经皮穴位电刺激对胸腔镜肺癌根治术患者术中循环抑制的影响

Effect of transcutaneous electrical acupoint stimulation on circulation depression in patients undergoing thoracoscopic radical resection of lung cancer

中文关键词: 经皮穴位电刺激  胸椎旁神经阻滞  胸腔镜肺癌根治术  全身麻醉  低血压

英文关键词: Transcutaneous electrical acupoint stimulation  Thoracic paravertebral block  Thoracoscopic radical resection of lung cancer  General anesthesia  Hypotension

中文摘要:

      
目的 探讨经皮穴位电刺激（TEAS）对全麻联合胸椎旁神经阻滞（TPVB）下胸腔镜肺癌根治术患者术中循环抑制的影响。
方法 选择2021年10月至2022年5月择期在全麻联合TPVB下行胸腔镜肺癌根治术患者150例，男58例，女92例，年龄19～64岁，BMI 18～30 kg/m²，ASA Ⅰ或Ⅱ级。采用随机数字表法将患者分为两组：TEAS组和对照组，每组75例。麻醉诱导前30 min,TEAS组于双侧合谷穴、内关穴、足三里穴进行TEAS至手术结束；对照组于相同穴位上贴敷电极片，不进行电刺激。记录穴位刺激前（T₀）、胸椎旁神经阻滞后10 min（T₁）、切皮即刻（T₂）、手术30 min（T₃）、手术60 min（T₄）、手术结束即刻（T₅）和术后30 min（T₆）的HR、SBP、DBP、MAP和BIS。记录术中心动过缓、心动过速、低血压、高血压、循环抑制发生情况及血管活性药物使用情况。记录术中丙泊酚、舒芬太尼、瑞芬太尼用量。记录术后1、2、7 d VAS疼痛评分和术后7 d内镇痛药物用量。记录术后恶心呕吐、头晕、胸闷、气促等不良反应发生情况及术后住院时间。
结果 与对照组比较，TEAS组术中输液量、低血压、高血压、循环抑制发生率、术中去氧肾上腺素、麻黄碱、去甲肾上腺素、乌拉地尔使用率、术后1、2 d VAS疼痛评分、术后7 d内镇痛药使用率明显降低（P<0.05），术后住院时间明显缩短（P<0.05），T₁时SBP、DBP和MAP明显升高（P<0.05），术中丙泊酚、舒芬太尼、瑞芬太尼用量均明显减少（P<0.05）。两组恶心呕吐、头晕、气促发生率差异无统计学意义。
结论 TEAS可以改善全麻联合TPVB下胸腔镜肺癌根治术患者术中循环抑制情况，减少围术期麻醉药物用量和血管活性药物使用，改善术后早期急性疼痛，缩短术后住院时间。

英文摘要:

      
Objective To observe the effect of transcutaneous electrical acupoint stimulation (TEAS) on circulation depression in patients underwent thoracoscopic radical resection of lung cancer under general anesthesia combined with thoracic paravertebral block (TPVB).
Methods A total of 150 patients from Octomber 2021 to May 2022, 58 males and 92 females, aged 19-64 years, BMI 18-30 kg/m², ASA physical status Ⅰ or Ⅱ, underwent thoracoscopic radical resection of lung cancer under general anesthesia combined with TPVB were enrolled. According to random number table method, the patients were divided into two groups: the TEAS group and the control group, 75 patients in each group. In the TEAS group, transcutaneous electrical acupoint stimulation was performed at Hegu, Neiguan, and Zusanli 30 minutes before induction until the end of operation. In the control group, the electrodes were only connected at the same time point without electrical stimulation. HR, SBP, DBP, MAP, and BIS were recorded before stimulation (T₀), 10 minutes after TPVB (T₁), the time of skin incision (T₂), 30 minutes after operation started (T₃), 60 minutes after operation started (T₄), the end of operation (T₅), and 30 minutes after operation (T₆). The incidences of bradycardia, tachycardia, hypotension, and hypertension, and the usages of vasoactive drugs during operation were recorded. The dosages of propofol, sufentanil, and remifentanil in the operation were recorded. The VAS pain score 1, 2, and 7 days after operation, the usages of analgesics used within 7 days after operation, postoperative adverse effects such as nausea and vomiting, dizziness, chest tightness, and shortness of breath, and the length of hospital stay were recorded.
Results Compared with the control group, intraoperative infusion volume, incidence of hypotension, hypertension, and circulation depression, the usages of deoxyepinephrine, ephedrine, norepinephrine, and urapidil intraoperation, VAS pain scores 1 and 2 days after operation, and the usage of analgesics within 7 days after operation were significantly decreased (P < 0.05), length of hospital stay was significantly shortened (P < 0.05), SBP, DBP, and MAP were significantly increased at T₁ (P < 0.05), the dosagesof propofol, sufentanil, and remifentanil were significantly decreased in the TEAS group (P < 0.05). There were no significantly differences of nausea and vomiting, dizziness, and shortness of breath between the two groups.
Conclusion TEAS can improve the circulation depression, and reduce the incidences of intraoperative hypotension and hypertension, decrease the dosages of anesthetics and the rate of using vasoactive drugs during operation, improve early postoperative acute pain and shorten the length of hospital stay in patients undergoing thoracoscopic radical resection of lung cancer under general anesthesia combined with TPVB．