经皮穴位电刺激对上腹部手术患者呼气末七氟烷浓度的影响

目的 探讨经皮穴位电刺激对上腹部手术患者呼气末七氟烷浓度的影响.方法 采用前瞻、随机、设盲原则,将50例ASAⅠ-Ⅱ级上腹部手术患者随机分为经皮穴位电刺激复合七氟烷组(A组,n=25),单纯七氟烷组(B组,n=25).麻醉诱导前,A组经皮穴位电刺激双侧内关、合谷、足三里穴30 min；B组在手术室静置30 min.插管后,A、B两组静脉连续输注瑞芬太尼,持续吸入七氟烷,维持BIS值在40～ 50,A组继续经皮穴位电刺激.分别在穴位刺激前(T0)、切皮时(T1)、开腹探查时(T2)、开腹探查后30 min(T3)、开腹探查后60 min(T4),采静脉血监测血浆血管紧张素Ⅱ、皮质醇浓度,手术开始后每10 min记录1次呼气末七氟烷浓度.结果 A组呼气末七氟烷浓度(1.4±0.2)％,明显低于B组的(1.9±0.4)％(t =3.147,P＜0.01)；两组皮质醇、血管紧张素Ⅱ在T1、T2时间点较T0明显升高(F=2.256、2.432,2.132、2.334,均P＜0.05),两组T1～T4时间点皮质醇、血管紧张素Ⅱ差异均有统计学意义(t=2.159、2.232、2.453、2.602,均P＜0.05).结论 经皮穴位电刺激降低了上腹部手术患者呼气末七氟烷浓度及应激反应,与七氟烷具有麻醉协同作用.

Effect of transcutaneous electrical acupoint stimulation on end-tidal concentration of sevoflurane in upper abdominal operation

Objective To study the effect of transcutaneous electrical acupoint stimulation （TEAS） on end-tidal concentration of sevoflurane in upper abdominal operation. Methods The use of prospective, randomized, blinded principles. A total of 50 patients underwent selective epigastric operations with ASA I - II were randomly divided into group A （25 cases） and B （25 cases）. In group A,TEAS was performed and sevoilurane was inhaled during operation. In group B, only sevoflurane was inhaled and TEAS was not performed during operation. Electrical stimulation on Nei-guan, He-gu and Zu-sanli was performed for 30rain before induction of anesthesia in group A and meanwhile patients in group B were waiting for 30min in operating room. After intubation, in group A, TEAS was performed persistently and sevoflurane was inhaled, meanwhile remifentanil was infused persistently during operation. In group B, only sevoflurane was inhaled and remifentanil was infused persistently during operation. At time points：before TEAS（ T0 ）, skin incision（ T1 ）, exploratory laparotomy（ T2 ） ,30min after exploratory laparotomy（ T3 ） ,60min after exploratory laparotomy（ T4 ） , blood glucose and angiotensin II were measured, recorded 10min after the start of surgery, once for each end-tidal sevoflurane concentration. Results End-tidal concentration of sevoflurane of group A （ 1.4 ± 0.2 ） %, was significantly lower than group B（ 1.9 ± 0.4） % （ t = 3. 147, P 〈 0.01 ）. Cortisol and angiotensin II were increased at T, and T2 compared with TO in both groups（ F =2. 256,2. 432,2. 132,2. 334 ,all P 〈0.05）. Cortisol and angiotensin II were decreased in group A compared with in group B at T1 -T4 （t = 2. 159,2. 232,2. 453,2. 602, all P 〈 0.05 ）. Conclusion TEAS can decrease end-tidal concentration of sevoflurane and stress response. TEAS combined with sevoflurane has synergistic effect on general anesthesia.