CAJ | 학술논문

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.
목적 탐토경피혈위전자격대상복부수술환자호기말칠불완농도적영향.방법 채용전첨、수궤、설맹원칙,장50례ASAⅠ-Ⅱ급상복부수술환자수궤분위경피혈위전자격복합칠불완조(A조,n=25),단순칠불완조(B조,n=25).마취유도전,A조경피혈위전자격쌍측내관、합곡、족삼리혈30 min；B조재수술실정치30 min.삽관후,A、B량조정맥련속수주서분태니,지속흡입칠불완,유지BIS치재40～ 50,A조계속경피혈위전자격.분별재혈위자격전(T0)、절피시(T1)、개복탐사시(T2)、개복탐사후30 min(T3)、개복탐사후60 min(T4),채정맥혈감측혈장혈관긴장소Ⅱ、피질순농도,수술개시후매10 min기록1차호기말칠불완농도.결과 A조호기말칠불완농도(1.4±0.2)％,명현저우B조적(1.9±0.4)％(t =3.147,P＜0.01)；량조피질순、혈관긴장소Ⅱ재T1、T2시간점교T0명현승고(F=2.256、2.432,2.132、2.334,균P＜0.05),량조T1～T4시간점피질순、혈관긴장소Ⅱ차이균유통계학의의(t=2.159、2.232、2.453、2.602,균P＜0.05).결론 경피혈위전자격강저료상복부수술환자호기말칠불완농도급응격반응,여칠불완구유마취협동작용.
Objective To study the effect of transcutaneous electrical acupoint stimulation(TEAS) on endtidal 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 sevoflurane 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 30min 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 T1 and T2 compared with T0 in both groups(F =2.256,2.432,2.132,2.334,all P＜0.05).Cortisol and angiotensin Ⅱwere decreased in group A compared with in group B at T1 ～T4(t =2.159,2.232,2.453,2.602,al1 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.