经皮穴位电刺激对乳腺癌根治术患者麻醉效果和心血管系统应激反应的影响

Effects of Transcutaneous Electrical Acupoint Stimulation on Anesthesia and Cardiovascular Stress Response in Patients Undergoing Radical Mastectomy

目的:探讨经皮穴位电刺激(TEAS)辅助超声引导下胸椎旁神经阻滞对乳腺癌根治术患者麻醉效果、心血管系统应激反应的影响。方法:选择120例行乳腺癌根治术患者,按随机数字表法分为对照组和观察组各60例,对照组术前行单纯超声引导下胸椎旁神经阻滞,观察组在对照组基础上行TEAS。记录两组围术期相关指标情况,对比两组患者不同时间点心率(HR)、平均动脉压(MAP)、脑电双频指数(BIS)水平、心血管系统应激反应指标[血管紧张素Ⅱ(AngⅡ)、皮质醇(CORT)、去甲肾上腺素(NE)、内皮素(ET)]水平,以及视觉模拟评分法(VAS)评分、Ramsay镇静评分及舒适度评分量表(BCS)评分,统计两组术后不良反应发生情况。结果:两组患者手术及麻醉时间比较,差异无统计学意义(P>0.05);观察组拔管及苏醒时间均短于对照组(P<0.001)。两组不同时间点的HR、MAP、BIS比较,差异有统计学意义(P<0.001);两组间HR、MAP、BIS比较,差异有统计学意义(P<0.001);观察组T1、T2、T3时间点HR、MAP、BIS均高于对照组;两组HR、MAP、BIS变化趋势比较,差异有统计学意义(P<0.001)。两组不同时间点的AngⅡ、CORT、NE、ET比较,差异有统计学意义(P<0.001);两组间AngⅡ、CORT、NE、ET比较,差异有统计学意义(P<0.001);观察组T2、T3时间点的AngⅡ、CORT、NE、ET均低于对照组;两组AngⅡ、CORT、NE、ET变化趋势比较,差异有统计学意义(P<0.001)。两组不同时间点的VAS评分、Ramsay镇静评分、BCS评分比较,差异有统计学意义(P<0.001);两组间VAS评分、Ramsay镇静评分、BCS评分比较,差异有统计学意义(P<0.001);观察组术后6 h、术后12 h的VAS评分、Ramsay镇静评分均低于对照组,BCS评分高于对照组;两组VAS评分、Ramsay镇静评分、BCS评分变化趋势比较,差异有统计学意义(P<0.001)。观察组不良反应发生率为3.33%,对照组为15.00%,差异有统计学意义(P<0.05)。结论:TEAS应用于乳腺癌根治术麻醉可有效平稳心血管系统,减轻应激反应,降低术后疼痛程度,且镇静效果较佳,安全性较高。

Objective:To investigate the effects of transcutaneous electrical acupoint stimulation(TEAS)-assisted ultrasound-guided thoracic paravertebral nerve block on anesthetic efficacy and cardiovascular stress response in patients undergoing radical mastectomy.Methods:A total of 120 patients undergoing radical mastectomy were randomly divided into the control group and the observation group,with 60 patients in each group.The control group received simple ultrasoud-guided thoracic paravertebral nerve block before surgery,and the observation group took TEAS on the basis of the treatment of the control group.Perioperative related indexes of the two groups were recorded.Heart rate(HR),mean arterial pressure(MAP),Bispectral index(BIS),cardiovascular stress response indexes[angiotensin Ⅱ(Ang Ⅱ),cortisol(CORT),norepinephrine(NE),endothelin(ET)]levels,visual analogue scale(VAS)score,Ramsay sedation score and bruggrmann comfort scale(BCS)score,and the occurrence of postoperative adverse reactions in the two groups were analyzed.Results:There was no significant difference in operation and anesthesia time between the two groups(P>0.05).Extubation and recovery time of the observation group were shorter than those of the control group(P<0.001).HR,MAP and BIS of the two groups at different time points were compared,and the differences were statistically significant(P<0.001).The differences in HR,MAP and BIS between the two groups were statistically significant(P<0.001).HR,MAP and BIS of the observation group were higher than those of the control group at T1、T2、T3 time points.The change trend of HR,MAP and BIS between the two groups was statistically significant(P<0.001).There were significant differences in Ang Ⅱ,CORT,NE and ET between the two groups at different time points(P<0.001).There were significant differences in Ang Ⅱ,CORT,NE and ET between the two groups(P<0.001).Ang Ⅱ,CORT,NE and ET in the observation group at T2、T3 were lower than those in the control group.The change trend of Ang Ⅱ,CORT,NE and ET between the two groups was statistically significant(P<0.001).VAS score,Ramsay sedation score and BCS score were compared between the two groups at different time points,and the differences were statistically significant(P<0.001).There were significant differences in VAS score,Ramsay sedation score and BCS score between the two groups(P<0.001).VAS score and Ramsay sedation score at 6 h and 12 h after surgery were lower in the observation group than those in the control group,but BCS score was higher than that in the control group.Comparison of the change trend of VAS score,Ramsay sedation score and BCS score between the two groups showed statistically significant differences(P<0.001).The incidence of adverse reactions was 3.33% in the observation group and 15.00% in the control group,and the difference was statistically significant(P<0.05).Conclusions:The application of TEAS in anesthesia for radical mastectomy can effectively stabilize the cardiovascular system,reduce stress response,and reduce postoperative pain,and the sedative effect is better and safe.