经皮穴位电刺激对全麻髋关节置换术老年患者控制性降压期间脑氧代谢的影响  

Effects of Transcutaneous Electrical Acupoint Stimulation Combined with General Anesthesia on Cerebral Oxygen Metabolism in Elderly Hip Replacement Patients during Controlled Hypotension

作　　者：袁岚[1] 唐炜[1] 王剑[1] 傅国强[1] 

机构地区：[1]上海中医药大学附属曙光医院麻醉科,上海201203

出　　处：《针刺研究》2014年第1期7-11,19,共6页Acupuncture Research

基　　金：上海市中医药事业发展三年行动计划(重大研究)项目"针药复合麻醉优选方案及临床疗效评价研究"(ZYSNXD-CC-ZDYJ 014);上海市中医药事业发展三年行动计划(重大研究)项目"研究型中医院建设"(ZYSNXD-CC-YJXYY-JS 19)

摘　　要：目的：观察经皮穴位电刺激对老年患者行控制性降压期间的脑保护作用。方法：40例美国麻醉医师协会分级I或Ⅱ级实施全髋关节置换手术的65岁以上老年患者，随机均分为对照组和复合针麻组，两组患者均采用控制性降压以减少术中出血。其中复合针麻组患者在麻醉诱导前给予双侧鱼腰、风池30min经皮穴位电刺激，并持续至手术结束，刺激参数：采用2Hz／100Hz的疏密波，电流强度8～12mA。对照组采用假穴位经皮穴位电刺激（与复合针麻组相同的穴位向内旁开1寸）。分别在降压开始前（T0），降压至目标平均动脉压（MAP）后20min（T1）、40min（T2）和停止降压后20min（T3），抽取颈内静脉球部和桡动脉血液进行血气分析，记录各时间点MAP、心率（HR）、动脉血氧含量（CaO2）、静脉血氧含量（CjvO2）、脑动一静脉血氧含量差（Da-jvO2）、脑氧摄取率（CERO2）。结果：与T0时比较，两组各时间点MAP、HR、CaO2的差异无统计学意义（P〉0．05），T1、T2和T3时CjvO2升高，Da-jvO2和CERO：降低（均P〈0．05）；与对照组比较，复合针麻组T2、T3时CjvO2升高，T2时Da-jvO2和CERO2降低（均P〈0．05）。结论：经皮穴位电刺激可降低全麻髋关节置换术老年患者控制性降压期间脑氧代谢率，具有脑保护作用。Objective To observe the protective effect of transcutaneeus electrical acupoint stimulation （TEAS） on ce- rebral tissue in elderly hip replacement operation patients during general anesthesia under controlled hypotension. Methods Forty hip replacement operation patients were randomly divided into general anesthesia （GA） control group and TEAS ＋ GA group （n = 20 in each group）. Patients of the two groups during operation were treated with controlled hypotensien for reducing blood loss. TEAS （2 Hz/100 Hz, 8- 12 mA） was applied to bilateral Yuyao （EX-HN 4） and Fengchi （GB 20） and began 30 min before GA. General anesthesia was performed by intravenous injection of Midazolam, Diprivan, Fentanyl and Cis-atracurium, sevoflu- rane-inhaling, Remifentanii, etc., and the patient＇s mean arterial pressure was maintained to be about 70% of the normal level （controlled hypotension） by using venous administration of Remifentanil about 10 min after the operation. GEM Premier 3000 blood gas analyzer was used to analyze levels of the arterial oxygen （CaO2）, internal jugular venous oxygen （CjvO2）, arterio-venous oxygen content difference （Da-jvO2） and cerebral oxygen （CERO2） uptake rates of blood samples before controlled hypotension （T0）, 20 min after controlled hypetension （T1）, 40 min after controlled hypotension （T2） and 20 min after the end of controlled hy- potension （T3）. Results Self-comparison of each group showed that in comparison with pre-controlled hypotension, CjvO2 le- vels at the time-points of T1, T2 and T3 were significantly increased in both GA control and TEAS＋ GA groups （P〈0.05）, while Da-jvO2 and CERO2 uptake rate levels at the time-points of T1, T2 and T3 in these two groups were significantly decreased （ P〈0.05）. Comparison between two groups showed that CjvO2 levels at the time-points of T2 and T3 were significantly higher in the TEAS＋ GA group than in the GA control group （P〈0.05）, while Da-jvO2 and CERO2 uptake rate leve

关 键 词：人工髋关节置换术 经皮穴位电刺激 控制性降压 老年患者 脑氧代谢率 脑保护 

分 类 号：R246.2[医药卫生—针灸推拿学]