经皮穴位电刺激对全麻患者异丙酚效应室靶浓度和芬太尼用量的影响

目的 探讨经皮穴位电刺激对全麻患者异丙酚效应室靶浓度和芬太尼用量的影响.方法 择期全麻下行上腹部手术患者40例,随机分为2组(n=20),异丙酚复合全麻组(P组),穴位电刺激+异丙酚复合全麻组(EP组)从麻醉诱导前30 min至术毕行持续双侧内关穴、足三里穴电刺激,以刺激频率2 Hz和100 Hz的疏密波进行交替刺激,刺激强度8～12 mA.麻醉诱导:两组均静脉注射咪达唑仑0.03 mg/kg、芬太尼1.5μg/kg、维库溴铵0.12 mg/kg,靶控输注异丙酚(血浆靶浓度2.5 μg/ml);麻醉维持:以0.1μg/ml幅度增加或降低异丙酚效应室靶浓度,维持BIS 45～55,间断静脉注射维库溴铵2 mg和芬太尼0.05～0.1 mg.于气管插管前、气管插管后、切皮前、切皮后、术中探查、术毕时记录HR、MAP和异丙酚效应室靶浓度,记录芬太尼用量.于麻醉诱导前(基础状态)、电刺激30 min、切皮后、术中探查、术毕时采集外周静脉血样,测定血清血管紧张素Ⅱ和皮质醇的浓度.结果 EP组异丙酚效应室靶浓度和芬太尼用量低于P组(P＜0.01);两组MAP和HR均波动在正常范围;两组间各时点血清血管紧张素Ⅱ和皮质醇浓度差异无统计学意义(P＞0.05).与基础值比较,EP组电刺激30 min时血清血管紧张素Ⅱ和皮质醇浓度下降(P＜0.05),P组术中探查时血管紧张素Ⅱ和皮质醇浓度升高(P＜0.05或0.01).结论 经皮穴位电刺激可降低全麻患者异丙酚效应室靶浓度,减少芬太尼用量.

Effects of transcutaneous electrical stimulation of acupuncture points on target effect-site concentration of propofol TCI and mount of fentanyl consumed in patients undergoing general anesthesia

Objective To investigate the effects of transcutaneous electrical stimulation of acupuncture points(TEAS)on the target effect-site concentration(CT)of propofol and amount of fentanyl consumed in patients undergoing general anesthesia.Methods Forty ASA Ⅰor Ⅱ patients aged 38-64 yr weighing 50-90 kg undergoing upper abdominal surgery under general anesthesia were randomly divided into 2 groups(n=20 each):group Ⅰpropofol(P)and group Ⅱ TEAS+pmpofol(EP).The patients were predemicated with intramuscular phenobarbital 0.1 g and scopolamine 0.3 mg.Anesthesia was induced with midazolam 0.03 mg/kg.fentanyl 1.5 μg/kg and TCI of propofol(the initial CT=2.5 μg/ml).As soon as the patients lost consciousness,vecuronium 0.12 mg/kg was given iv.The patients were mechanically ventilated after tracheal intubation.PET CO2 was maintained at 30-35 mm Hg.Anesthesia was maintained with TCI of propofol and intermittent iv boluses of fentanyl and vecuronium.CT of propofol was adjusted to maintain BIS at 45-55 during operation.In EP group transcutaneons electrical stimulation of bilateral Neiguan and Zusardi points was performed at 30 min before induction of general anesthesia and maintained until the end of surgery with alternative stimulation at frequency of 2 Hz and 100 Hz and intensity of 8-12 mA.HR and MAP were recorded before induction of anesthesia(To,baseline),before(T1)and after tracheal intubation(T2),before(T3)and after skin incision(T4),during surgical exploration(T5)and at the end of operation(T6).The CT of propofol and amount of fontanyl consumed were also recorded at T1-6.Blood samples were taken at 30 min of TEAS before induction of anesthesia and at T4-6 for determination of serum concentrations of angiotensin Ⅱ and cortisol by radioimmuno assay.ResultsCT of propofol and the amount of fentanyl consumed were significantly lower in group EP than in group P(P＜0.01).There were no significant differences in the serum concentrations of angiotensinⅡand cortisol at all time points between the 2 groups.Compared with the baseline values the sernm concentrations of angiotensin Ⅱ and contisol were significantly decreased at 30 min of TEAS in group EP and were significantly increased at T5 in group P.Conclusion TEAS can reduce propofol CT and amou~of fentanyl consumed during general anesthesia.