CAJ | 학술논문

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～ 90 kg,ASA分级Ⅰ-Ⅲ级.采用随机数字表法分为4组(n=20):对照组(Con组)假刺激穴位,2/100 Hz组、2 Hz组和100 Hz组电刺激列缺+曲池+内关+合谷穴,从麻醉诱导前30 min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1 ng/ml,切皮时调至4 ng/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4 ng/ml,ANI值仍＜50,则静脉注射舒芬太尼0.1 μg/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 2/100 Hz组术中瑞芬太尼用量明显少于Con组、2 Hz组和100 Hz组(P＜0.01);Con组、2 Hz组和100 Hz组上述指标比较差异无统计学意义(P＞0.05).结论 2/100 Hz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100 Hz相同穴位的经皮电刺激无此作用.
목적 평개불동빈솔경피혈위전자격대흉강경폐협절제술중환자아편류약물적절검작용.방법 택기전마하행흉강경폐협절제술환자80례,년령40 ～ 64세,체중50～ 90 kg,ASA분급Ⅰ-Ⅲ급.채용수궤수자표법분위4조(n=20):대조조(Con조)가자격혈위,2/100 Hz조、2 Hz조화100 Hz조전자격렬결+곡지+내관+합곡혈,종마취유도전30 min지술필지속안조각자빈솔전자격상응혈위,강도이환자능내수적최대전류위의,Con조지첩전겁편.정맥주사미체서륜、이병분、서분태니、순아곡고안행마취유도.술중파공수주서분태니화이병분、정맥수주순아곡고안유지마취,근거정황추가서분태니.근거BIS치조정이병분파농도,유지BIS치40～60.서분태니기시효응실파농도1 ng/ml,절피시조지4 ng/ml,근거진통상해감수지수(ANI)치조정서분태니파농도화서분태니용량,유지ANI치50 ～ 70.서분태니파농도증가지4 ng/ml,ANI치잉＜50,칙정맥주사서분태니0.1 μg/kg.기록술중서분태니(장술중서분태니용량등효전환성서분태니용량)용량,제이환자체중화수술시간후,계산매분종매공근체중약물용량.결과 2/100 Hz조술중서분태니용량명현소우Con조、2 Hz조화100 Hz조(P＜0.01);Con조、2 Hz조화100 Hz조상술지표비교차이무통계학의의(P＞0.05).결론 2/100 Hz경피전자격렬결+곡지+내관+합곡혈대흉강경폐협절제술중환자아편류약물유명현절검작용,이2화100 Hz상동혈위적경피전자격무차작용.
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 (LI11)-Neiguan (PC6)-Hegu (LI4) at 2/100 Hz group (group 2/100 Hz),stimulation on LU7-LI11-PC6-LI4 at 2 Hz group (group 2 Hz),and stimulation on LU7-LI1 1-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-LI11-PC6-LI4 acupoints ipsilateral to the surgery site,respectively,starting from 30 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 μg/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-LI11-PC6-LI4 significantly reduces intraoperative opioid consumption in the patients undergoing video-assisted thoracoscopic pneumonectomy.