经皮穴位电刺激对小儿扁桃体切除术后躁动的影响

目的 评价经皮穴位电刺激(TEAS)复合全麻对小儿扁桃体切除术后躁动及血流动力学的影响.方法 择期行扁桃体切除手术患儿60例,随机均分为经皮穴位电刺激组(T组)和对照组(C组),T组患儿予持续TEAS两侧合谷和内关穴位,两组麻醉诱导后全凭静脉维持麻醉,术后若患儿出现不能安慰的躁动,则静脉给予芬太尼0.5 μg/kg(T组)或1 μg/kg(C组).于入室时、插管时、拔管时、拔管后10 min以酶联免疫法测定两组患者血浆、肾上腺素(E)、去甲肾上腺素(NE)、β-内啡肽(β-EP)的变化.记录拔管时,拔管后5、10、15、30 min小儿麻醉后躁动(PAED)评分和疼痛评分(CHIPPS).结果 与入室时比较,插管时、拔管时、拔管后10 min两组患者E、NE均显著升高(P＜0.05),且C组显著高于T组(P＜0.05)；T组插管时、拔管时、拔管后10 min时β-EP高于入室时和C组(P＜0.05)；T组患者拔管后各时点PAED和CHIPPS均显著低于C组(P＜0.05).结论 TEAS可减少小儿扁桃体切除术后躁动的发生率.

Effects of transcutaneous electrical acupoint stimulation on postoperative agitation in children undergoing adenotonsillectomy

Objective To investigate the effects of transcutaneous electrical acupoint stimulation(TEAS) combined with general anesthesia on postoperative agitation and hemodynamics in children undergoing adenotonsillectomy.Methods Sixty patients scheduled for undergoing adenotonsillectomy were randomly assigned to the following two groups:TEAS(group T,n=30)and controlled (group C,n= 30).Group T received continuous TEAS at the points of Hegu and Neiguan.In both groups,after induction,the patients were maintained with total intravenous anesthesia.If the patient emergence inconsolable after operation,infusion of fentanyl 0.5 μg/kg(group T) or 1 μg/kg(group C) was administered.Changes of plasma level of epinephrine(E),norepinephrine(NE) and Beta-endorphin(β-EP) were observed at baseline,intubation,extubation and after 10 minutes.Agitation Scale (evaluate by pediatric anesthesia emergence delirium,PAED) and analgesia(evaluated by children and infants postoperative pain scale,CHIPPS) was assessed at extubation and after 5,10,15,30 minutes.Results Compared with that at baseline,plasma levels of E,NE at intubation,extubation and after 10 minutes increased significantly (P<0.05),levels of plasma E,NE of group C was significantly higher than those of group T (P< 0.05).Levels of plasma β-EP at intubation,extubation and after 10 minutes of group T was significantly higher than those of group C(P< 0.05).The PAED Scale and the CHIPPS in group T was both lower than those in group C after extubation(P<0.05).Conclusion Transcutaneous electrical acupoint stimulation is beneficial for reducing postoperative agitation and hemodynamics changes in children undergoing adenotonsillectomy.