内关穴联合膻中穴经皮穴位电刺激对乳腺癌根治术患者围术期疼痛的影响

Effect of transcutaneous electrical acupoint stimulation at Neiguan combined with Danzhong on perioperative pain in patients undergoing radical mastectomy

目的探讨内关穴联合膻中穴经皮穴位电刺激对乳腺癌根治术患者术中瑞芬太尼用量和术后早期疼痛的影响。方法选择择期全麻下行乳腺癌根治术的女性患者153例,年龄18~64岁,BMI 18.5~30.0 kg/m^(2),ASAⅠ或Ⅱ级。将患者随机分为三组:单穴组(内关穴)、双穴组(内关穴和膻中穴)和对照组,每组51例。在麻醉诱导前30 min行经皮穴位电刺激(单穴组刺激内关穴,双穴组刺激内关穴和膻中穴,对照组不刺激),采用疏密波2/10 Hz,强度4~11 mA,持续时间30 min。记录术中瑞芬太尼用量、呼之睁眼时间和拔管时间。记录PACU内和术后24 h VAS疼痛评分及患者满意度评分。结果双穴组术中瑞芬太尼用量明显少于单穴组和对照组(P<0.05)。双穴组患者满意度评分明显高于单穴组和对照组(P<0.05)。三组在PACU内及术后24 h VAS疼痛评分差异无统计学意义。结论与单纯电刺激内关穴比较,同时刺激内关穴和膻中穴明显减少乳腺癌根治术患者术中的瑞芬太尼用量,患者满意度明显提高。

Objective To investigate the effects of transcutaneous electrical acupoint stimulation at Neiguan combined with Danzhong on intraoperative remifentanil dosage and early postoperative pain in patients undergoing radical mastectomy.Methods A total of 153 female patients undergoing radical mastectomy under general anaesthesia aged 18-64 years,BMI 18.5-30.0 kg/m^(2) and ASA physical statusⅠorⅡwere enrolled.The patients were randomly assigned into three groups:single-acupoint(Neiguan)group,dual-acupoint(Neiguan and Danzhong)group and control group,51 patients in each group.TEAS for 30 minutes at different points(Neiguan combined with Danzhong for the dual-acupoint group,Neiguan for the single-acupoint group,no stimulation for the sham group)were given before anaesthesia induction.30 minutes of disperse/dense stimulation of 2/10 Hz with an intensity of 4-11 mA was used.The consumption of remifentanil,time to recall and to extubation were recorded.The visual analogue scale(VAS)pain score in PACU and 24 hours after surgery,and patient satisfaction scores was recorded.Results The intra-operative remifentanil consumption in the dual-acupoint group was significantly less than groups single-acupoint and sham(P<0.05).Patient satisfaction score 24 hours after surgery was significantly higher in the dual-acupoint group than those in groups single-acupoint and sham(P<0.05).The VAS scores in PACU and 24 hours after surgery had no significantly differences among the three groups.Conclusion Compared with single-acupoint,stimulation at Neiguan combined with Danzhong in patients undergoing radical mastectomy induced stronger remifentanil-sparing effect and higher patients satisfaction after radical mastectomy.