经皮穴位电刺激对机器人妇科手术患者苏醒质量的影响  

Effects of transcutaneous electrical acupoint stimulation on recovery of patients undergoing robotic gynecologic surgery

作　　者：杨玉峰[1] 路志红[1] 董海龙[1] 陈敏[1] 成丹丹[1] 熊利泽[1] 

机构地区：[1]第四军医大学西京医院麻醉科,西安市710032

出　　处：《临床麻醉学杂志》2018年第1期11-15,共5页Journal of Clinical Anesthesiology

基　　金：973项目(2014CB543200);国家自然科学基金(81590954)

摘　　要：目的机器人妇科手术术中患者需长时间处于头低位及CO2气腹下,可能增加脑水肿的风险,造成苏醒延迟和躁动。本研究观察经皮穴位电刺激(transcutaneous electrical acupoint stimulation,TEAS)能否改善机器人妇科手术苏醒和恢复质量,并探讨其可能机制。方法筛选拟在全麻下行机器人妇科手术的患者,年龄18~65岁,BMI 18~30kg/m^2,ASAⅠ或Ⅱ级,随机分为TEAS组(T组)、无关穴位组(N组)和对照组(C组),分别于麻醉诱导前30 min至手术结束给予TEAS(足三里、三阴交、跗阳、昆仑)、髋部电刺激和无刺激。测定麻醉诱导前和术毕时血清水通道蛋白(aquaporin,AQP)-4(AQP4)、基质金属蛋白酶(matrix metallop roteinase,MMP)-9(MMP9)和S100β浓度。记录苏醒期、PACU内和术后24h恢复指标。结果与麻醉诱导前比较,术毕时T组APQ4浓度明显降低(P<0.05),术毕时C组MMP9和S100β浓度明显升高(P<0.05或P<0.01)。T组患者呼之睁眼时间[(18.3±6.7)min]和拔管时间[(19.4±6.6)min]明显短于C组[(21.9±7.3]min和(23.1±7.3)min](P<0.05)。T组PACU内最高VAS评分明显低于C和N组(P<0.05)。结论 TEAS可缩短机器人妇科手术患者的呼之睁眼时间,改善术后镇痛。脑水肿相关分子AQP4、MMP9和脑损伤相关分子S100β的改变可能参与其中。Objective To observe whether transcutaneous electrical acupoint stimulation（TEAS）could improve the emergence and recovery of patients undergoing robotic gynecologic surgery,and to explore the mechanism behind it.Methods Patients（aged 18-65 years,BMI 18-30 kg/m^2,ASA gradeⅠ or Ⅱ）scheduled for elective robotic gynecologic surgery were screened and randomized into three groups：group TEAS（groups T）,no acupoint group（group N）and control group（group C）,receiving TEAS（ST-36,SP6,BL59,BL60）,stimulation at bilateral hips and no-stimulation respectively.Stimulations were given from 30 min before anesthesia induction to the end of surgery.Recovery measurements during emergence,PACU stay and 24 hafter surgery were recorded.Levels of serum AQP4,MMP9 and S100βwere analyzed.Results Time to response to verbal command and time to extubation in group T [（18.3±6.7） min and（19.4±6.6） min respectively]were significantly shorter than those in group C [（21.9±7.3）min and（23.1±7.3）min respectively]（P0.05）.Maximum VAS scores during PACU stay were significantly lower in group T than that in groups C and N（P0.05）.Postoperative AQP4 level in group T significantly decreased compared with baseline（P0.05）.However,postoperative MMP9 and S100βlevel in group C significantly increased compared with the baseline（P0.05 or P0.01）.Conclusion TEAS could fasten emergence of patients after robotic gynecologic surgery and improve postoperative analgesia.Mechanisms involving AQP4,MMP9 and S100βmay be involved.

关 键 词：经皮穴位电刺激 机器人手术 头低位 苏醒 

分 类 号：R614[医药卫生—麻醉学]