经皮穴位电刺激对胸腔镜肺叶切除术患者术后早期肺功能的影响  

Effects of transcutaneous electrical acupoint stimulation on early postoperative lung function in patients undergoing video-assisted thoracoscopic pneumonectomy

作　　者：彭文平[1] 黄舜[2] 冯艺[1] 粱汉生 

机构地区：[1]卫生部北京医院麻醉科 [2]北京大学人民医院麻醉科,100044

出　　处：《中华麻醉学杂志》2014年第4期439-441,共3页Chinese Journal of Anesthesiology

基　　金：北京大学人民医院研究与发展基金（RDC2013-09）

摘　　要：目的 探讨经皮穴位电刺激对胸腔镜肺叶切除术患者术后早期肺功能的影响.方法 择期胸腔镜肺叶切除术患者60例,年龄34 ～ 83岁,体重50 ～ 93 kg,ASA分级Ⅰ或Ⅱ级,第1秒用力呼出量（FEV1）＞1.5 L,采用随机数字表法,将其分为3组（n=20）：对照组（C组）、列缺＋曲池＋内关＋合谷穴组（S1组）和心俞＋肺俞＋内关＋合谷穴组（S2组）.S1组和S2组于麻醉诱导前30 min至术毕,手术后第1天和第2天刺激手术侧相应穴位,疏密波,频率2/100 Hz,强度以病人能耐受的最大电流为宜,列缺、曲池、内关、合谷穴大约为6～ 18 mA,心俞穴和肺俞穴大约为20 ～ 35 mA,1次/d、30min/次,C组在穴位上贴电极,不做电刺激.术后进行PCIA,维持静息和深呼吸时的疼痛强度评分＜4分.于术前和术后（拔除胸腔引流管后）床旁检测肺用力肺活量（FVC）和FEV1,并计算其变化率.结果 与术前比较,3组患者术后FVC和FEV1降低（P＜0.05）;3组患者术前和术后FVC以及FEV1及其变化率比较差异无统计学意义（P＞0.05）.结论 经皮穴位电刺激（术中和术后2d内实施,30min/d,2/100Hz）对胸腔镜肺叶切除术患者术后早期肺功能无明显改善作用.Objective To investigate the effects of transcutaneous electrical acupoint stimulation （TEAS） on early postoperative lung function in patients undergoing video-assisted thoracoscopic pneumonectomy.Methods Sixty ASA physical status Ⅰ or Ⅱ patients whose preoperative forced expiratory volume in 1 second （FEV1） 〉 1.5 L,scheduled for elective video-assisted thoracoscopic pneumonectomy under general anesthesia,were randomly divided into 3 groups （n =20 each） using a random number table：control group （group C）,Lieque （LU7）-Quchi （LI11）-Neiguan （PC6）-Hegu （LI4） group （group S1）,and Xinshu （BL1S）-Feishu （BL13）-PC6-LI4 group （group S2）.TEAS was applied to the corresponding acupoints on the operated side for 30 min once a day starting from 30 min before induction of anesthesia until the end of surgery,and on 1 st and 2nd days after surgery in S1 and S2 groups.The frequency was 2/100 Hz,the intensity was the maximum current that could be tolerated,and the intensity was about 6-18 mA for LU7,LI11,PC6 and LI4,or about 20-35 mA for BL15 and BLI3.Patient-controlled intravenous analgesia was performed to maintain the score for the intensity of pain 〈 4.Before and after surgery,forced vital capacity （FVC） and FEV1 were measured after the chest tube was withdrawn and the changing rate was calculated.Results FEV1 and FVC were significantly lower after surgery than before surgery in all the groups （P 〈 0.05）.There was no significant difference in FEV1 and FVC before and after surgery and the changing rate between the three groups （P 〉 0.05）.Conelusion TEAS （applied during surgery and within 2 days after surgery,30 min/d,2/100 Hz） provides no obvious improvement in early postoperative lung function for the patients undergoing video-assisted thoracoscopic pneumonectomy.

关 键 词：经皮神经电刺激 肺切除术 呼吸功能试验 

分 类 号：R614[医药卫生—麻醉学]