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经皮穴位电刺激对择期幕上开颅手术老年患者全麻拔管期应激反应的影响:一项前瞻性随机对照试验。

Effects of Transcutaneous Electrical Acupoint Stimulation on the Stress Response During Extubation After General Anesthesia in Elderly Patients Undergoing Elective Supratentorial Craniotomy: A Prospective Randomized Controlled Trial.

机构信息

Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China.

出版信息

J Neurosurg Anesthesiol. 2018 Oct;30(4):337-346. doi: 10.1097/ANA.0000000000000460.

Abstract

BACKGROUND

Elderly patients have an increased risk of a stress response during extubation after general anesthesia. In this study, we aimed to investigate whether transcutaneous electrical acupoint stimulation (TEAS) might decrease the stress response and improve the quality of recovery in elderly patients after elective supratentorial craniotomy.

MATERIALS AND METHODS

In this prospective randomized controlled study, patients were randomly assigned to either a TEAS group (n=37) or a control group (n=38). The primary outcomes were the hemodynamic parameters and plasma concentrations of epinephrine, norepinephrine, and cortisol. The secondary outcome included the consumption of remifentanil and propofol, time to extubation and reorientation, extubation quality score, postoperative quality of recovery, and postoperative complications.

RESULTS

Compared with the control group, hemodynamic parameters and plasma concentrations of epinephrine, norepinephrine, and cortisol during extubation were decreased in the TEAS group. TEAS reduced the consumption of remifentanil (P<0.01), as well as incidence of postoperative complications. The extubation quality score was lower (P<0.01) and the quality of recovery score was higher (P<0.01) in the TEAS group than in the control group. However, the time to extubation and reorientation, and the consumption of propofol were not significantly different between the 2 groups.

CONCLUSIONS

TEAS may decrease the stress response during extubation, improve quality of postoperative recovery, and decrease incidence of postoperative complications in elderly patients undergoing elective supratentorial craniotomy.

摘要

背景

老年患者在全身麻醉后拔管时会增加应激反应的风险。在这项研究中,我们旨在研究经皮穴位电刺激(TEAS)是否可以减轻择期幕上开颅术后老年患者的应激反应并改善恢复质量。

材料和方法

在这项前瞻性随机对照研究中,患者被随机分配到 TEAS 组(n=37)或对照组(n=38)。主要结局是血流动力学参数和肾上腺素、去甲肾上腺素和皮质醇的血浆浓度。次要结局包括瑞芬太尼和丙泊酚的消耗量、拔管和定向时间、拔管质量评分、术后恢复质量和术后并发症。

结果

与对照组相比,TEAS 组在拔管时的血流动力学参数和肾上腺素、去甲肾上腺素和皮质醇的血浆浓度降低。TEAS 减少了瑞芬太尼的消耗(P<0.01),并降低了术后并发症的发生率。TEAS 组的拔管质量评分较低(P<0.01),恢复质量评分较高(P<0.01),而对照组则较低。然而,两组间拔管和定向时间以及丙泊酚的消耗无显著差异。

结论

TEAS 可减轻择期幕上开颅术后老年患者拔管时的应激反应,改善术后恢复质量,降低术后并发症的发生率。

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