经皮穴位电刺激对胸腔镜肺切除术病人拔管期应激反应的影响  

Effects of transcutaneous electrical acupoint stimulation on stress response during extubation period in patients undergoing thoracoscope pneumoresection

作　　者：张爽 甘建辉[1] 涂青 李峰[1] 谷书涵 史金麟[1] ZHANG Shuang;GAN Jianhui;TU Qing;LI Feng;GU Shuhan;SHI Jinlin(Department of Anesthesiology,Tangshan people Hospital,Tangshan,Hebei 063000,China)

机构地区：[1]唐山市人民医院麻醉科,河北唐山063000

出　　处：《安徽医药》2020年第7期1407-1411,共5页Anhui Medical and Pharmaceutical Journal

摘　　要：目的观察经皮穴位电刺激(TEAS)对胸腔镜肺切除术病人拔管期应激反应的影响。方法按排除标准筛选2017年11月至2018年3月在唐山市人民医院需要进行胸腔镜肺部分切除术的病人,共有84例入选,并统一按照全麻标准使用双腔气管导管(DLT)通气,按随机数字表法分成两组:与刺激器连接完整且予以有效电流刺激的为电刺激组,连接中断未有实际刺激产生的为假刺激组,每组42例,从诱导前30 min开始两组分别予以有效刺激或假刺激在双侧内关(PC6)、合谷(LI4)、列缺(LU7)、尺泽(LU5)穴持续至术毕。在入室5 min(T1)后记录病人未接受任何刺激时的基础状态下的平均动脉压(MAP)和心率(HR),在接受30 min刺激或假刺激后(T2)、拔除DLT即刻(T3)、拔除DLT后5 min(T4)和10 min(T5)分别测量MAP和HR;在上述各时刻检测肾上腺素(E)、去甲肾上腺素(NE)和皮质醇的浓度。结果在T1和接受30 min的电刺激或假刺激后的T2时刻两组MAP和HR差异无统计学意义(P>0.05);电刺激组和假刺激组在受到拔管强烈刺激时(T3)MAP分别骤升至(106.81±13.04)mmHg、(113.26±9.92)mm Hg,均明显高于基础时刻(P<0.05),且接受有效刺激的电刺激组明显低于接受假刺激的假刺激组(P<0.05),电刺激组和假刺激组在拔除DLT时HR分别提高到(87.69±14.00)次/分、(94.21±15.27)次/分,均明显较未接受刺激的T1时升高(P<0.05),且电刺激组升高程度明显低于假刺激组(P<0.05);电刺激组儿茶酚胺中的E、NE在刺激最高时刻(T3)提升到(114.31±6.77)ng/mL、(428.07±44.74)pg/mL,明显高于T1水平(P<0.05),但明显低于假刺激组的(170.64±13.97)ng/mL、(466.45±59.37)pg/mL(P<0.05),电刺激组皮质醇浓度升至(548.64±48.57)nmol/L,明显高于基础水平(P<0.05),也明显较假刺激组的(664.71±57.22)nmol/L减少(P<0.05);假刺激组在拔管完成后10 min内MAP、HR、E、NE、皮质醇仍显著高于T1(P<0.05);而电刺激组在拔除DLT后的T4~T5虽然儿茶酚胺和�Objective To explore effects of transcutaneous electrical acupoint stimulation on stress response during extubation period in patients undergoing thoracoscope pneumoresection.MethodsAccording to the exclusion criteria,a total of 84 patients who needed thoracoscopic lung surgery in Tangshan People’s Hospital from November 2017 to March 2018 were selected,and DLT(double lumen tube)ventilation was used in accordance with the general anesthesia standard.The TEAS group(group T)was completely connected to the stimulator and was effectively stimulated;the sham stimulation group(group S)was not given actual stimulation in which the connection is interrupted by random number table method,42 cases in each group.30 min before induction of anesthesia,the group T and S were given effective stimulation or sham stimulation in Neiguan(PC6),Hegu(LI4),Lieqiu(LU7),and Chize(LU5)points to the end of the surgery.MAP(mean arterial pressure)and HR(heart rate)of basal state when patients did not receive any stimulation 5 minutes after patient admission(T1),after receiving 30 minutes of stimulation or false stimulation(T2),immediately after removal DLT(T3),5 min(T4)and 10 min(T5)after removal DLT were recorded.So were the concentrations of E(epinephrine),NE(norepinephrine)and cortisol.ResultsThere was no significant difference between the two groups at T1 and T2 after receiving 30 minutes of electrical stimulation or sham stimulation(P>0.05);The MAP of group T and group S rose to(106.81±13.04)mmHg and(113.26±9.92)mmHg respectively when patients were strongly stimulated by extubation(T3),both group were significantly higher than basic time of T1(P<0.05),and the group T receiving effective stimulation was significantly lower than the group S receiving false stimulation(P<0.05),the difference was statistically significant.The HR of group T and S increased to(87.69±14.00)times/min and(94.21±15.27)times/min when DLT was removed,which were significantly higher than those at T1(P<0.05),and the increase level in group T was significantly l

关 键 词：胸腔镜检查/方法 肺切除术 电针 气管插管拔除 经皮穴位电刺激 双腔气管导管 应激反应 

分 类 号：R614[医药卫生—麻醉学]