胃肠镜检查术麻醉的优化:TEAS联合丙泊酚中度镇静的效果

Optimization of anesthesia for gastrointestinal endoscopy:effect of TEAS combined with moderate sedation with propofol

目的评价经皮穴位电刺激(TEAS)联合丙泊酚中度镇静(TEAS-丙泊酚平衡麻醉)用于胃肠镜检查术的优化效应。方法本研究为随机单盲对照试验。选择青岛大学附属医院内镜诊疗中心2022年5—8月拟行胃肠镜检查术患者,年龄18~64岁,ASA分级Ⅰ-Ⅲ级。采用区组随机分组法分为2组:常规麻醉组(C组)采用丙泊酚中度镇静复合芬太尼50μg常规麻醉;TEAS-丙泊酚平衡麻醉组(TPB组)术前至术毕TEAS双侧内关、合谷和足三里穴位,联合丙泊酚中度镇静(改良警觉镇静评分为3分)。观察麻醉有效性和安全性及转归相关各指标。结果本研究招募66例患者,每组33例,两组麻醉失败率均为3%,均未见反流误吸发生。与C组相比,TPB组当日患者满意度、术中疼痛反应评分、术中不良反应(心动过速、高血压、呛咳和体动)的发生率、清醒时间、丙泊酚用量、术中知晓率及术后希望再次接受同样麻醉方式率的差异无统计学意义(P>0.05);次日患者满意度升高(P<0.05);术中呼吸抑制发生率、医师满意度、术后眩晕和恶心程度降低(P<0.05);离院时间及恢复正常活动时间缩短(P<0.05)。结论双侧内关、合谷和足三里TEAS联合丙泊酚中度镇静用于胃肠镜检查术不仅安全、有效,而且有利于患者术后转归,其效果优于丙泊酚复合芬太尼常规麻醉。

Objective To evaluate the optimization effect of transcutaneous electrical acupoint stimulation(TEAS)combined with moderate sedation with propofol(TEAS-propofol balanced anesthesia)for gastrointestinal endoscopy.Methods This was a single-blind randomized controlled trial.American Society of Anesthesiologists Physical Status classificationⅠ-Ⅲpatients,aged 18-64 yr,undergoing elective gastrointestinal endoscopy at the Endoscopic Diagnosis and Treatment Center of the Affiliated Hospital of Qingdao University from May to August 2022,were divided into 2 groups using the block random allocation method:conventional anesthesia group(group C)and TEAS-propofol balanced anesthesia group(group TPB).Patients received moderate sedation with propofol plus routine anesthesia with fentanyl 50μg in group C.In TPB group,TEAS was performed at bilateral Neiguan,Hegu and Zusanli acupoints before surgery until the end of surgery,and patients received propofol for moderate sedation(Modified Observer′s Assessment of Alertness/Sedation scale score was 3).The efficacy and safety of anesthesia and parameters related to outcomes were observed and recorded.Results In this study,66 patients were recruited,with 33 in each group,the failure rate of anesthesia in both groups was 3%,and no reflux or aspiration was found.Compared with group C,no significant changes were found in the patients′satisfaction on the same day,intraoperative pain response score,incidence of intraoperative adverse reactions(tachycardia,hypertension,bucking and body movement),awake time,consumption of propofol,rate of intraoperative awareness and rate of patients hoping to receive the same anesthesia method again postoperatively(P>0.05),the patients′satisfaction was significantly increased on the next day(P<0.05),the incidence of intraoperative respiratory depression,physician satisfaction,and degree of postoperative dizziness and nausea were significantly reduced(P<0.05),and the discharge time and time to the complete recovery of normal behavior function was significantly shortened in group TPB(P<0.05).Conclusions The combination of TEAS at bilateral Neiguan,Hegu and Zusanli acupoints with moderate sedation using propofol for gastrointestinal endoscopy is not only safe and effective,but also beneficial to the postoperative outcome of patients,and the effect is better than that of conventional anesthesia with propofol and fentanyl.