经皮穴位电刺激辅助全身麻醉对腹腔镜胆囊手术麻醉管理及效果的影响

Effects of transcutaneous electrical acupoint stimulation assisted general anesthesia on anesthetic management and efficacy in laparoscopic gallbladder surgery

目的观察经皮穴位电刺激辅助全身麻醉下腹腔镜胆囊切除术的麻醉管理及效果的影响。方法选择北京市第一中西医结合医院2019年3月至2020年3月择期行腹腔镜胆囊手术患者80例,采用随机数字表法分为经皮穴位电刺激组(T组)和常规麻醉组(C组),最终每组各38例(两组各有2例自愿退出)。T组于麻醉诱导前30 min经皮电刺激足三里、内关、合谷穴直至手术结束,C组则采用常规全身麻醉方法完成手术,不给予穴位电刺激。记录两组患者麻醉诱导前(T1)、气管插管时(T2)、切皮时(T3)、手术探查时(T4)、术毕拔管时(T5)心率、平均血压。采用视觉模拟评分法(VAS)对术后(8、16、24、48 h)疼痛情况进行评估并记录疼痛评分,记录术中麻醉药物用量、手术时间、气管拔管时间、术后首次肛门排气时间及术后并发症发生情况。结果T组患者术中丙泊酚、瑞芬太尼用量少于C组(P<0.05)。T组术毕拔管时间、术后首次肛门排气时间短于C组(P<0.05)。两组患者手术时间和术中各时间点心率、平均血压变化比较,差异无统计学意义(P>0.05)。T组患者术后8、16 h VAS评分显著高于C组(P<0.05),但两组术后24、48 h VAS评分比较,差异无统计学意义(P>0.05)。T组患者术后恶心呕吐、躁动及嗜睡发生率少于C组(P<0.05)。结论全身麻醉辅助应用经皮穴位电刺激技术,可使患者术中血流动力学更加平稳,减轻术后疼痛,有利于促进术后胃肠道功能的早期康复。

Objective To observe the effects of anesthetic management and efficacy in laparoscopic cholecystectomy under transcutaneous electrical acupoint stimulation assisted general anesthesia.Methods A total of 80 patients undergoing elective laparoscopic cholecystectomy in Beijing First Hospital of Integrated Chinese and Western Medicine from March 2019 to March 2020 were selected and divided into the transcutaneous electrical acupoint stimulation group(Group T)and the conventional anesthesia group(Group C)according to the random number table method,with 38 patients in each group(2 patients in each group voluntarily withdrew).Group T underwent transcutaneous electrical stimulation at the foot Sanli,Neiguan and Hegu acupoints 30 minutes before induction of anesthesia until the end of surgery,while Group C underwent conventional general anesthesia until the completion of the surgery without electrical acupoint stimulation.The heart rate,mean blood pressure before induction of anesthesia(T1),at the time of tracheal intubation(T2),at the time of skin incision(T3),at the time of surgical exploration(T4)and at the time of extubation at the end of surgery(T5)in both groups were recorded.The postoperative(8,16,24 and 48 hours)pain was assessed by visual analogue scale(VAS)method and pain scores were recorded.The intraoperative anesthetic dosage,operation time,time of tracheal extubation,time of the first postoperative anal exhaust and the occurrence of postoperative complications were recorded.Results The intraoperative propofol and remifentanil dosage in Group T was less than that in Group C(P<0.05).The time to extubation at the end of surgery and the time of the first postoperative anal exhaust in Group T were shorter than those in Group C(P<0.05).There were no statistically significant differences between the two groups in the operating time and snack rate,mean blood pressure during operation changes(P>0.05).8-h and 16-h postoperative VAS scores in Group T were significantly higher than those in Group C(P<0.05),but there was no statistically significant difference between the two groups in 24-h and 48-h postoperative VAS scores(P>0.05).The incidence of postoperative nausea,vomiting,restlessness and somnolence in Group T was less than that in Group C(P<0.05).Conclusion The application of transcutaneous electrical acupoint stimulation assisted by general anesthesia can further stabilize the intraoperative hemodynamics,relieve postoperative pain,and facilitate early recovery of postoperative gastrointestinal function of patients.