经耳迷走神经刺激对前交叉韧带重建术患者止血带相关高血压的影响  

Effect of transcutaneous auricular vagus nerve stimulation on tourniquet-induced hypertension in patients undergoing anterior cruciate ligament reconstruction

作　　者：周琦 高明阳 于丽丽[2] 李亚南[1] 陈旭光[1] 于沛霞[1] 张亚辉[1] 董江涛[3] 王秋筠[1] Zhou Qi;Gao Mingyang;Yu Lili;Li Yanan;Chen Xuguang;Yu Peixia;Zhang Yahui;Dong Jiangtao;Wang Qiujun(Department of Anesthesiology,The Third Hospital of Hebei Medical University,Shijiazhuang 050051,China;Department of Anesthesiology,Cangzhou Central Hospital,Cangzhou 061000,China;Department of Arthrology,The Third Hospital of Hebei Medical University,Shijiazhuang 050051,China)

机构地区：[1]河北医科大学第三医院麻醉科,石家庄050051 [2]沧州市中心医院麻醉科,沧州061000 [3]河北医科大学第三医院关节科,石家庄050051

出　　处：《中华麻醉学杂志》2024年第3期272-276,共5页Chinese Journal of Anesthesiology

基　　金：河北省医学适用技术跟踪项目(GZ2024057)

摘　　要：目的评价经耳迷走神经刺激(taVNS)对前交叉韧带重建术患者止血带相关高血压(TIH)的影响。方法拟在全身麻醉联合股神经阻滞下行前交叉韧带重建术患者74例,性别不限,年龄18~60岁,ASA分级Ⅰ或Ⅱ级,BMI 18~30 kg/m2。采用随机数字表法分为2组(n=37):假刺激组(SS组)和taVNS组。SS组电刺激左侧耳垂和耳轮尾;taVNS组电刺激左侧耳甲艇和耳垂。2组均从麻醉诱导前1 h进行电刺激至手术结束(频率30 Hz,脉宽300μs,振幅为患者在不感觉到疼痛情况下能耐受的最强电流振幅)。止血带充气压力为280 mmHg,充气时间60~90 min。于止血带充气前记录SBP、DBP和HR,评估术中TIH的发生情况。记录术中丙泊酚、瑞芬太尼、硝酸甘油、艾司洛尔、去甲肾上腺素和阿托品使用情况,记录术后恶心呕吐、皮肤瘙痒和头痛头晕的发生情况。结果与SS组相比,taVNS组TIH发生率及硝酸甘油使用例数减少(P<0.05),其他指标差异无统计学意义(P>0.05)。结论taVNS可降低前交叉韧带重建术患者TIH的发生。Objective To evaluate the effect of transcutaneous auricular vagus nerve stimulation(taVNS)on tourniquet-induced hypertension(TIH)in the patients undergoing anterior cruciate ligament reconstruction.Methods Seventy-four patients of either sex,aged 18-60 yr,of American Society of Anesthesiologists Physical Status classification I or II,with body mass index of 18-30 kg/m^(2),undergoing elective anterior cruciate ligament reconstruction under general anesthesia combined with preoperative femoral nerve block,were divided into 2 groups(n=37 each)using a random number table method:sham stimulation group(group SS)and group taVNS.Group SS received stimulation on the ear lobe and the tail of the helix of the left ear.Group taVNS received stimulation on the cymba concha and the earlobe of the left ear.Both groups received stimulation from 1 h before induction of anesthesia until the end of the procedure(frequency of 30 Hz,pulse width of 300μs,and amplitude of the strongest current that could be tolerated by the patient in the absence of pain).The tourniquet inflation pressure was 280 mmHg,with an inflation time of 60-90 min.Systolic blood pressure,diastolic blood pressure and heart rate were recorded before tourniquet inflation to assess the development of intraoperative TIH.The consumption of intraoperative propofol,remifentanil,nitroglycerin,esmolol,norepinephrine and atropine was recorded,and the occurrence of postoperative nausea and vomiting,skin itching and headache and dizziness was also recorded.Results Compared with group SS,the incidence of TIH and the number of patients used nitroglycerin were significantly reduced(P<0.05),and no significant changes were found in the other parameters in group taVNS(P>0.05).Conclusions taVNS can decrease the occurrence of TIH in the patients undergoing anterior cruciate ligament reconstruction.

关 键 词：耳 迷走神经刺激术 前交叉韧带重建 止血带 高血压 

分 类 号：R614[医药卫生—麻醉学]