经皮穴位电刺激在乳腺癌根治手术中镇痛效应的研究  

Observation on the Analgesic Effect of Transcutaneous Electrical Acupoint Stimulation for Breast Radical Carcinoma Operation

作　　者：余建明[1] 曲丕盛[1] 范皓[1] 王振[1] 金亚蓓[1] 陶凡[1] 

机构地区：[1]浙江省中西医结合医院,杭州310003

出　　处：《针刺研究》2010年第1期43-46,共4页Acupuncture Research

摘　　要：目的:观察经皮穴位电刺激(TEAS)在全身麻醉中的辅助镇痛效应,初步探讨其镇痛机制。方法:择期行乳腺癌根治术的患者,采用随机数字表法分为单纯全身麻醉组(全麻组)、TEAS复合全身麻醉组(TEAS+全麻组),每组30例。全麻组用异丙酚复合舒芬太尼、顺式阿曲库胺进行诱导插管;术中异丙酚靶浓度为(3.0±0.5)μg/mL,瑞芬太尼恒速输注(22±5)mL/h,顺式阿曲库胺间断静脉注射。TEAS+全麻组选用疏密波(2 Hz/100 Hz)TEAS患侧合谷配劳宫穴、内关配外关穴30 min,再行气管内插管全麻。记录两组TEAS前、麻醉诱导后及插管后1 min各时间点的心率(HR)、平均动脉压(MAP),并记录麻醉药物的使用量,观察手术结束后病人苏醒质量、气管拔管情况及术后并发症的发生情况;放射免疫法测定TEAS前、TEAS 30 min、切皮后5 min、术毕各时间点血浆中β-内啡呔(-βEP)的含量。结果:麻醉诱导和气管插管时,TEAS+全麻组的MAP平稳,优于单纯全麻组(P<0.05)。TEAS+全麻可明显减少镇痛药用量,缩短病人术后苏醒时间、拔管时间,减少术后并发症。TEAS+全麻组TEAS 30 min、切皮后5 min及术毕的-βEP水平与单纯全麻组比较明显升高(P<0.05)。结论:在乳腺癌手术麻醉中,TEAS可强化单纯全麻的镇痛效应,其机制可能与血浆中-βEP的升高有关,是一种较为优良的麻醉辅助方法。Objective To observe the analgesic effect of transcutaneous electrical acupoint stimulation （TEAS） in assisting general anesthesia （GA） for radical operation of breast carcinoma so as to explore its clinical application value. Methods Sixty patients scheduled for radical operations of the breast carcinoma were randomly and equally divided into GA group and TEAS ＋ GA group. For GA, Propofol [ 4. 5 μg/mL, target concentration; （3.0±0. 5） μg/mL during operation] was used in combination with Sufentanil （0.25 μg/kg） and Cis-atracurium amine （0.2 mg/kg）. TEAS （5-- 10 mA, 2 Hz/100 Hz） was applied to Hegu （LI 4）-Laogong （PC 8） and Neiguan （PC 6）-Waiguan （SJ 5） on the affected side of the body for 30 min. Heart rate （HR）, mean aterial pressure （MAP）, tube removing time and postoperative complications were recorded. Plasma β-endorphin content was assayed by radioimmunoassay. Results After anesthesia, patients with reduction in MAP in GA group were significantly more than those in TEAS＋ GA group （P〈0. 05）, and their HR decreased remarkably （P〈0.05）. After tracheal intubation, MAP in TEAS ＋GA group kept relatively stable, which was superior to that of GA group （P〈0.05）. In comparison with GA group, the patients＇ analepsia time and tube withdrawal time of TEAS＋ GA group were significantly shorter; and the dosage of analgesics of TEAS＋ GA group was significantly smaller than that of GA group （P〈0.05）. Patients with complications of pain, restlessness, drowsiness, nausea and vomitting were obviously fewer in TEAS＋ GA group than those in GA group. Compared with GA group, plasma beta-endorphin content in TEAS＋ GA group increased considerably 30 min after TEAS, 5 min after skin-incision and after operation （P〈0.05） . Conclusion TEAS combined with general anesthesia for breast radical carcinoma operation can help keep a stable blood pressure during surgery, reduce the dosage of analgesics and strengthen pain relief. The analgesic effe

关 键 词：乳腺癌手术 经皮穴位电刺激 Β-内啡肽 镇痛 

分 类 号：R246.2[医药卫生—针灸推拿学]