电针联合全身麻醉对腰椎后路开放手术患者应激反应的影响

目的观察电针联合全身麻醉对腰椎后路开放手术患者围术期血流动力学及应激反应的影响。方法选择择期行腰椎后路开放手术患者180例,男68例,女112例,年龄18~70岁,ASAⅠ或Ⅱ级。随机分为三组:电针组(A组)、非经非穴组(B组)和对照组(C组),每组60例。麻醉诱导前,A组予双侧合谷、内关穴电针治疗30 min;B组取上肢2个非经非穴点予电针刺激;C组不予电针治疗。三组麻醉方法相同,术后予PCIA。记录术中丙泊酚、瑞芬太尼用量,术后24、48 h镇痛泵累积用量,电针治疗前(T₂)、麻醉诱导前(T₁)、气管插管即刻(T₂)、切皮时(T₃)和缝皮结束即刻(T₄)的HR、MAP。检测T₂、T₃、T₄时肾上腺素(E)、去甲肾上腺素(NE)、多巴胺(DA)、皮质醇(Cor)及血糖浓度。结果A组术中瑞芬太尼用量明显少于B组,术后48 h镇痛泵累积用量明显少于B组、C组(P<0.05);与T₂时比较,T₂、T₃时A组、C组与T₂时B组HR明显增快,MAP明显升高(P<0.05);T₁时B组HR明显快于A组,T₃时B组HR明显慢于A组、C组,T₂、T₃时A组、B组MAP明显低于C组(P<0.05)。T₃时A组DA浓度明显低于C组,T₄时A组E浓度明显低于B组、C组。与T₂时比较,T₃、T₄时三组Cor和血糖浓度明显升高(P<0.05)。T₃、T₄时A组、T₄时B组Cor浓度明显低于C组(P<0.05)。结论电针联合全身麻醉有利于维持腰椎后路开放手术患者围术期血流动力学稳定,减轻急性应激反应,减少麻醉镇痛药用量,与非经非穴电针刺激比较,疗效更优。

Effect of electroacupuncture combined with general anesthesia on stress response in patients with open posterior lumbar spine surgery

Objective To observe the effect of electroacupuncture combined with general anesthesia on the stress response of patients with open posterior lumbar spine surgery.Methods A total of 180 patients who scheduled for open posterior lumbar spine surgery,68 males and 112 females,aged 18-70 years,ASA physical statusⅠorⅡ,were randomly divided into three groups(n=60 in each group):electroacupuncture group(group A),non-acupoint group(group B)and the control group(group C).Before the induction of anesthesia,group A was treated with electroacupuncture at bilateral Hegu(LI4)and Neiguan(PC6)for 30 minutes,group B was treated with electroacupuncture at non-acupoints on the upper limb for 30 minutes,group C was not given any electroacupuncture stimulation.The anesthesia methods in the three groups were the same,and patient-controlled intravenous analgesia(PCIA)was performed after the operation.The intraoperative dosage of propofol and remifentanil,and the cumulative dosage of PCIA within 24 hours and 48 hours after surgery were recorded.HR and MAP were recorded before electroacupuncture treatment(T₀),before anesthesia induction(T₁),immediately after tracheal intubation(T₂),during incision(T₃),and at the end of suture(T₄).The concentrations of epinephrine(E),norepinephrine(NE),dopamine(NA),cortisol(Cor),and blood glucose were measured at T₂,T₃,and T₄.Results The intraoperative dosage of remifentanil in group A was lower than that in group B,and the dosage of PCIA analgesics within 48 hours after surgery was lower than that in the other two groups(P<0.05).Compared with T₂,the HR and MAP were significantly higher in groups A and C at T₂ and T₃ and in group B at T₂(P<0.05).HR in group B was higher than that in group A at T₁,lower than that in groups A and C at T₃.MAP in groups A and B was significantly lower than that in group C at T₂ and T₃(P<0.05).The concentration of E in group A was significantly lower than that in groups B and C at T₄,and the concentration of DA in group A was lower than that in group C at T₃.Compared with T₂,Cor and blood glucose concentrations in the three groups at T₃ and T₄ were significantly increased(P<0.05).The concentration of Cor in group A at T₃ and T₄ and Cor in group B at T₄ were lower than that in group C(P<0.05).Conclusion Electroacupuncture combined with general anesthesia is beneficial to maintain perioperative hemodynamic stability in patients with open lumbar posterior surgery,reduce acute stress response and the amount of anesthetic analgesics.Compared with non-acupoints,electroacupuncture combined with general anesthesia has better effect.