自控经皮电刺激耳神门穴对剖宫产术中镇静的有效性及安全性观察

目的 探讨自控经皮电刺激耳神门穴用于剖宫产术中镇静的有效性及安全性。 方法 184例焦虑自评分（SAS）>30分的择期剖宫产产妇，拟行腰-硬联合麻醉，随机分为3组；自控经皮电刺激耳神门穴组（简称A组，60例）、自控经皮电刺激耳眼点穴组（简称B组，60例）及对照组（简称C组,60例）。A组产妇入手术室后行自控电刺激耳神门穴，持续刺激至手术结束；B组刺激耳眼点穴；C组夹穴连线等与A组相同，不行电刺激。观察产妇入室后（T0）、刺激30min后（T1）、取出胎儿后（T2）、术毕时（T3）的脑电双频指数（bispectral index,BIS）、心率（heart rate,HR）、平均动脉压（mean arterial pressure,MAP）、Ramsay镇静评分（Ramsay sedation score）；产妇血浆血管紧张素II（Ang II）及皮质醇（Cor）水平；术中缩宫素、麻黄碱、阿托品使用率、出血量及新生儿Apgar评分。结果 与A组比较，B组及C组在T1、T2、T3时BIS、血浆Ang II及Cor水平升高（P<0.05），Ramsay镇静评分减少（P<0.05）；T1时HR、MAP升高（P<0.05）与本组T0时比较，A组T1时BIS、HR、MAP、Ramsay镇静评分、血浆Ang II及Cor水平降低（P<0.05）。缩宫素、麻黄碱、阿托品使用率、出血量、新生儿Apgar评分两两比较，差异无统计学意义（P>0.05）。 结论 自控经皮电刺激耳神门穴用于剖宫产术具有明显的镇静作用，对产妇及新生儿无不良影响。

Efficacy and Safety of Patient-controlled Sedation with Transcutaneous Electrical Stimulation of Auricular Shenmen(TF4) in Cesarean Section

Objective To study the efficacy and safety of patient-controlled sedation with transcutaneous electrical stimulation of auricular Shenmen(TF4) in cesarean section.Methods A randomized controlled clinical trail was conducted on 180 singleton primiparas(SAS>30) undergoing selective cesarean section.They were randomly assigned to three groups,i.e.,the patient-controlled sedation with transcutaneous electrical stimulation of auricular Shenmen(TF4) group(Group A,60 cases),the patient-controlled sedation with transcutaneous electrical stimulation of auricular eye point group(Group B,60 cases),and the control group(Group C,60 cases).Patients in Group A received patient-controlled sedation with transcutaneous electrical stimulation of auricular Shenmen(TF4) in the operating room.The strength was controlled by patients themselves.The stimulation lasted for 30 min before the epidural puncture till ending the surgery.Patients in Group B received stimulation of auricular eye point.Patients in Group C received pressurization with the same connected line as Group A,but without electric stimulation.The following indices were observed:(1) the bispectral index(BIS),heart rate(HR),mean arterial pressure(MAP),Ramsay sedation score when the women entered the operating room(T0),30 min after stimulation(T1),at the time after removing the fetus(T2),and by the end of surgery(T3);(2) the concentrations of plasma angiotensin Ⅱ(AngⅡ) and cortisone(Cor) at the aforesaid time points;(3) the use rates of oxytocin,atropine,and ephedrine;the hemorrhage amount,and the neonatal Apgar score.Results Compared with Group A,the BIS,the plasma concentrations of AngⅡ and Cor increased at T1,T2,and T3(P<0.05),and the Ramsay sedation score decreased(P<0.05).The HR and MAP increased at T1(P<0.05) in Group B and Group C.Compared with T0,the BIS,HR,MAP,and Ramsay sedation score,the plasma concentrations of AngⅡ and Cor were lowered in Group A at T1(P<0.05).There was no statistical difference in the use rates of oxytocin,atropine,and ephedrine;the hemorrhage amount,and the neonatal Apgar score(P>0.05).Conclusions Patient-controlled sedation with transcutaneous electrical stimulation of auricular Shenmen(TF4) in cesarean section had obvious sedative effects.It had no adverse effects on puerperal or neonates.