经皮穴位电刺激对咽喉部手术后恢复质量的影响

Effect of transcutaneous electrical acupoint stimulation on postoperative recovery of patients undergoing laryngoscopy surgery

目的探讨经皮穴位电刺激(transcutaneous electrical acupuncture stimulation,TEAS)对喉显微手术术后恢复质量的影响。方法选择拟在全麻下择期行喉显微手术的患者,年龄18~65岁,BMI18~30kg/m2,ASAⅠ~Ⅱ级,随机分为TEAS组(T组)、无关穴位组(N组)和对照组(C组),分别于麻醉诱导前30min至手术结束,T组给予TEAS(扶突、列缺穴)、N组给予穴位旁开1cm电刺激,C组无刺激。术后咽喉部疼痛以布鲁格尔曼舒适度评级(Bruggrmann comfort scale,BCS)评判并记录,同时记录三组患者手术时间、麻醉时间、拔管时间、术中瑞芬太尼、丙泊酚用量以及支撑喉镜悬吊时的丙泊酚效应室浓度(Ce)。记录不同时间点:麻醉诱导前(T1)、支撑喉镜悬吊固定即刻(T2),支撑喉镜置入后1 min(T3)、术毕(T4)的血压和心率。评估术后1h、2h、24h及48h患者不良反应。结果三组患者术中不同时间点血流动力学变化无明显差异。T组拔管时间短于N组和C组,术中瑞芬太尼、丙泊酚用量以及支撑喉镜悬吊固定即刻的丙泊酚效应室浓度低于N组和C组。术后1h、2h、24hBCS评分T组优于N组和C组,术后48hBCS评分三组差异无统计学意义。结论经皮穴位电刺激扶突、列缺穴可一定程度上减轻喉显微手术后咽喉部疼痛,减少麻醉药用量,缩短拔管时间,提高患者术后恢复质量。

Objective To explore the effect of transcutaneous electrical acupuncture stimulation(TEAS)on postoperative recovery after laryngoscopy surgery.Methods Patients scheduled for laryngoscopy surgery under general anesthesia,aged 18-65 years,BMI18~30 kg/m2,ASAⅠorⅡ,were randomly divided into TEAS group(T group),non-acupoint group(N group)and control group(C group).TEAS stimulation(LU7,LI18),non-acupoint stimulation,or no stimulation,respectively,were delivered continuously from 30 min before anesthesia induction till the end of surgery.Pharynx and laryngeal pain as evaluated with Bruggrmann comfort scale(BCS)was documented.The duration of surgery,anesthesia,extubation time,remifentanil dosage,propofol dosage and effect-site concentration of propofol at laryngoscope suspension were recorded in all three groups.The blood pressure and heart rate were recorded at following time points:before anesthesia induction(T1),immediately after laryngoscope suspension(T2),1 min after laryngoscope suspension(T3)and immediately after operation(T4).Adverse events of patients at 1h,2h,24h and 48h after operation were evaluated.Result No significant difference in hemodynamic parameters was found at any time point among the three groups.Extubation time of patients in group T was shorter than that in group N and group C.The dosage of remifentanil and propofol during operation and the effect-site concentration of propofol at laryngoscope suspension were lower in patients from group T than those in group N and group C.BCS in group T was better than that in group N and group C at 1 h,2 h and 24 h after operation.There was no significant difference in BCS 48 hours after operation among the three groups.Conclusion TEAS(LU7,LI18)reduced pharynx and larynx pain,reduced anesthetics consumption,shortened extubation time and improved postoperative recovery after laryngoscopy surgery.