老年患者腰椎手术麻醉的改良策略:经皮穴位电刺激-竖脊肌平面阻滞-全身麻醉  

Improved anesthesia strategy for lumbar spine surgery in elderly patients:transcutaneous electrical acupoint stimulation-erector spinal plane block-general anesthesia

作　　者：何庆标 黎玉辉[1] 梁雨晴 黄威 He Qingbiao;Li Yuhui;Liang Yuqing;Huang Wei(Department of Anesthesiology,The First Affliated Hospital of Guangzhou University of Chinese Medicine,Guangdong Clinical Research Academy of Chinese Medicine,Guangzhou 510405,China)

机构地区：[1]广州中医药大学第一附属医院麻醉科、广东省中医临床研究院,广州510405

出　　处：《中华麻醉学杂志》2024年第11期1356-1360,共5页Chinese Journal of Anesthesiology

摘　　要：目的评价经皮穴位电刺激(TEAS)-竖脊肌平面阻滞(ESPB)-全身麻醉用于老年患者腰椎手术的麻醉效果。方法选择2023年10月至2024年3月于广州中医药大学第一附属医院,择期行2个节段以内腰椎后路减压融合内固定术的老年患者100例,性别不限,年龄65~75岁,BMI 19~27 kg/m^(2),ASA分级Ⅱ或Ⅲ级。采用随机数字表法分为2组(n=50):TEAS组(T组)和对照组(C组)。T组于麻醉诱导前30 min至术毕持续行TEAS,术后连续2 d行TEAS,1次/d,30 min/次,刺激部位取双侧合谷、内关和足三里穴。C组于相同穴位上贴敷电极片,不进行电刺激。2组全身麻醉诱导后均在超声引导下行双侧ESPB,每侧注射0.375%罗哌卡因20 ml。术毕采用枸橼酸舒芬太尼行PCIA至术后48 h。VAS评分≥4分时静脉注射曲马多补救镇痛。记录术中瑞芬太尼、丙泊酚用量和术后48 h内PCA有效按压次数(D1)、实际按压次数(D2)、补救镇痛情况,计算D1/D2比值。分别于穴位刺激前、术后24和48 h时测定血清IL-6、IL-10、TNF-α浓度及T淋巴细胞亚群水平(CD3^(+)、CD4^(+)、CD8^(+)),计算CD4^(+)/CD8^(+)比值。结果与C组比较,T组术中瑞芬太尼用量减少,D1和D2减少,D1/D2比值升高,术后补救镇痛率降低,术后各时点血清IL-6、IL-10和TNF-α浓度降低,血清CD3^(+)、CD4^(+)水平及CD4^(+)/CD8^(+)比值升高(P<0.05)。结论相对于ESPB联合全身麻醉而言,TEAS-ESPB-全身麻醉可以为老年腰椎手术患者提供较好的镇痛效果,减轻术后炎症反应,提高免疫功能。Objective To evaluate the anesthetic effect of transcutaneous electrical acupoint stimulation(TEAS)-erector spinal plane block(ESPB)-general anesthesia in elderly patients undergoing lumbar spine surgery.Methods A total of 100 American Society of Anesthesiologists Physical Status classificationⅡorⅢelderly patients,aged 65-75 yr,with a body mass index of 19-27 kg/m 2,undergoing elective lumbar fusion internal fixation within two levels in the First Affiliated Hospital of Guangzhou University of Chinese Medicine from October 2023 to March 2024,were selected and divided into 2 groups(n=50 each)using a random number table method:TEAS group(T group)and control group(C group).In T group,TEAS was performed at 30 min before anesthesia induction until the end of operation,then transcutaneous electrical stimulation of bilateral Hegu,Neiguan and Zusanli was performed for 2 consecutive days after surgery,once a day,30 min per time.Electrodes were applied to the same acupoints without electrical stimulation in group C.After induction of general anesthesia,bilateral ESPB was performed under ultrasound guidance,and 0.375% ropivacaine 20 ml was injected on each side in both groups.Patient-controlled intravenous analgesia was carried out with sufentanil citrate from the end of surgery until 48 h after surgery.When VAS score≥4,tramadol was intravenously injected as rescue analgesic.The consumption of remifentanil and propofol,the total number of successfully delivered doses(D1)and the number of attempts(D2)within 48 h after operation,and the D1/D2 ratio and rescue analgesia were recorded.The concentrations of interleukin-6,interleukin-10,tumor necrosis factor-α and T-lymphocyte subsets(CD3^(+),CD4^(+),CD8^(+))were determined before stimulation of acupoints and at 24 and 48 h after surgery.The CD4^(+)/CD8^(+)ratio was calculated.Results Compared with group C,the consumption of intraoperative remifentanil was significantly decreased,D1 and D2 were reduced,the D1/D2 ratio was increased,the rate of rescue analgesia was decrease

关 键 词：经皮神经电刺激 神经传导阻滞 麻醉 全身 老年人 

分 类 号：R614[医药卫生—麻醉学]