鼻内镜手术中应用TEAS复合药物全麻行控制性降压临床观察

发布时间：2018-07-09 15:49

本文选题：鼻内镜手术 + 经皮穴位电刺激　；参考：《中国针灸》2015年12期

【摘要】：目的:研究经皮穴位电刺激(TEAS)复合药物全麻在需要控制性降压的鼻内镜手术中,TEAS是否可以减少控制性降压药物的用量、减少全麻药物的用量;是否有助于患者血压和心率的控制。方法:选择在药物全麻和控制性降压下择期行鼻内镜手术患者60例,随机分为TEAS组、假TEAS组,每组30例。两组患者选择在双侧合谷、足三里、三阴交、曲池贴上电刺激电极,接韩氏电刺激仪(Hans-200),TEAS组刺激强度为3~5mA,频率2 Hz/100 Hz,以患者舒适为宜。假TEAS组有穴位贴,但不予电刺激。干预30min后开始全身麻醉诱导,电刺激维持到手术结束。观察并记录两组患者入室后监护完成、安静10 min后(T0)、电刺激干预30 min后(T1)、全麻诱导后(T2)、手术开始30min后(T3)、手术开始60min后(T4)、拔管后30min(T5)各时间点的血压、心率,统计手术中维库溴铵、丙泊酚、硝酸甘油的用量,以及术中出血量、手术时间、苏醒时间和苏醒后疼痛视觉模拟评分(VAS)。结果:与T0时间点平均动脉压(MAP)比较,TEAS组T2、T3、T4、T5,假TEAS组T3、T4均降低,差异有统计学意义(均P0.01),且TEAS组T2、T5时间点低于假TEAS组(均P0.01);与T0时间点心率比较,TEAS组除T2时点(P0.05)外,其余各时间点差异均无统计学意义(均P0.05),而假TEAS组T2至T5时间点差异有统计学意义(均P0.01)。两组间术中维库溴铵、丙泊酚、硝酸甘油的用量,出血量、手术时间、苏醒时间和苏醒后VAS评分差异均无统计学意义(均P0.05)。结论:TEAS复合药物全麻行控制性降压在鼻内镜手术中应用有利于患者血压和心率的控制;对控制性降压药物、全麻药物的用量、手术中出血量、苏醒时间和术后镇痛的影响不明显。
[Abstract]:Objective: to study whether teas can reduce the dosage of controlled antihypertensive drugs and reduce the dosage of general anesthesia in nasal endoscopic surgery which needs to be controlled hypotension by percutaneous acupoint electrical stimulation (tea) combined with general anesthesia. Help control blood pressure and heart rate. Methods: sixty patients undergoing selective endoscopic sinus surgery under general anesthesia and controlled hypotension were randomly divided into tea group and false tea group with 30 cases in each group. Two groups of patients were selected in bilateral Hegu, Zusanli, Sanyinjiao, curved pool affixed with electric stimulation electrode. The stimulation intensity and frequency of TEAS group were 3 ~ 5 Ma and 2 Hz / 100 Hz, which was suitable for the comfort of the patients. In the sham tea group, there were acupoints sticking, but no electrical stimulation. After the intervention of 30min, the induction of general anesthesia was started, and the electrical stimulation was maintained until the end of the operation. The blood pressure, heart rate and vecuronium were observed and recorded after 10 min of rest (T0), 30 min after electrical stimulation (T1), after induction of general anesthesia (T2), after the beginning of operation (T3), 60min (T4), 30min (T5) after extubation. Dosage of propofol, nitroglycerin, intraoperative bleeding, operation time, recovery time and visual analogue score (VAS) of pain after recovery. Results: compared with the mean arterial pressure (map) at T0 time point, T2T3OT4T5 and T3T4 in TEAS group decreased significantly (all P0.01), and the T2T5 time point in TEAS group was lower than that in pseudo-TEAS group (P0.01), and the dim sum rate in T2T3T4T5 group was significantly lower than that in T0 time group (P0.05), and the mean arterial pressure (map) in T0 time group was significantly lower than that in T0 time group (P0.01), and that in tea group was significantly lower than that in T0 time group (P0.05). There was no significant difference in other time points (P0.05), but there was statistical difference between T2 and T5 time points in false tea group (all P0.01). There was no significant difference between the two groups in the dosage of vecuronium propofol nitroglycerin the amount of blood loss the time of operation the recovery time and the VAS score after recovery (P0.05). Conclusion the controlled hypotension under general anesthesia with general anesthetic solution of 1% tea is beneficial to the control of blood pressure and heart rate, the dosage of controlled antihypertensive drug, the dosage of general anesthetic, the amount of bleeding during operation, and the control of blood pressure and heart rate in endoscopic sinus surgery. The effect of recovery time and postoperative analgesia was not obvious.
【作者单位】：浙江中医药大学附属第二医院麻醉科;浙江大学附属第一医院麻醉科;浙江中医药大学第三临床医学院针灸生物实验室;
【基金】：国家重点基础研究发展计划(973计划)项目:2013CB531903
【分类号】：R614.2

【参考文献】