全身麻醉复合经皮穴位电刺激在小儿加速康复外科的应用

Application of general anesthesia combined with transcutaneous electrical acupoint stimulation in pediatric enhanced recovery after surgery

目的观察全身麻醉(全麻)复合经皮穴位电刺激(TEAS)在小儿加速康复外科(ERAS)的应用效果。方法择期行扁桃体切除和鼻内镜下腺样体射频消融术患儿60例随机分为两组,每组30例。C组仅用静脉复合全麻;T组从麻醉前30min直至术毕加用TEAS两侧合谷和内关穴位。记录术毕麻醉恢复时间、拔管时间和术中全麻药的用量。评估拔管后5min和15min时的苏醒期躁动评分(PAED)和改良加拿大东安大略儿童医院疼痛评分(m-CHEOPS)。于术后1d和1周回访患儿术后不良行为改变发生情况。结果T组术中丙泊酚和雷米芬太尼总用量少于C组(P<0.05)。T组拔管时间和麻醉恢复时间短于C组(P<0.05)。与C组相比,T组患儿拔管后5min和15min时的PAED评分降低,躁动发生率下降(P<0.05)。T组术后1d的m-CHEOPS评分少于C组(P<0.05)。结论全麻复合TEAS在小儿ERAS中安全、有效,有较好的应用价值。

Objective To investigate the effect of general anesthesia combined with transcutaneous electrical acupoint stimulation(TEAS)on the enhanced recovery after surgery(ERAS)in pediatric patients.Methods Sixty children undergoing elective adenotonsillectomy and radiofrequency adenoid ablation under nasal endoscopy were randomly assigned into two groups with 30cases each.Group C received general anesthesia alone.Group T given additional TEAS at bilateral points of hegu and neiguan,which was performed continuously from 30minutes before anesthesia induction till the end of operation.The recovery time of anesthesia,extubation time and the amount of intraoperative general anesthetic were recorded.At the time points of 5and 15 minutes after extubation,pediatric anesthesia emergence delirium(PAED)score and modified Children's Hospital of Eastern Ontario Canada Pain Scale(m-CHEOPS)score were evaluated.The occurrence of the negative postoperative behavioral changes was observed one day and one week after operation.Results The total consumption of propofol and remifentanil in group T was less than that in group C(P<0.05).The extubation time and anesthesia recovery time of group T were shorter than those of group C(P<0.05).At the time points of 5and 15minutes after extubation,the PAED score was decreased and the incidence rate of restlessness was lower in group T than those in group C(P<0.05).The m-CHEOPS score one day after operation was decreased in group T than that in group C(P<0.05).Conclusion General anesthesia combined with TEAS is safe and effective in pediatric ERAS,and has a good application value.