经皮穴位电刺激对胆囊切除术老年患者的肺保护作用

Protective Effect of Transcutaneous Electrical Acupoint Stimulation on Lung in Elderly Patients Undergoing Cholecystectomy

目的:评价经皮穴位电刺激对老年患者腹腔镜胆囊切除术中的肺保护作用。方法:选择我院择期腹腔镜胆囊手术患者40例,年龄≥65岁,采用随机数字表法分为经皮穴位电刺激组(T组)和对照组(C组),每组20例。T组于麻醉前30 min经皮电刺激足三里、内关、合谷穴直至手术结束,C组不给予穴位电刺激。两组患者样本采集时间点标记为:麻醉诱导前(T0)、气管插管后即刻(T1)、建立气腹后(T2)、关闭气腹后10 min(T3)、拔除气管导管后5 min(T4)。记录患者心率、平均压情况、手术时间、拔管时间。分别在T1、T2、T3时间点采集桡动脉血行动脉血气分析,记录患者机械通气状态下气道峰压(P_(peak))、平均气道压(P_(mean))、驱动压(DP),并计算氧合指数(OI)。在T0、T4采静脉血送检,检测血清TNF-α及IL-1β水平。结果:T组患者术中丙泊酚、瑞芬太尼用量明显少于C组(P<0.05)。T组患者拔管时间短于C组(P<0.05)。T组患者在T2、T3时刻P_(peak)、P_(mean)、DP及OI与C组患者比较,差异均有统计学意义(P<0.05)。两组患者气腹建立前后组内P_(peak)、P_(mean)、DP及OI比较,差异均有统计学意义(P<0.05);T组患者T3时刻P_(mean)、DP与T1时刻比较,差异均无统计学意义(P>0.05)。T组患者术后TNF-α及IL-1β水平升高幅度小于C组(P<0.05)。结论:经皮穴位电刺激技术可以减少麻醉药用量,增加老年患者腹腔镜手术中气道顺应性,改善OI,减轻机体炎症反应。

Objectives:To evaluate the protective effect of transcutaneous electrical acupoint stimulation(TEAS)on lung in elderly patients undergoing laparoscopic cholecystectomy.Methods:A total of 40 patients(age≥65 years old)with elective laparoscopic cholecystectomy in our hospital were selected.The patients were divided into TEAS group and control group,with 20 patients in each group.The TEAS group received transcutaneous electrical stimulation at Zusanli(ST36),Neiguan(PC6)and Hegu(LI4)points 30 minutes before anesthesia until the end of surgery,while the control group did not receive acupoint electrical stimulation.The sample collection time points of the two groups were marked as:before anesthesia induction(T0),immediately after endotracheal intubation(T1),after pneumoperitoneum establishment(T2),10 min after pneumoperitoneum closure(T3),and 5 min after endotracheal tube removal(T4).The heart rate,mean pressure,operation time and extubation time of the patients were recorded.Arterial blood gas analysis of radial artery was collected at T1,T2 and T3 time points,respectively.Airway peak pressure(P_(peak)),mean airway pressure(P_(mean))and driving pressure(DP)under mechanical ventilation were recorded,and oxygenation index(OI)was calculated.Venous blood samples were collected at T0 and T4 for detection of serum TNF-α and IL-1β levels.Results:The dosage of propofol and remifentanil in TEAS group was significantly less than that in control group(P<0.05).The extubation time in TEAS group was shorter than that in control group(P<0.05).The differences in P_(peak),P_(mean),DP and OI at T2 and T3 between the TEAS group and the control group were statistically significant(P<0.05).There were differences in P_(peak),P_(mean),DP and OI between the two groups before and after the establishment of pneumoperitoneum(P<0.05).There was no significant difference in P_(peak) and DP at T3 and T1 in TEAS group(P>0.05).The levels of TNF-α and IL-1β in TEAS group were lower than those in control group(P<0.05).Conclusion:TEAS can reduce the dosage of anesthetics,increase airway compliance during laparoscopic surgery in elderly patients,improve oxygenation index,and reduce inflammatory response.