经皮穴位电刺激辅助麻醉对腰椎内固定术后患者心率变异性的影响  

Effect of percutaneous acupoint electrical stimulation assisted anesthesia on heart rate variability of patients after lumbar internal fixation

作　　者：蔡清香[1] 吴财能[1] 张志权[1] 黎玉辉[1] 张广防[2] CAI Qing-xiang;WU Cai-neng;ZHANG Zhi-quan;LI Yu-hui;ZHANG Guang-fang(The Anaesthesiology Department,the First Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou 510405,Guangdong,China;不详)

机构地区：[1]广州中医药大学第一附属医院麻醉科,广东广州510405 [2]广东省中医院疼痛科,广东广州510120

出　　处：《广东医学》2021年第8期940-944,共5页Guangdong Medical Journal

基　　金：广东省科技计划项目(2016A020226016);广东省中医药局科研课题(20181098)。

摘　　要：目的评价经皮穴位电刺激(transcutaneous electrical acupoint stimulation,TEAS)辅助麻醉对腰椎内固定术患者术后心率变异性(heart rate variability,HRV)的影响。方法选择择期气管内插管全麻下行腰椎后路内固定术的患者70例,其中男31例,女39例,年龄50~65岁,BMI 18~27 kg/m^(2),ASAⅠ~Ⅱ级。采用随机数字表法分为经皮穴位电刺激组(T组)和对照组(N组),每组35例。T组麻醉诱导前,以2/15 Hz疏密波经皮电刺激两侧内关穴和足三里穴30 min后,再以2/100 Hz疏密波刺激持续至手术结束。N组操作同T组,但不开启电源。观察并记录两组的身高、体重、ASA分级,手术腰椎节段数,电流刺激的强度,手术时间、麻醉时间,瑞芬太尼和丙泊酚用量,术前(T0),术后第1天(T1)及第2天(T2)的心率变异度参数总体标准差(SDNN)、均值标准差(SDANN)、差值的均方根(RMSSD)、差值>50 ms的百分比(pNN50);频域指标:频域功率24 h,最小频域功率,最大频域功率;记录术后心悸、胸闷、胸痛等心脏不良反应,术后2 d的VAS评分。结果两组患者手术所需的丙泊酚总量比较,差异无统计学意义(P>0.05),T组瑞芬太尼的用量较N组要少,且术后第1天及第2天的VAS评分低于N组,差异有统计学意义(P<0.05)。两组患者心率变异性参数指标的比较,组内比较:术后第1天,两组SDNN、SDANN、rMSSD、频域功率24 h、最大频域功率、最小频域功率低于术前,差异有统计学意义(P<0.05);术后第2天,T组频域功率24 h、SDANN、rMSSD较术前第1天升高,差异有统计学意义(P<0.05)。组间比较:术后第1天,T组SDNN、pNN50、最大频域功率、最小频域功率高于对照组,差异有统计学意义(P<0.05);术后第2天,SDNN、SDANN、rMSSD、pNN50、最大频域功率高于对照组,差异有统计学意义(P<0.05);术后第1天胸闷发生率,N组高于T组,差异有统计学意义(P<0.05)。结论经皮穴位电刺激辅助麻醉对腰椎内固定手术的术后自主神经紊乱�Objective To observe the effect of transcutaneous electrical acupoint stimulation(TEAS)assisted anesthesia on postoperative heart rate variability(HRV)in patients with lumbar spinal fixation.Methods Seventy patients undergoing lumbar spinal fixation,31 males and 39 females,aged 50-65 years old,BMI 18-27 kg/m2,ASA statusⅠorⅡ,were randomized divided into TEAS group(Group T)and control group(Group N).Group T used 2/15 Hz dilatational wave to stimulate bilateral Zusanli and Neiguan acupoints 30 min before anesthesia,followed by and 2/100 Hz dilatational wave until the end of surgery.The height,weight,ASA grade,number of surgical lumbar segments,and intensity of electrical stimulation were recorded.The operation time,anesthesia time,dosage of remifentanil and propofol,preoperative parameters of HRV and the HRV parameters 1 day and 2 days after operation.The HRV parameters include the standard deviation of NN intervals(SDNN),the mean standard deviation(SDANN),the difference between root mean square(RMSSD),the number of pairs of successive NNs that differ by more than 50 ms(pNN50);frequency domain indexes include frequency domain power-24 h,the minimum power frequency domain,the maximum frequency domain power.The postoperative cardiac adverse reactions such as palpitation,chest tightness,and chest pain were recorded;so was VAS score 2 days after surgery.Results There was no significant difference in general data between 2 groups(P>0.05).There was no significant difference in the total amount of propofol required for surgery between the two groups(P>0.05).The amount of remifentanil in Group T was significantly less than that in Group N,and the VAS scores on the 1st and 2nd day after surgery were significantly lower than those in Group N(P<0.05).On the 1st day after operation,SDNN-24 h SDANN,frequency domain power 24 hours a day,maximum frequency domain power,the minimum power frequency domain in both groups,and rMSSD in Group B were significantly lower than those before operation(P<0.05).On the 2nd day after operatio

关 键 词：穴位电刺激 麻醉 腰椎内固定术 心率变异性 

分 类 号：R614.27[医药卫生—麻醉学] R687.43[医药卫生—外科学]