经皮穴位电刺激对腹腔镜子宫全切术患者颅内压的影响:测量视神经鞘直径

Effect of transcutaneous electrical acupoint stimulation on intracranial pressure in patients undergoing laparoscopic hysterectomy:measurement of optic nerve sheath diameter

目的通过超声测量视神经鞘直径评价经皮穴位电刺激对腹腔镜子宫全切术患者颅内压的影响。方法择期拟行腹腔镜子宫全切术患者42例,年龄18~60岁,ASA分级Ⅰ或Ⅱ级,BMI 18~28 kg/m^(2)。采用随机数字表法将患者分为2组(n=21):对照组(C组)和经皮穴位电刺激组(T组)。T组麻醉前30 min选择鱼腰穴、太阳穴实施经皮穴位电刺激,电流频率为2/100 Hz的疏密波交替,电流强度从1 mA开始,至患者体感疼痛时所能承受最大电流,术中维持合谷穴、颧髎穴、风池穴电刺激至术毕停止。C组患者仅在对应穴位粘贴电极片,不行电刺激。于入室(T_(0))、麻醉诱导后3 min(T_(1))、头低脚高位5 min(T_(2))、头低脚高位30 min(T_(3))、头低脚高位60 min(T_(4))和术毕即刻(T_(5))时测量视神经鞘直径。结果与T_(0)时比较,C组T_(3-5)时和T组T_(4,5)时视神经鞘直径升高(P<0.05);T组T_(4,5)时视神经鞘直径低于C组(P<0.05)。结论经皮穴位电刺激可在一定程度上降低腹腔镜子宫全切术患者的颅内压。

Objective:To evaluate the effect of transcutaneous electrical acupoint stimulation(TEAS)on the intracranial pressure in patients undergoing laparoscopic hysterectomy by measuring the optic nerve sheath diameter(ONSD)via ultrasound.Methods:Forty-two American Society of Anesthesiologists Physical Status classificationⅠorⅡpatients,aged 18-60 yr,with a body mass index of 18-28 kg/m^(2),scheduled for elective laparoscopic hysterectomy,were divided into 2 groups(n=21 each)using a random number table method:control group(group C)and TEAS group(group T).In group T,TEAS was applied to the Yintang(EX-HN3)and Taiyang(EX-HN5)acupoints at 30 min before anesthesia,the stimulation used alternating dense-disperse waves at a frequency of 2/100 Hz,with the current intensity starting at 1 mA and increasing to the maximum tolerable level just below the pain threshold,and stimulation was maintained at the Hegu(LI4),Quanliao(SI18),and Fengchi(GB20)acupoints during surgery until the procedure was completed.Patients had electrode pads applied to the corresponding acupoints without electrical stimulation in group C.The ONSD was measured upon entry into the operating room(T_(0)),3 min after anesthesia induction(T_(1)),5 min after trendelenburg position(T_(2)),30 min after trendelenburg position(T_(3)),60 min after trendelenburg position(T_(4)),and immediately after the end of operation(T 5).Results:Compared to the baseline at T_(0),the ONSD was significantly increased at T_(3-5) in group C and at T_(4,5)in group T(P<0.05).The ONSD was significantly lower at T_(4,5)in group T than in group C(P<0.05).Conclusions:TEAS can reduce the intracranial pressure to some extent in patients undergoing laparoscopic hysterectomy.