摘要
目的评估经皮穴位电刺激(TEAS)结合靶控输注技术在乳腺手术中对丙泊酚-芬太尼静脉麻醉的辅助作用。方法采用数字表法将90例患者随机分为3组,每组30例。A组:丙泊酚靶控输注+芬太尼静脉全麻(PFVA);B组:TEAS患侧合谷配劳宫穴、内关配外关穴30min+PFVA。C组:TEAS患侧合谷配劳宫穴、内关配外关穴、双侧肩井穴30min+PFVA。观察并记录TEAS前(A组为入室)、TEAS30min后(A组为入室后30min)、诱导后、切皮后5min、缝皮、术毕、清醒各时点的BIS值、心率、脉搏血氧饱和度、血压及切皮时体动反应、苏醒质量。并在TEAS前(A组为入室)、TEAS30min后(A组为入室后30min)、切皮后5min、清醒各时间点抽取动脉血各3mL,测定肾上腺素和β-内啡肽的含量。结果TEAS30min后(A组为入室后30min),B、C组BIS值、血压、心率显著下降(P<0.05),A组无明显变化(P>0.05);B、C两组在各时点丙泊酚靶浓度均低于A组(P<0.05),且C组明显低于B组(P<0.05),丙泊酚平均用量B、C组比A组分别减少19%、27%;与TEAS前相比,B、C两组TEAS30min后β-内啡肽明显升高(P<0.05),C组较B组显著(P<0.05);两组的肾上腺素水平TEAS前后无明显改变(P>0.05)。结论TEAS对丙泊酚+芬太尼静脉麻醉有一定的辅助作用,对镇痛效应有明显的协同作用。
Objective To evaluate the adjuvant effect of transcutaneous electrical acupoint stimulation （TEAS） in propofol-fentanyl anesthesia in partial mastcctomy. Methods Ninety patients undergoing partial mastcctomy were randomly divided into 3 groups （n=30）, namely group A with propofol-fentanyl anesthesia （PFVA）, group B with PFVA and TEAS at Hegu-Laogong and Neiguan-WaiGuan acupoints, and group C with PFVA and TEAS at Hegu-Laogong, Neignan-Waiguan, and bilateral Jianjing acupoints. The bispectral index （BIS）, heart rate （HR）, saturation of pulse oxygen （SpO2）, blood pressure （BP）, the reaction of patients to the incision and awakening quality were observed at different time points. Blood samples were obtained from the dorsal artery of the foot to determine the levels of adrenaline and beta-endorphin using the enzyme-linked immunosorbent assay before TEAS （entry into the OR in group A） and at 30 min after TEAS （30 min after entry into the OR in group A）, 5 min after incision, end of the surgery and awakening. Results Thirty minutes after TEAS （or 30 min after entry into the OR in group A）, BIS, BP and HR were all decreased significantly in groups B and C （P〈0.05） but remained stable in group A （P〉0.05）. The plasma propofol concentration of groups B and C were significantly lower than that in group A, and group B had the highest plasma propofol concentration （P〈0.05）. The total dose of propofol in groups B and C were decreased by 19% and 27% in comparison with that in group A, respectively. Compared with the basal value, the content of beta-endorphin in groups B and C increased obviously 30 min after TEAS, being the highest in group C （P〈0.05）; the adrenaline level in groups B and C remained stable after TEAS （P〉0.05）. Conclusion TEAS provides an adjuvant effect in propofol-fentanyl anesthesia and obviously enhances the analgesia effect.
出处
《南方医科大学学报》
CAS
CSCD
北大核心
2009年第10期2064-2066,共3页
Journal of Southern Medical University
基金
广州中医药大学中医药科学技术研究专项"围手术期中西医结合临床研究项目"(08W04)
关键词
经皮穴位电刺激
丙泊酚
脑电双频谱指数
辅助作用
transcutaneous electrical acupoint stimulation
propofol
bispectral index
adjuvant effects
