摘要
目的评价不同频率经皮穴位电刺激对胸腔镜肺叶切除术中患者阿片类药物的节俭作用。方法择期全麻下行胸腔镜肺叶切除术患者80例，年龄40～64岁，体重50～90kg，ASA分级I-Ⅲ级。采用随机数字表法分为4组（Ⅱ=20）：对照组（Con组）假刺激穴位，2／100Hz组、2Hz组和100Hz组电刺激列缺＋曲池＋内关＋合谷穴，从麻醉诱导前30min至术毕持续按照各自频率电刺激相应穴位，强度以患者能耐受的最大电流为宜，Con组只贴电极片。静脉注射咪达唑仑、异丙酚、舒芬太尼、顺阿曲库铵行麻醉诱导。术中靶控输注瑞芬太尼和异丙酚、静脉输注顺阿曲库铵维持麻醉，根据情况追加舒芬太尼。根据BIS值调整异丙酚靶浓度，维持BIS值40～60。瑞芬太尼起始效应室靶浓度1ng／ml，切皮时调至4ng／ml，根据镇痛伤害感受指数（ANI）值调整瑞芬太尼靶浓度和舒芬太尼用量，维持ANI值50～70。瑞芬太尼靶浓度增加至4ng／ml，ANI值仍〈50，则静脉注射舒芬太尼0．1μg／kg。记录术中瑞芬太尼（将术中舒芬太尼用量等效转换成瑞芬太尼用量）用量，除以患者体重和手术时间后，计算每分钟每公斤体重药物用量。结果2／100Hz组术中瑞芬太尼用量明显少于Con组、2Hz组和100Hz组（P〈0．01）；Con组、2Hz组和100Hz组上述指标比较差异无统计学意义（P〉0．05）。结论2／100Hz经皮电刺激列缺＋曲池＋内关＋合谷穴对胸腔镜肺叶切除术中患者阿片类药物有明显节俭作用，而2和100Hz相同穴位的经皮电刺激无此作用。
Objective To evaluate the intraoperative opioid-sparing effect of different frequency transcutaneous electrical acupoint stimulation （TEAS） in the patients undergoing video-assisted thoracoscopic pneumonectomy. Methods Eighty patients, aged 40-64 yr, weighing 50-90 kg, of ASA physical status I -Ⅲ, scheduled for elective thoracoscopic pneumonectomy under general anesthesia, were randomly divided into 4 groups （ n = 20 each） using a random number table： control group （ group Con） , stimulation on Lieque （ LU7）-Quchi （ LIll）-Neiguan （ PC6）-Hegu （LI4） at 2/100 Hz group （ group 2/100 Hz）, stimulation on LU7-LIll-PC6-LI4 at 2 Hz group （group 2 Hz）, and stimulation on LU7- LIll-PC6-LI4 at 100 Hz group （group 100 Hz）. The patients in group Con had the electrodes applied, but received no stimulation. In 2/100 Hz, 2 Hz and 100 Hz groups, the patients received 2/100, 2 and 100 Hz TEAS on LU7-Llll-PC6-LI4 acupoints ipsilateral to the surgery site, respectively, starting from 50 min before induction of anesthesia until the end of surgery, and the intensity was the maximum current that could be tolerated. Anesthesia was induced with iv midazolam, propofol, sufentanil and cisatracurim, and maintained with target-controlled infusion of remifentanil and propofol, continuous infusion of cisatracurim,and iv boluses of sufentanil when necessary. The target plasma concentration of propofol was adjusted to maintain BIS value at 40-60 during operation. The initial target effect-site concentration of remifentanil was 1 ng/ml, and adjusted to 4 ng/ml at skin incision. The concentration of remifentanil and consumption of sufentanil were adjusted to maintain Analgesia Nociception Index （ANI） at 50- 70. When the concentration of remifentanil was increased to 4 ng/ml, ANI was still less than 50, and then 0.1 tzg/kg sufentanil was given. The duration of operation and intraoperative consumption of remifentanil and sufentanil （the consumption of sufentanil was converted to the consumption of remifentanil producing the equivalent effect by 1 ： 10） were recorded. Results The intraoperative consumption of remifentanil was significantly reduced in 2/100 Hz group as compared with Con, 2 Hz and 100 Hz groups. There was no significant difference in the intraoperative consumption of remifentanil between Con group, 2 Hz group and 100 Hz group. Conclusion The use of 2/100 Hz but not 2 and 100 Hz TEAS on LU7-Llll-PC6-LI4 significantly reduces intraoperative opioid consumption in the patients undergoing video-assisted thoracoscopic pneumonectomy.
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2015年第3期340-343,共4页
Chinese Journal of Anesthesiology
关键词
经皮神经电刺激
镇痛药
阿片类
肺切除术
Transcutaneous electric nerve stimulation
Analgesics,opioid
Pneumonectomy
