经皮穴位电刺激对腹腔镜胆囊切除术患者肺通气功能的影响:肺电阻抗成像法评价  

Effect of transcutaneous electrical acupoint stimulation on function of lung ventilation in patients undergoing laparoscopic cholecystectomy:evaluation using electrical impedance tomography

作　　者：姜灵燕 王琛[2] 邓岩军 李华[2] 徐府奇 Jiang Lingyan;Wang Chen;Deng Yanjun;Li Hua;Xu Fuqi(Gusu School,Nanjing Medical University,Suzhou 215002,China;Department of Anesthesiology,the Affiliated Suzhou Science and Technology Town Hospital of Nanjing Medical University,Suzhou 215153,China)

机构地区：[1]南京医科大学姑苏学院,苏州215002 [2]南京医科大学附属苏州科技城医院麻醉学部,苏州215153

出　　处：《中华麻醉学杂志》2022年第5期522-526,共5页Chinese Journal of Anesthesiology

基　　金：苏州市医学重点学科(szxk202131);苏州高新区青年拔尖人才基金资助。

摘　　要：目的采用肺电阻抗成像法评价经皮穴位电刺激对腹腔镜胆囊切除术患者肺通气功能的影响。方法择期腹腔镜胆囊切除术患者60例,性别不限,年龄18~64岁,BMI 18.5~24.9 kg/m^(2),ASA分级Ⅰ或Ⅱ级。采用随机数字表法分为2组(n=30):对照组(CON组)和经皮穴位电刺激组(TEAS组)。入室后采用肺电阻抗成像法监测肺通气功能,TEAS组患者双侧肺俞穴和尺泽穴实施经皮穴位电刺激,CON组只放置刺激电极,但不通电。于入室(T_(1))、气管插管后5 min(T_(2))、CO_(2)气腹后5 min(T_(3))、CO_(2)气腹排气后5 min(T_(4))、拔除气管导管后5 min(T_(5))和拔除气管导管后30 min(T_(6))时测定重力依赖区潮气比例和中心通气区(CoV)面积百分比。于T_(1)、T_(3)和T_(6)时抽取桡动脉血行血气分析,计算氧合指数(OI)和肺泡-动脉血氧分压差(A-aDO_(2)),采集外周静脉血样,测定血清Clara细胞分泌蛋白(CC16)、IL-6和TNF-α浓度。结果与T_(1)时比较,2组患者T_(2)~6时CoV面积百分比、重力依赖区潮气比例、T_(6)时OI和A-aDO_(2)降低,T_(3)和T_(6)时血清TNF-α、IL-6和CC16浓度升高(P<0.05);与CON组比较,TEAS组T_(5),6时重力依赖区潮气比例和T_(6)时OI升高,T_(6)时A-aDO_(2)、血清TNF-α、IL-6和CC16浓度降低(P<0.05)。结论经皮穴位电刺激可改善腹腔镜胆囊切除术患者肺通气功能。Objective To evaluate the effect of transcutaneous electrical acupoint stimulation(TEAS)on function of lung ventilation in the patients undergoing laparoscopic cholecystectomy using electrical impedance tomography(EIT).Methods Sixty American Society of Anesthesiologists physical statusⅠorⅡpatients of both sexes,aged 18-64 yr,with body mass index of 18.5-24.9 kg/m^(2),undergoing elective laparoscopic cholecystectomy,were divided into 2 groups(n=30 each)using a random number table method:control group(CON group)and TEAS group.EIT was carried out after entering the operating room.In group TEAS,bilateral Feishu(BL13)and Chize(LU5)acupoints were stimulated,while stimulation electrodes were only placed without electricity in group CON.The percentages of area in center of ventilation and tidal volume in the dependent areas were determined on admission to the operating room(T_(1)),at 5 min after tracheal intubation(T_(2)),at 5 min after CO_(2)pneumoperitoneum(T_(3)),at 5 min after CO_(2)was exhausted(T_(4)),and at 5 and 30 min after removal of the tracheal tube(T_(5),6).Radial artery blood samples were collected for blood gas analysis at T_(1),T_(3)and T_(6),and the oxygenation index(OI)and alveolar-arterial oxygen difference(A-aDO_(2))were calculated.Blood samples were taken from the peripheral vein at T_(1),T_(3)and T_(6)for determination of the serum concentrations of Clara cell secretion protein(CC16),interleukin(IL)-6 and tumor necrosis factor(TNF)-α.Results Compared with the baseline at T_(1),the percentages of area in center of ventilation and tidal volume in dependent areas at T_(2)-6 and OI and A-aDO_(2)at T_(6)were significantly decreased,and the serum concentrations of TNF-α,IL-6 and CC16 were increased at T_(3)and T_(6)in two groups(P<0.05).Compared with group CON,the percentage of tidal volume in dependent areas at T_(5),6 and OI at T_(6)were significantly increased,and A-aDO_(2)and serum concentrations of TNF-α,IL-6 and CC16 were decreased at T_(6)in group TEAS(P<0.05).Conclusions TEAS can improve th

关 键 词：电刺激 胆囊切除术 腹腔镜 肺通气 体层摄影术 

分 类 号：R657.4[医药卫生—外科学]