CAJ | 학술논문

目的：评价针药复合麻醉下不同时程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75例，年龄18～64岁，体重40～96 kg，ASA分级Ⅰ或Ⅱ级。采用随机数字表法，将其分为3组（ n＝25）：对照组（ C组）、麻醉诱导前电刺激30 min组（ B组）、手术全程电刺激组（ T组）。 B组从麻醉诱导前30 min开始使用经皮穴位电刺激仪在患者手术侧心俞、肺俞、内关、合谷穴进行电刺激，频率为2∕100 Hz疏密波，以患者能耐受的最大电流强度为宜，内关、合谷穴约6～12 mA，心俞和肺俞穴约9～18 mA，麻醉诱导开始前终止。 T组从麻醉诱导前30 min至术毕持续电刺激患者上述4个穴位。 C组只贴电极片不行电刺激。患者均采用异丙酚?舒芬太尼?顺阿曲库铵行麻醉诱导后插入双腔气管导管，靶控输注异丙酚以维持BIS值40～60，静脉输注顺阿曲库铵维持肌松，根据镇痛∕伤害性刺激指数（ ANI）值调整瑞芬太尼输注速率，维持ANI值50～70。记录术中瑞芬太尼（将术中舒芬太尼用量以1∶10等效转换成瑞芬太尼用量）用量。结果与C组比较，B组和T组术中瑞芬太尼用量减少（ P＜0．05）。与B组比较，T组术中瑞芬太尼用量减少（ P＜0．05）。结论手术全程经皮穴位电刺激和麻醉诱导前经皮穴位电刺激30 min心俞、肺俞、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，而手术全程经皮穴位电刺激的效果更明显。
목적：평개침약복합마취하불동시정경피혈위전자격대흉강경폐협절제술중환자아편류약물적절검작용。방법택기전마하행흉강경폐협절제술환자75례，년령18～64세，체중40～96 kg，ASA분급Ⅰ혹Ⅱ급。채용수궤수자표법，장기분위3조（ n＝25）：대조조（ C조）、마취유도전전자격30 min조（ B조）、수술전정전자격조（ T조）。 B조종마취유도전30 min개시사용경피혈위전자격의재환자수술측심유、폐유、내관、합곡혈진행전자격，빈솔위2∕100 Hz소밀파，이환자능내수적최대전류강도위의，내관、합곡혈약6～12 mA，심유화폐유혈약9～18 mA，마취유도개시전종지。 T조종마취유도전30 min지술필지속전자격환자상술4개혈위。 C조지첩전겁편불행전자격。환자균채용이병분?서분태니?순아곡고안행마취유도후삽입쌍강기관도관，파공수주이병분이유지BIS치40～60，정맥수주순아곡고안유지기송，근거진통∕상해성자격지수（ ANI）치조정서분태니수주속솔，유지ANI치50～70。기록술중서분태니（장술중서분태니용량이1∶10등효전환성서분태니용량）용량。결과여C조비교，B조화T조술중서분태니용량감소（ P＜0．05）。여B조비교，T조술중서분태니용량감소（ P＜0．05）。결론수술전정경피혈위전자격화마취유도전경피혈위전자격30 min심유、폐유、내관、합곡혈대흉강경폐협절제술중환자아편류약물유명현절검작용，이수술전정경피혈위전자격적효과경명현。
Objective To evaluate the intraoperative opioid?sparing effect of different duration transcutaneous electrical acupoint stimulation ( TEAS ) in video?assisted thoracoscopic lobectomy. Methods Seventy?five patients, aged 18-64 yr, weighing 40-96 kg, of ASA physical status Ⅰ or Ⅱ, scheduled for elective video?assisted thoracoscopic lobectomy under general anesthesia, were randomly divided into 3 groups (n=25 each) using a random number table: control group (group C), 30 min of stimulation before induction of anesthesia group ( group B) , and stimulation throughout surgery ( group T) . In group B, the patients received TEAS ( frequency 2∕100 Hz ) on acupoints Xinshu ( BL15 ) , Feishu (BL13), Neiguan (PC6), Hegu (LI4) on the operated side starting from 30 min before induction of anesthesia until the beginning of induction, and the intensity was the maximum current that could be tolerated. The intensity for Neiguan ( PC6) and Hegu ( LI4) was 6-12 mA, and for Xinshu ( BL15) and Feishu ( BL13 ) was 9-18 mA. In group T, the patients received TEAS on the four acupoints mentioned above starting from 30 min before induction of anesthesia until the end of surgery. The patients had the electrodes applied, but received no stimulation in group C. After anesthesia was induced with propofol?sufentanil?cisatracurium, double lumen endotracheal tube was inserted. Propofol was given by target?controlled infusion to maintain BIS value within the range of 40-60. Cisatracurium was infused continuously to facilitate muscle relaxation. The infusion rate of remifentanil was adjusted to maintain analgesia nociception index value within the range of 50-70. The intraoperative consumption of remifentanil ( the intraoperative consumption of sufentanil was converted to the consumption of remifentanil producing the equivalent effect by 1∶ 10) was recorded. Results Compared with group C, the intraoperative consumption of remifentanil was significantly decreased in B and T groups. The intraoperative consumption of remifentanil was significantly lower in group T than in group B. Conclusion TEAS on Xinshu ( BL15 ) , Feishu (BL13), Neiguan ( PC6) and Hegu acupoints throughout surgery and for 30 min before induction of anesthesia significantly reduces intraoperative opioid consumption in the patients undergoing video?assisted thoracoscopic lobectomy, while TEAS throughout surgery provides better effect.