电针刺激患肢同侧星状神经节对上肢骨折全麻患者手术应激反应的影响

Effect of electroacupuncture stimulation of the ipsilateral stellate ganglion on the surgical stress response in patients under general anesthesia for upper limb fracture surgery

目的探讨电针刺激患肢同侧星状神经节对上肢骨折全麻患者手术应激反应及炎症反应的抑制作用。方法选取2021-12/2023-06期间因上肢骨折拟行全麻手术治疗的患者70例,采用随机数字表法分为对照组(n=35)和试验组(n=35)。麻醉诱导前,对照组予针刺患肢侧星状神经节20 min,不予任何频率和强度的针刺通电操作,试验组予高频电针刺激患肢侧星状神经节20 min。比较2组患者入手术室时(T_(1))、气管插管即刻(T_(2))、手术开始时(T_(3))、手术结束时(T_(4))和气管拔管时(T_(5))5个时间点:应激反应血液指标(肾上腺素、皮质醇)及炎症反应指标(肿瘤坏死因子α、白介素6)。记录术中阿片类药物(舒芬太尼和瑞芬太尼)用量。结果与对照组比较,试验组应激反应指标及炎症反应指标均较低,术中阿片类药物用量减少,差异具有统计学意义(P<0.05)。结论术前应用电针刺激星状神经节,可抑制手术麻醉过程中的应激反应,减少炎症因子的释放,降低阿片类药物用量。

Objective To explore the inhibitory effects of electroacupuncture stimulation of the ipsilateral stellate ganglion on the surgical response and inflammation response in patients with upper limb fracture under general anesthesia.Methods A total of 70 patients scheduled to receive upper limb fracture under general anesthesia,from December 2021 to June 2023,were divided into the control group(n=35)and the experimental group(n=35)according to random number table method.The control group received 20 min acupuncture,while the experimental group received high frequency electroacupuncture stimulation of the stellate ganglion for 20 min.Stress response blood indexes(epinephrine,norepinephrine,cortisol),and inflammatory response indexes(TNF-α,IL-6)were recorded at entering the operating room(T_(1)),immediately after endotracheal intubation(T_(2)),the beginning of surgery(T_(3)),the end of surgery(T_(4))and endotracheal extubation(T_(5)).Intraoperative opioid dosage(Sufentanil and remifentanil)were recorded.Results Compared with the control group,stress response blood indexes and inflammatory response indexes of the experimental group were lower(P<0.05).Conclusion Preoperative application of electroacupuncture stimulation of the stellate ganglion inhibits the stress response during surgery and the release of inflammatory factors in patients as well as reduces the intraoperative opioid dosage.