全身麻醉联合经皮穴位电刺激在小儿腹腔镜疝修补术中的应用效果

Effect of general anesthesia combined with transcutaneous electrical acupoint stimulation on laparoscopic herniorrhaphy in children

目的探讨全身麻醉联合经皮穴位电刺激在小儿腹腔镜疝修补术中的应用效果。方法选择2017年10月至2018年10月广州市中西医结合医院拟择期在全身麻醉下行腹腔镜疝修补术患儿60例,采用随机数字表法分为研究组和对照组,每组30例。两组均由同一组外科医师实施手术,采用相同药物的静吸复合全麻,研究组辅以经皮穴位电刺激,对照组单纯实施静吸复合麻醉。两组患儿全麻诱导后置入气管导管后行机械通气,以瑞芬太尼2μg/kg及2%七氟烷吸入维持麻醉。记录时点设定为麻醉诱导前30 min(T0)、插管后即刻(T1)、手术开始(T2)、手术缝皮结束(T3)、拔除气管导管时(T4)、拔管后5 min(T5),观察不同时点血压和心率,记录手术时间、麻醉时间、拔管时间、麻醉恢复室停留时间,观察拔管期间躁动、恶心呕吐等不良反应情况,记录躁动评分结果。结果两组患儿的一般情况及手术时间比较差异未见统计学意义(P>0.05)。研究组患儿在T2、T3、T4、T5时点心率及平均动脉压明显低于对照组(P<0.05)。研究组患儿在T4、T5时点的躁动评分显著低于对照组(P<0.05)。对照组患儿的拔管时间和在麻醉恢复室停留时间均比研究组延长,术后恶心呕吐等不良反应的发生率高于研究组,两者差异有统计学意义(P<0.05)。结论经皮穴位电刺激联合全身麻醉能使小儿腹腔镜下疝修补术的拔管期血流动力学更稳定,缩短了拔管及麻醉恢复室停留时间,降低不良反应的发生率。

Objective To investigate the effect of general anesthesia combined with transcutaneous electrical acupoint stimulation on laparoscopic herniorrhaphy in children.Methods From October 2017 to October 2018,60 cases of children undergoing laparoscopic hernia repair under general anesthesia in Guangzhou Hospital of Integrated Traditional Chinese and Western Medicine were selected and divided into study group and control group by random number table method,with 30 cases in each group.Both groups were operated by the same group of surgeons,and the same drugs of static aspiration combined with general anesthesia were used.The study group was supplemented by percutaneous electrical stimulation at acupoints,and the control group was simply administered with static aspiration combined with anesthesia.After general anesthesia induction,the children in the two groups received mechanical ventilation after endotracheal catheter placement,and were maintained with remifentanil 2 g/kg and 2%sevoflurane inhalation.Record point set for 30 min(T0)before anesthesia induction and intubation(T1),immediately after surgery(T2),sewing leather end(T3),removing the endotracheal tube(T4),5 min after extubation(T5).The blood pressure and heart rate,the operation time,anesthesia time,extubation time,anesthesia recovery room,residence time at different time point was recorded,and the agitation during extubation,adverse reactions such as nausea and vomiting,agitation score results were observed.Results There was no significant difference in general conditions or operation time between the two groups(P>0.05).The heart rate and mean arterial pressure of the children in the study group were significantly lower than those in the control group at time points T2,T3,T4 and T5(P<0.05).The agitation score of the children in the study group at time point T4 and T5 was significantly lower than that of the control group(P<0.05).In the control group,the duration of extubation and stay in the anesthesia recovery room were longer than those in the study group,and the incidence of postoperative adverse reactions such as nausea and vomiting was higher than that in the study group,with significant differences(P<0.05).Conclusions Percutaneous electrical stimulation combined with general anesthesia can make the hemodynamics of extubation period more stable,shorten the time of extubation and staying anesthesia recovery room,and reduce the incidence of adverse reactions during laparoscopic hernia repair in children.