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[不同穴位组电针对幕上肿瘤切除术患者七氟醚麻醉的影响]

[Effects of electroacupuncture of different acupoint groups on sevoflurane anesthesia in patients undergoing resection of supratentorial tumors].

作者信息

An Li-Xin, Li Jin, Ren Xiu-Jun, Liu Yun-Ning, Wang Bao-Guo

机构信息

Department of Anesthesia, Beijing Tiantan Hospital Affiliated to Capital Medical University, Beijing 100050, China.

出版信息

Zhen Ci Yan Jiu. 2010 Oct;35(5):368-74.

Abstract

OBJECTIVE

To observe the effect of electroacupuncture (EA) of different acupoint groups on the sevoflurane anesthetic requirement for resection of supratentorial tumors and the speed of post-operation recovery.

METHODS

A total of 120 cases of supratentorial tumor resection patients were randomly and equally allocated into general anesthesia (GA) group, EA-proximal acupoints group (EA-PA group) and EA-distant acupoints group (EA-DA group). The supratentorial tumor patients were anesthetized with sevoflurane for surgery. Proximal acupoints used were Fengchi (GB 20), Tianzhu (BL 10), Cuanzhu (BL 2) and Yuyao (EX-HN 4) that the former 2 acupoints and the latter 2 acupoints were for penetrative needling; and distant acupoints used were Hegu (LI 4), Waiguan (TE 5), Jinmen (BL 63), Taichong (LR 3), Zusanli (ST 36) and Qiuxu (GB 40) on the craniotomy side, and stimulated with EA (2 Hz/100 Hz, a tolerable electric stimulating strength), beginning from the anesthesia induction till the end of surgical operation. All patients were anesthetized by inhalation of propofol (2 mg/kg), sufentanil (0.3 microg/kg) and vecuronium bromide (0.1 mg/kg) and maintained with sevoflurane. The end-tidal sevoflurane concentration, minimum alveolar concentration (MAC), bispectral index (BIS), and the speed of recovery were recorded.

RESULTS

In comparison with the GA group, the end-tidal concentrations during anesthesia maintenance at the time-points of post skull drilling, dura incising, intracranial operation in EA-PA group, the time-points of post skull drilling, skull opening, dura incising, and intracranial operation in EA-DA group, and the MAC of sevoflurane at the time-points of skull drilling in EA-DA group, and skull opening, dura incising, intracranial operation and dura suturing in both EA-PA and EA-DA groups were significantly lower (P < 0.05, P < 0.01). Compared to the GA group, the BIS values of EA-DA group at the time-points of skull drilling and opening, and dura incising were significantly higher (P < 0.05), while during the recovery stage of anesthesia, in comparison with the GA group, the autonomous respiration recovery time, tracheo-tube removing time, eye-opening time, voluntary motion recovery time, orientation force recovery time, and operating room-departure time of both EA-PA and EA-DA groups were significantly shorter (P < 0.05, P < 0.01). No significant differences were found between the EA-PA and EA-DA groups in the aforementioned indexes (P > 0.05).

CONCLUSION

EA of both proximal and distant acupoints can reduce the expired concentration and MAC of sevoflurane during anesthesia maintenance, and accelerate the recovery after cease of anesthesia in supratentorial tumor resection patients.

摘要

目的

观察不同穴位组电针(EA)对幕上肿瘤切除术七氟醚麻醉需求量及术后恢复速度的影响。

方法

将120例幕上肿瘤切除术患者随机等分为全身麻醉(GA)组、电针近部穴位组(EA-PA组)和电针远部穴位组(EA-DA组)。幕上肿瘤患者采用七氟醚麻醉进行手术。近部穴位选用风池(GB 20)、天柱(BL 10)、攒竹(BL 2)和鱼腰(EX-HN 4),前2穴与后2穴采用透刺法;远部穴位选用开颅侧的合谷(LI 4)、外关(TE 5)、金门(BL 63)、太冲(LR 3)、足三里(ST 36)和丘墟(GB 40),采用电针刺激(2Hz/100Hz,耐受的电刺激强度),从麻醉诱导开始至手术结束。所有患者均经吸入丙泊酚(2mg/kg)、舒芬太尼(0.3μg/kg)和维库溴铵(0.1mg/kg)进行麻醉诱导,并用七氟醚维持麻醉。记录呼气末七氟醚浓度、最低肺泡有效浓度(MAC)、脑电双频指数(BIS)及恢复速度。

结果

与GA组比较,EA-PA组颅骨钻孔后、硬脑膜切开时、颅内手术时的麻醉维持期呼气末浓度,EA-DA组颅骨钻孔后、颅骨切开、硬脑膜切开及颅内手术时的麻醉维持期呼气末浓度,EA-DA组颅骨钻孔时及EA-PA组和EA-DA组颅骨切开、硬脑膜切开、颅内手术及硬脑膜缝合时七氟醚的MAC均显著降低(P<0.05,P<0.01)。与GA组比较,EA-DA组颅骨钻孔、切开及硬脑膜切开时的BIS值显著升高(P<0.05),而在麻醉恢复阶段,与GA组比较,EA-PA组和EA-DA组自主呼吸恢复时间、拔管时间、睁眼时间、自主运动恢复时间、定向力恢复时间及出手术室时间均显著缩短(P<0.05,P<0.01)。上述指标EA-PA组与EA-DA组比较,差异无统计学意义(P>0.05)。

结论

近部和远部穴位电针均可降低幕上肿瘤切除术患者麻醉维持期七氟醚的呼出浓度及MAC,并加快麻醉停止后的恢复。

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