经皮穴位电刺激和电针复合局部麻醉对颈动脉支架置入术患者术中及术后恢复的影响  

Influence of transcutaneous electrical acupoint stimulation and electro-acupuncture combined with local anesthesia on intraoperative maintenance and postoperative recovery in carotid artery stenting patients

作　　者：赵春美[1] 谢思宁[1] 张晴[1] 贾春蓉[2] 安立新 Zhao Chunmei;Xie Sining;Zhang Qing;Jia Chunrong;An Lixin(Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China;Department of Traditional Chinese Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China;Department of A nesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China)

机构地区：[1]首都医科大学附属北京天坛医院麻醉科,100050 [2]首都医科大学附属北京天坛医院中医科,100050 [3]首都医科大学附属北京友谊医院麻醉科,100050

出　　处：《国际麻醉学与复苏杂志》2018年第5期434-439,共6页International Journal of Anesthesiology and Resuscitation

基　　金：北京市中医药科技发展基金（JJ2014-04）

摘　　要：目的 观察经皮穴位电刺激（transcutaneous electrical acupoint stimulation, TEAS）及电针（electro-acupuncture, EA）对局部麻醉下行颈动脉支架置入术（carotid artery stenting, CAS）患者术中循环及术后恢复的影响。 方法 局部麻醉行CAS的患者124例，根据随机数字表法分为EA组（A组，41例）、TEAS组（T组，42例）、假EA对照组（C组，41例）。穴位的选择为术侧，水沟连百会，合谷连外关。对A组患者进行EA；对T组患者进行TEAS；对C组患者，采用假EA做对照。术中将BP和HR维持在基础值的80%~110%范围。记录术中的循环变化及血管活性药的使用情况，以及患者的术后恢复情况。 结果 3组患者术中及术后1 d BP和HR变化差异无统计学意义（P〉0.05）。但A组和T组术中尼莫地平的平均使用量均明显小于C组（P〈0.05）。A组和T组在术后1 d疼痛评分均明显低于C组，差异有统计学意义（P〈0.05）。A组和T组麻醉非常满意的患者例数明显高于C组（P〈0.05），麻醉一般满意的患者例数明显少于C组（P〈0.05）。 结论 TEAS及EA复合局部麻醉行CAS手术可稳定术中血流动力学变化，减少术中血管活性药物用量，降低术后疼痛的发生率，提高患者的麻醉满意度。Objective We are aimed to investigate the effects of transcutaneous electrical acupoint stimulation（TEAS） and electro-acupuncture（EA） combined with local anesthesia on intraoperative anesthesia maintenance and post-operative recovery in carotid artery stenting （CAS） patients. Methods One hundred and twenty four cases of CAS were randomly assigned into EA group （group A）, TEAS group （group T） and sham group （group C）. The patients in group A received EA at acupoints of Shuigou, Baihui, Hegu and Waiguan at the same side of the stenting before 30 min of operation. The patients in group T received TEAS at the same acupoints through self-adhesive skin electrodes. In group T and group A, stimulations were continued until the end of the operation. The patients in group C were not received EA or TEAS. Blood pressure and heart rates were maintained at 80%~110% of baseline level. We observed the change of BP and the use of vasoactive drugs during three groups. Post-operative pain scores （VAS） and the recovery condition after operation were analyzed in three groups. Results The average use of nimodipine was significantly less in group A and group T （P〈0.05）. After 1 day of operation, the occurrence rate of pain is less during group A and group T （P〈0.05）. However, there were no statistically significant in the in incidence of postoperative nausea and vomiting （PONV） （P〉0.05）. Conclusions Acupuncture anesthesia could provide a more stable hemodynamics, stronger analgesia effect, higher anesthesia satisfaction compared with single local anesthesia. Both TEAS and EA combined with local anesthesia could be a worthwhile anesthesia method in CAS patients.

关 键 词：经皮穴位电刺激 电针 颈动脉支架置入术 

分 类 号：R614[医药卫生—麻醉学]