低频脉冲电针反馈调控丙泊酚靶控输注对全身麻醉患者心率变异性的影响

发布时间：2018-10-04 22:00

【摘要】：目的低频脉冲电针辅助全麻反馈调控丙泊酚靶控输注,评价低频脉冲电针对全身麻醉患者心率变异性(HRV)的影响。方法择期行腹腔镜胆囊切除手术患者80例,随机分为低频脉冲电针反馈调控丙泊酚靶控组(观察组)和靶控丙泊酚输注组(对照组),每组40例。观察组术前30 min预先给予经皮电针刺激,穴位选取双侧合谷、内关穴,频率选择2 Hz,波形选择连续波,电针强度选择3,时间设定30 min。两组患者均采用相同全身麻醉方式,麻醉诱导采用咪达唑仑0.05 mg/kg、芬太尼2.0μg/kg,丙泊酚2.0 mg/kg,阿曲库铵0.5 mg/kg,行气管插管。麻醉维持用阿曲库铵0.25 mg/kg/h,2%七氟醚吸入。观察组丙泊酚靶控输注,血浆靶浓度为2.0 mg/mL,设定丙泊酚反馈值为脑电双频指数(BIS)=50,BIS≥50时输注持续进行,BIS50时反馈程式启动,输注将被终止,对照组丙泊酚靶控输注,血浆靶浓度为2.0 mg/mL。分别记录观察组实施电针前(T0)、观察组实施电针后(T1)、插管后(T2)、切皮(T3)、分离胆囊(T4)、胆囊切除(T5)、缝皮(T6)7个时间点的血压(BP)、心率(HR)、HRV、BIS的变化和丙泊酚的用量。结果观察组丙泊酚用量为(241.3±21.4)mL,对照组为(315.2±13.2)mL,观察组丙泊酚用量明显少于对照组(P0.05)。对照组在T2、T4时间点SBP下降较观察组明显,观察组中有4例需用多巴胺升高血压,对照组中有10例需用多巴胺升高血压。两组患者的HR在麻醉后均有下降,对照组在T4时间点HR下降较观察组明显。两组患者的高频(HF)、低频(LF)、低频高频比(LF/HF)在T0、T1、T2、T3各个时间点均有下降,对照组的下降幅度大于观察组,在T4、T5时间点牵拉胆囊时LF、HF均升高,其中HF显著升高,LF/HF降低,对照组的降低幅度大于观察组。结论低频脉冲电针辅助全身麻醉,可以降低患者BP、HR的波动,对HRV有正性调节作用,BIS作为反馈控制变量调控丙泊酚靶控输注,可以达到较精确地控制麻醉深度,减少术中血流动力学波动,并减少丙泊酚用量。
[Abstract]:Objective to evaluate the effect of low frequency pulse electroacupuncture on heart rate variability (HRV) in patients with general anesthesia. Methods 80 patients undergoing laparoscopic cholecystectomy were randomly divided into low frequency pulse electroacupuncture controlled propofol target control group (observation group) and target controlled propofol infusion group (control group) with 40 cases in each group. The observation group was given transcutaneous electroacupuncture stimulation 30 min before operation. The acupoints were selected as bilateral Hegu, Neiguan acupoint, frequency selection 2 Hz, waveform, electroacupuncture intensity 3, time 30 min.. Both groups were given the same general anesthesia. Midazolam 0.05 mg/kg, fentanyl 2.0 渭 g / kg and propofol 2.0 mg/kg, atracurium 0.5 mg/kg, were used for intubation. Anesthesia was maintained by inhalation of atracurium 0.25 mg/kg/h,2% sevoflurane. In the observation group, the target controlled infusion of propofol and the plasma target concentration of 2.0 mg/mL, set the feedback value of propofol as the EEG bispectral index (BIS) 50 BIS 鈮，

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