经皮穴位电刺激辅助吸入麻醉在幕上肿瘤切除术中的应用  

Application of Transcutaneous Acupoint Electrical Stimulation and Inhalation Anesthesia in Supratentorial Tumor Resection

作　　者：陈雪[1] 安立新[1] 王莉莉[1] 吴海丰[1] 王保国[1] 

机构地区：[1]首都医科大学附属北京天坛医院,北京100050

出　　处：《上海针灸杂志》2013年第2期79-82,共4页Shanghai Journal of Acupuncture and Moxibustion

基　　金：国家重点基础研究发展计划项目(2007CB512503)

摘　　要：目的观察经皮穴位电刺激对幕上肿瘤切除术患者七氟烷吸入全麻麻醉维持期及其恢复期的影响。方法择期进行幕上肿瘤切除术的患者80例,随机分为经皮穴位电刺激加七氟烷复合麻醉组(T组,n=40)和七氟烷吸入全麻组(S组,n=40)。在麻醉诱导开始前,选择开颅侧穴位,合谷连外关,金门连太冲,足三里连丘墟,相应穴位贴上皮肤自粘电极,连接穴位神经刺激仪,频率2/100 Hz。电刺激时间为麻醉诱导开始前直至手术结束。S组患者在上述相应穴位上贴上导线,不进行行针和电刺激。两组患者在异丙酚2 mg/kg、枸橼酸舒芬太尼0.3 g/kg、维库溴铵0.1 mg/kg诱导下行气管插管,吸入2%七氟烷维持麻醉,术毕停止吸入七氟烷。记录各时间点七氟烷呼气末浓度、最小肺泡气浓度(MAC)、脑电双频指数(BIS)以及麻醉恢复期情况。结果两组患者平均动脉压和心率均无统计学差异。七氟烷呼气末浓度和MAC,T组在开颅期、颅内期(颅内操作10 min、20 min、30 min)各时间点所需七氟烷呼出浓度均显著低于S组(P<0.05),节省七氟烷用量10.37%。两组都能够维持BIS值在40～60之间。T组的自主呼吸恢复时间、拔管时间、睁眼时间、随意运动恢复时间、定向力恢复时间、离开手术室时间,均明显小于S组(P<0.01)。T组躁动和恶心呕吐的发生率低于S组。结论对幕上肿瘤切除术的患者进行经皮穴位电刺激复合七氟烷麻醉,可明显减少七氟烷用量,并能够显著缩短麻醉恢复时间,提高麻醉恢复质量。Objective To investigate the effect of transcutaneous acupoint electrical stimulation on the sustaining period of inhalation anesthesia with Sevoflurane and the recovery stage in patients undergoing a supratentorial tumor resection. Method Eighty patients with supratentorial tumor who were going to receive a tumor resection were randomized into a combined anesthesia group treated with transcutaneous acupoint electrical stimulation and inhalation of Sevoflurane （group T, n=40） and an inhalation anesthesia group treated with Sevoflurane only （group S, n=40）. Before the anesthesia induction, acupoints on the same side of craniotomy were selected. Hegu （LI4） was paired with Waiguan （TES）, Jinmen （BL36） with Taichong （LR3）, and Zusanli （ST36） with Qiuxu （GB40）. The acupoints were stuck with self-adhesive electrodes and connected to nerve stimulator to receive electrical stimulation, with a frequency at 2/100 Hz and intensity within the patients＇ maximum tolerance. The electrical stimulation should last from the beginning of anesthesia induction to the end of the operation. Same acupoints were selected in group S and stuck with wires but received neither needling manipulations nor electrical stimulation. Patients in both groups underwent tracheal intubation with induction of Propofol 2 mg/kg, Sufentanil 0.3 μg/kg, and Vecuronium 0.1 mg/kg, and then were anesthetized by using Sevoflurane via inhalation. Inhalation of Sevoflurane stopped at the end of operation. End tidal concentration, MAC, and BIS of Sevoflurane at different time points were recorded, as well as the anesthesia recovery condition. Result There were no significant differences between the two groups in comparing the average arterial pressure and heart rate. In group T, end tidal concentration and MAC, as well as the expiratory concentration of Sevoflurane during skull opening and at different time points during intracranial procedure （10 min, 20 min, 30 min） were all significantly lower than those in group S （P〈0

关 键 词：穴位疗法 经皮穴位电刺激 肿瘤 麻醉恢复期 

分 类 号：R246.2[医药卫生—针灸推拿学]