电针对腹腔镜全麻患者术后寒战的影响

Effect of electroacupuncture on laparoscope postoperative shivering in patients undergoing general anesthesia

目的:观察电针对腹腔镜全麻患者术后寒战的影响,并探讨其作用机制。方法:将择期于全身麻醉下行腹腔镜肠道肿瘤切除术患者80例随机分为电针组和曲马多组,每组40例。手术结束前30 min,电针组于内麻点与足三里予电针治疗,疏密波,频率2 Hz/100 Hz,电流强度1 mA,留针30 min;曲马多组静脉注射盐酸曲马多注射液(1 mg/kg)。记录两组患者在麻醉恢复室(PACU)期间寒战及头晕、恶心呕吐和躁动的发生情况;观察治疗前(T_(0))、拔管即刻(T_(1))、拔管后3 min(T_(2))和术后1 h(T_(3))的心率(HR)、收缩压(SBP)和舒张压(DBP);采用ELISA法检测T_(0)和T_(3)时间点血浆白细胞介素6(IL-6)和5-羟色胺(5-HT)的含量;记录拔管时发生呛咳和躁动的情况。结果:(1)电针组患者在PACU寒战、头晕、恶心呕吐和躁动的发生率低于曲马多组(P<0.05)。(2)与T_(0)比较,曲马多组患者HR、SBP和DBP在T_(1)和T_(2)时间点升高(P<0.05);电针组患者HR、SBP和DBP在T1和T2时间点低于曲马多组(P<0.05)。(3)与T_(0)比较,曲马多组患者血浆IL-6和5-HT在T_(3)时间点升高(P<0.05);电针组患者血浆IL-6和5-HT在T_(3)时间点低于曲马多组(P<0.05)。(4)电针组患者拔管时呛咳与躁动发生率低于曲马多组(P<0.05)。结论:电针能降低腹腔镜全麻患者术后寒战的发生率,其机制可能与调控手术创伤引起IL-6和5-HT的表达有关。

Objective To observe the effect of electroacupuncture(EA)on laparoscope postoperative shivering in patients undergoing general anesthesia and explore its effect mechanism.Methods A total of 80 patients with elective laparoscopic resection of intestinal tumor under general anesthesia were randomly divided into an EA group and a tramadol group,40 cases in each group.Thirty min prior to the end of the operation,in the EA group,EA was exerted at Neimadian and Zusanli(ST 36),with disperse-dense wave,2 Hz/100 Hz in frequency,1 mA in intensity,and lasting 30 min.In the tramadol group,tramadol hydrochloride injection was dropped intravenously,1 mg/kg.The conditions of shivering,dizziness,nausea,vomiting and agitation were observed in the post-anesthesia care unit(PACU).Heart rate(HR),systolic blood pressure(SBP)and diastolic blood pressure(DBP)were observed before treatment(T_(0)),at the moment of extubation(T_(1)),in 3 min of extubation(T_(2))and 1 h after operation(T_(3)).Using ELISA,at T_(0)and T_(3),the expression levels of interleukin 6(IL-6)and 5-hydroxytryptamine(5-HT)in plasma were detected separately.Choking and agitation were recorded during extubation.Results(1)In the EA group,the incidence of shivering,dizziness,nausea,vomiting and agitation in the PACU was lower than that in the tramadol group(P<0.05).(2)Compared with T_(0),HR,SBP and DBP were increased at T_(1) and T_(2) in the tramadol group(P<0.05).HR,SBP and DBP in the EA group were lower than the tramadol group at T_(1) and T_(2)(P<0.05).(3)Compared with T_(0),the expression levels of IL-6 and 5-HT in plasma were increased at T_(3) in the tramadol group(P<0.05).The expression levels of IL-6 and 5-HT in the EA group were lower than the tramadol group at T_(3)(P<0.05).(4)The incidence of choking and agitation during exudation in the EA group was lower than that in the tramadol group(P<0.05).Conclusion Electroacupuncture can reduce the incidence of laparoscopic postoperative shivering under general anesthesia.The potential mechanism mays related to the modulation of the expression levels of IL-6 and 5-HT caused by surgical trauma.