0.6 ms,调节刺激电流至患者可耐受的最大强度,穴位选择双侧合谷穴、内关穴,20 min后靶控输注咪达唑仑。对照组患者在相应穴位贴电极片,并连接刺激器,不予电刺激。对患者进行警觉/镇静(OAA/S)评分,依据脑电双频指数(BIS)调整咪达唑仑靶控输注浓度。观察并记录OAA/S评分首次为3分时的目标靶浓度(Ce)、BIS、咪达唑仑用量、平均动脉压(MAP)、血氧饱和度(SpO2)、心率(HR)及氟马西尼使用和不良反应发生情况。结果:经皮穴位电刺激组在OAA/S评分首次为3分时咪达唑仑效应室靶浓度较对照组低[(60.3±8.0)ng/mL vs.(66.8±8.5)ng/mL],经皮穴位电刺激组的咪达唑仑用量少于对照组[(4.9±0.6)mg vs.(5.3±0.5)mg],差异均有统计学意义(P<0.05);经皮穴位电刺激组术后应用氟马西尼12例,低于对照组的28例,差异有统计学意义(P<0.05);2组间BIS、SpO2、MAP、HR差异无统计学意义。结论:经皮穴位电刺激能够增强咪达唑仑的镇静作用,减少咪达唑仑用量。

Objective To investigate the effect of transcutaneous acupoint electrical stimulation(TAES)on sedation of midazolam.Methods Totally 80 patients undergoing lower limb surgery under elective spinal anesthesia in our hospital were randomly divided into two groups(n=40):TAES group and control group.In the TAES group,TAES was given after spinal anesthesia.The frequency of stimulation parameters was 2/100 Hz and the wave width was 0.2–0.6 ms.The stimulation current was adjusted to the maximum intensity that the patients could tolerate.Bilateral Hegu and Neiguan acupoints were selected as acupoints,and midazolam was injected by target-controlled infusion 20 min later.The patients in the control group applied electrodes at corresponding acupoints and connected stimulator without electric stimulation.The patients were scored by OAA/S and the target-controlled infusion concentration of midazolam was adjusted according to BIS,Ce,BIS,midazolam dosage,SpO2,MAP,HR,flumazenil use and adverse reactions were observed and recorded when OAA/S score was 3 min for the first time.Results The target concentration of midazolam in the TEAS group(60.3±8.0)ng/mL was lower than that in the control group(66.8±8.5)ng/mL(P<0.05),and the dose of midazolam in the TAES group(4.9±0.6)mg was less than that in the control group(5.3±0.5)mg(P<0.05).There were 12 cases in the TEAS group and 28 cases in the control group,with significant difference(P<0.05);there were no significant differences in BIS,SpO2,MAP and HR between the two groups(P>0.05).Conclusion TAES can enhance the sedative effect of midazolam and reduce the dosage of midazolam.