针刺辅助麻醉对脊柱手术患者应激反应的影响  

Effect of acupuncture assisted anesthesia on stress response in spinal surgery

作　　者：姬严冬 吴欣圆 李思蓓 马武华[2] 黎玉辉[2] JI Yandong;WU Xinyuan;LI Sibei;MA Wuhua;LI Yuhui(The First Clinical Medical College of Guangzhou University of Chinese Medicine,Guangzhou 510405,China)

机构地区：[1]广州中医药大学第一临床医学院,510405 [2]广州中医药大学第一附属医院麻醉科

出　　处：《临床麻醉学杂志》2020年第6期525-529,共5页Journal of Clinical Anesthesiology

基　　金：广东省科技计划项目(2016A020226016)。

摘　　要：目的观察经皮穴位电刺激(TEAS)辅助麻醉对脊柱手术患者应激反应的影响。方法脊柱手术患者90例,男47例,女43例,年龄45~65岁,ASAⅠ或Ⅱ级,随机分为三组:全凭静脉麻醉组(A组)、TEAS连续波组(B组)和TEAS疏密波组(C组)。A组不给予TEAS,B组、C组在麻醉诱导前30 min采用2/15 Hz疏密波TEAS双侧足三里、三阴交穴,随后B组100 Hz连续波,C组2/100 Hz疏密波直至术毕。三组均采用全凭静脉麻醉。于麻醉诱导前(T0)、气管插管后(T1)、椎板减压时(T2)、术后1 h(T3)检测血清β-内啡肽、皮质醇、ACTH、NE浓度,记录术中丙泊酚、瑞芬太尼消耗总量以及辅助药物追加情况,记录术后恶心呕吐、皮肤瘙痒、头晕头痛、咳嗽咳痰等不良反应的发生情况。结果 T1-T3时A组β-内啡肽浓度明显高于B组、C组(P<0.05),T2、T3时B组β-内啡肽浓度明显高于C组(P<0.05)。T2、T3时C组皮质醇浓度明显低于A组、B组(P<0.05)。T2时C组ACTH浓度明显低于A组、B组(P<0.05),T3时A组ACTH浓度明显高于B组、C组(P<0.05)。T2、T3时A组NE浓度明显高于B组、C组(P<0.05)。A组术中瑞芬太尼消耗总量明显高于B组、C组(P<0.05)。三组丙泊酚消耗总量、辅助药物追加情况差异无统计学意义。B组、C组术后恶心呕吐发生率明显低于A组(P<0.05),C组头痛头晕发生率明显低于A组(P<0.05)。结论 TEAS辅助麻醉可以减轻脊柱手术患者的应激反应。与100 Hz连续波比较,2/100 Hz疏密波能更大程度地减轻患者的应激反应。Objective To observe the effect of transcutaneous electrical acupoint stimulation(TEAS) assisted anesthesia on the stress response of spinal surgery patients. Methods Ninety patients undergoing spinal surgery, 47 males and 43 females, aged 45-65 years, falling into ASA physical status Ⅰ or Ⅱ, were randomized divided into 3 groups: intravenous anesthesia group(group A), TEAS continuous wave group(group B) and TEAS dilatational wave group(group C). Group A was set up as control group. Groups B and C used 2/15 Hz dilatational wave to stimulate bilateral Zusanli and Sanyinjiao acupoints 30 min before anesthesia, followed by 100 Hz continuous wave in group B, and 2/100 Hz dilatational wave in group C until the end of surgery.The patients in the three groups were all given intravenous anesthesia. β-endorphins, cortisol, ACTH, NE were detected before anesthesia(T0), after intubation(T1), during laminar decompression(T2), 1 hour after surgery(T3). The total consumption of remifentanil and propofol and the addition of adjuvant drugs were recorded. The occurrence of adverse reactions such as nausea and vomiting, itchy skin, headache and dizziness, cough and sputum were recorded after the operation. ResultsThe concentration of β-endorphin in group A was significantly higher than that in groups B and C at T1-T3(P < 0.05).The concentration of β-endorphin in group B was significantly higher than that in group C at T2 and T3(P < 0.05). The cortisol concentration in group C was significantly lower than that in groups A and B at T2 and T3(P < 0.05). The concentration of ACTH in group C was significantly lower than that in groups A and B at T2(P < 0.05). The concentration of ACTH in group A was significantly higher than that in groups B and C at T3(P < 0.05). The NE concentration in group A was significantly higher than that in groups B and C at T2 and T3(P < 0.05). The total consumption of remifentanil in group A were significantly higher than those in groups B and C(P < 0.05). There was no statistically significant differ

关 键 词：经皮穴位电刺激 辅助麻醉 脊柱手术 应激反应 

分 类 号：R614[医药卫生—麻醉学]