经皮穴位电刺激对乳腺癌改良根治术患者焦虑的影响

Effect of transcutaneous electrical acupoint stimulation on anxiety of patients undergoing modified radical mastectomy for breast cancer

目的评价经皮穴位电刺激对乳腺癌改良根治术患者焦虑的影响。方法择期行乳腺癌改良根治术女性患者(医院焦虑抑郁量表中焦虑亚量表评分≥8分)90例,年龄18~64岁,BMI 18.5~28.0 kg/m2,ASA分级Ⅰ或Ⅱ级。采用随机数字表法分为2组(n=45):经皮穴位电刺激组(T组)和对照组(C组)。T组于术前1 d及手术当日麻醉诱导前各行1次经皮穴位电刺激,选穴为患者印堂穴及术侧内关穴、劳宫穴、足三里穴,频率2/100 Hz,疏密波,强度以患者能接受的最大电流强度为宜,时间30 min。C组仅在相同穴位处粘贴电极片无电流通过。2组均采用静吸复合全身麻醉,麻醉维持采用靶控输注丙泊酚和瑞芬太尼。于手术当日第2次刺激前、术后1、3 d和术后3个月采用医院焦虑抑郁量表评估患者焦虑和抑郁评分。于第1次刺激前、术后3 d和3个月时采用15项恢复质量评分量表(QoR-15量表)评估患者术后恢复质量。于术后3个月电话随访,采用Leeds神经性症状和体征评估量表评估神经病理性疼痛的发生情况。记录术中丙泊酚及瑞芬太尼的用量、拔除喉罩时间及术后并发症的发生情况。结果与C组比较,T组患者手术当日第2次刺激前、术后1 d内和术后3 d内焦虑发生率降低,术后3 d时QoR-15量表评分升高,术中丙泊酚和瑞芬太尼用量减少,拔除喉罩时间缩短(P<0.05)。2组患者术后止吐药物使用率、便秘、发热及皮下积液发生率、补救镇痛率、术后3个月内焦虑发生率、QoR-15量表评分及神经病理性疼痛发生率比较差异无统计学意义(P>0.05)。结论经皮穴位电刺激可降低乳腺癌改良根治术患者焦虑的发生,提高患者术后早期恢复质量。

Objective To evaluate the effect of transcutaneous electrical acupoint stimulation(TEAS)on the anxiety of patients undergoing modified radical mastectomy for breast cancer.Methods Ninety female patients(the anxiety subscale of Hospital Anxiety and Depression Scale score≥8)with breast cancer,aged 18-64 yr,with body mass index of 18.5-28.0 kg/m2,of American Society of Anesthesiologists physical statusⅠorⅡ,scheduled for elective modified radical mastectomy,were divided into 2 groups(n=45 each)using a random number table method:TEAS group(group T)and control group(group C).In group T,TEAS was performed on 1 day before operation and before induction of anesthesia on the day of operation,Yintang(EX-HN3)and Neiguan(PC6),Laogong(PC8),and Zusanli(ST36)were selected as the main acupoints,patients received TEAS with a frequency 2/100 Hz,disperse-dense waves,the intensity was the maximum current that could be tolerated,and each TEAS lasted for 30 min.In group C,only the electrodes were pasted at the same acupoints without electric current.Both groups received combined intravenous-inhalational general anesthesia,and anesthesia was maintained by target-controlled infusion of propofol and remifentanil.Before the second TEAS on the day of operation,and 1st and 3rd days and 3rd month after operation,the Hospital Anxiety and Depression Scale was used to evaluate the patient′s anxiety and depression.Before the first TEAS and at 3rd day and 3rd month after operation,the Quality of Recovery-15(QoR-15)was used to evaluate the quality of recovery.The patients were followed up by telephone at the 3rd month after operation,and Leeds Assessment of Neuropathic Symptoms and Sign Scale was used to assess the occurrence of neuropathic pain.The consumption of propofol and remifentanil during operation,time of laryngeal mask removal,and occurrence of postoperative complications were recorded.Results Compared with group C,the incidence of anxiety was significantly reduced before the second stimulation on the day of surgery,within 1 day after surgery,and within 3 days after surgery,QoR-15 scores were increased at 3 days after surgery,the consumption of propofol and remifentanil during operation was reduced,and the time of laryngeal mask removal was shortened in group T(P<0.05).There was no significant difference in the use of postoperative antiemetic drug,incidence of constipation,fever and subcutaneous fluid,requirement for rescue analgesia,incidence of anxiety within 3 months after surgery,QoR-15 score,and incidence of neuropathic pain between the two groups(P>0.05).Conclusion TEAS can decrease the occurrence of anxiety and improve the quality of early postoperative recovery in the patients undergoing modified radical mastectomy for breast cancer.