南方医科大学学报
南方醫科大學學報
남방의과대학학보
JOURNAL OF SOUTHERN MEDICAL UNIVERSITY
2009年
10期
2064-2066
,共3页
司俊丽%徐琳%李国才%肖建斌
司俊麗%徐琳%李國纔%肖建斌
사준려%서림%리국재%초건빈
经皮穴位电刺激%丙泊酚%脑电双频谱指数%辅助作用
經皮穴位電刺激%丙泊酚%腦電雙頻譜指數%輔助作用
경피혈위전자격%병박분%뇌전쌍빈보지수%보조작용
transcutaneous electrical acupoint stimulation%propofol%bispectral index%adjuvant effects
目的 评估经皮穴位电刺(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)、TEAS 30 min后(A组为入室后30min)、诱导后、切皮后5 min、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)、TEAS 30 min后(A组为入室后30 min)、切皮后5 min、清醒各时间点抽取动脉血各3 mL,测定肾上腺素和β内啡肽的含量.结果 TEAS 30min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TEAS 30 min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.
目的 評估經皮穴位電刺(TEAS)結閤靶控輸註技術在乳腺手術中對丙泊酚-芬太尼靜脈痳醉的輔助作用.方法 採用數字錶法將90例患者隨機分為3組,每組30例.A組:丙泊酚靶控輸註+芬太尼靜脈全痳(PFvA);B組:TEAS患側閤穀配勞宮穴、內關配外關穴30min+PFVA.C組:TEAS患側閤穀配勞宮穴、內關配外關穴、雙側肩井穴30min+PFVA.觀察併記錄TEAS前(A組為入室)、TEAS 30 min後(A組為入室後30min)、誘導後、切皮後5 min、縫皮、術畢、清醒各時點的BIS值、心率、脈搏血氧飽和度、血壓及切皮時體動反應、囌醒質量.併在TEAS前(A組為入室)、TEAS 30 min後(A組為入室後30 min)、切皮後5 min、清醒各時間點抽取動脈血各3 mL,測定腎上腺素和β內啡肽的含量.結果 TEAS 30min後(A組為入室後30min),B、C組BIS值、血壓、心率顯著下降(P<0.05),A組無明顯變化(P>0.05);B、C兩組在各時點丙泊酚靶濃度均低于A組(P<0.05),且C組明顯低于B組(P<0.05),丙泊酚平均用量B、C組比A組分彆減少19%、27%;與TEAS前相比,B、C兩組TEAS 30 min後β-內啡肽明顯升高(P<0.05),C組較B組顯著(P<0.05);兩組的腎上腺素水平TEAS前後無明顯改變(P>0.05).結論 TEAS對丙泊酚+芬太尼靜脈痳醉有一定的輔助作用.對鎮痛效應有明顯的協同作用.
목적 평고경피혈위전자(TEAS)결합파공수주기술재유선수술중대병박분-분태니정맥마취적보조작용.방법 채용수자표법장90례환자수궤분위3조,매조30례.A조:병박분파공수주+분태니정맥전마(PFvA);B조:TEAS환측합곡배로궁혈、내관배외관혈30min+PFVA.C조:TEAS환측합곡배로궁혈、내관배외관혈、쌍측견정혈30min+PFVA.관찰병기록TEAS전(A조위입실)、TEAS 30 min후(A조위입실후30min)、유도후、절피후5 min、봉피、술필、청성각시점적BIS치、심솔、맥박혈양포화도、혈압급절피시체동반응、소성질량.병재TEAS전(A조위입실)、TEAS 30 min후(A조위입실후30 min)、절피후5 min、청성각시간점추취동맥혈각3 mL,측정신상선소화β내배태적함량.결과 TEAS 30min후(A조위입실후30min),B、C조BIS치、혈압、심솔현저하강(P<0.05),A조무명현변화(P>0.05);B、C량조재각시점병박분파농도균저우A조(P<0.05),차C조명현저우B조(P<0.05),병박분평균용량B、C조비A조분별감소19%、27%;여TEAS전상비,B、C량조TEAS 30 min후β-내배태명현승고(P<0.05),C조교B조현저(P<0.05);량조적신상선소수평TEAS전후무명현개변(P>0.05).결론 TEAS대병박분+분태니정맥마취유일정적보조작용.대진통효응유명현적협동작용.
Objective To evaluate the adjuvant effect of transcutaneous electrical acupoint stimulation (TEAS) in propofol-fentanyl anesthesia in partial mastectomy. Methods Ninety patients undergoing partial mastectomy 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, Neiguan-Waiguan, and bilateral Jianjing acupoints. The bispectral index (BIS), heart rate (HR), saturation of pulse oxygen (SpO_2), 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.
