经皮穴位电刺激在老年骨科手术麻醉中的应用

目的探究经皮穴位电刺激在老年骨科手术麻醉中的应用价值。方法选取92例老年骨科手术患者,按照麻醉方法随机分成穴位电刺激组和全身麻醉组,每组46例。全身麻醉组行全身麻醉,穴位电刺激组在全身麻醉组基础上行经皮穴位电刺激。比较两组拔管时间、睁眼时间、应答时间、术中丙泊酚使用量、麻醉前后血流动力学指标[平均动脉压(MAP)、心率(HR)]、血浆皮质醇(Cor)、内皮素(ET)、简易精神状态检测量表(MMSE)评分。结果穴位电刺激组应答时间较全身麻醉组短,术中丙泊酚使用量较全身麻醉组低(P<0.05);T1(诱导后)穴位电刺激组MAP较全身麻醉组高,T2(插管时)、T3(切皮后5 min)穴位电刺激组MAP较全身麻醉组低,T2、T3、T4(手术结束时)穴位电刺激组HR较全身麻醉组低(P<0.05),穴位电刺激组血流动力学波动较全身麻醉组小;T2、T3穴位电刺激组血浆Cor水平较全身麻醉组低(P<0.05),T1穴位电刺激组血浆ET水平较全身麻醉组高,T2、T3、T4穴位电刺激组血浆ET水平较全身麻醉组低(P<0.05);麻醉后12 h、24 h穴位电刺激组MMSE评分较全身麻醉组高(P<0.05)。结论经皮穴位电刺激应用于老年骨科手术麻醉中,可减小患者术中血流动力学波动,减轻术中应激反应,减少术中麻醉药物使用量,促进患者术后意识恢复。

Application of Transcutaneous Electrical Acupoint Stimulation to Anesthesia for Orthopedic Surgery in the Elderly

Objective To explore the value of application of transcutaneous electrical acupoint stimulation to anesthesia for orthopedic surgery in the elderly.Method Ninety-two elderly patients hospitalized for orthopedics surgery were randomized to electrical acupoint stimulation and general anesthesia groups according to anesthesia method,with 46 cases in each group.The general anesthesia group received general anesthesia and the electrical acupoint stimulation group,transcutaneous electrical acupoint stimulation in addition.Extubation times,eye opening times,response times,intraoperative propofol dosages,and pre-and post-anesthesia hemodynamic indicators[mean arterial pressure(MAP)and heart rate(HR)],plasma cortisone(Cor)and endothelin(ET)levels and Mini-mental State Examination(MMSE)scores were compared between the two groups.Result Response time was shorter,intraoperative propofol dosage was lower(P<0.05),MAP at T1(after induction)was higher,MAP at T2(at intubation)and T3(5 min after skin incision)was lower,HR at T2,T3 and T4(at the end of surgery)was slower(P<0.05),hemodynamic fluctuation was smaller,plasma Cor levels at T2 and T3 were lower(P<0.05),plasma ET levels at T1 were higher and plasma ET levels at T2,T3 and T4 were lower(P<0.05)in the electrical acupoint stimulation group than in the general anesthesia group.The MMSE score was higher in the electrical acupoint stimulation group than in the general anesthesia group at 12 and 24 hrs after anesthesia(P<0.05).Conclusions The application of transcutaneous electrical acupoint stimulation to anesthesia for orthopedic surgery in the elderly can reduce intraoperative hemodynamic fluctuation,stress reaction and anesthetic dosage to promote postoperative recovery of consciousness in the patients.