经皮穴位电刺激对老年膝关节置换患者松止血带引起的血流动力学波动的影响

[Effect of Transcutaneous Acupoint Electrical Stimulation on Hemodynamic Fluctuation Caused by Loosing Tourniquet in Elderly Patients Undergoing Knee Joint Replacement].

作者信息

Liang Han-Sheng, Feng Yi

机构信息

Department of Anesthesiology, People's Hospital of Peking University, Beijing 100044, China.

出版信息

Zhen Ci Yan Jiu. 2017 Dec 25;42(6):522-6. doi: 10.13702/j.1000-0607.2017.06.011.

DOI:10.13702/j.1000-0607.2017.06.011

PMID:29318860

Abstract

OBJECTIVE

To observe the effect of transcutaneous acupoint electrical stimulation (TAES) on hemodynamic fluctuation caused by loosing tourniquet in the elderly patients undergoing knee joint replacement.

METHODS

A total of 60 ASA (America Society Anesthesiologist) I or II elderly patients for elective knee joint replacement surgery were randomly divided into control group (30 cases) and TAES group (30 cases). Patients of both groups were treated by intravenous anesthesia, and monitored with bispectral index (BIS, between 45－60) for anesthesia depth, stroke volume variation (SVV) for fluid management, mean arterial pressure (MAP) and cardiac index (CI) for hemodynamic fluctuation evaluation, and with analgesia nociception index (ANI, between 50－70) for remifentanil dosage adjustment. TAES (2 Hz/100 Hz, 8－20 mA) was applied to bilateral Xinshu (BL 15), Feishu (BL 13), Neiguan (PC 6) and Hegu (LI 4) acupoints for 30 min first (followed by anesthesia induction and operation), and given continuously until 15 min after tourniquet loosing. Patients of the control group were only given with electrodes attachment without electrical stimulation. The levels of MAP, CI, and arterial blood pH, PaCO, PaO, base excess (BE) and lactic acid (Lac) 1 min before, and 5 and 15 min after tourniquet loosing, and the dosages of remifentanil and ephedrine after tourniquet loosing were recorded.

RESULTS

The changed levels of MAP, CI and blood Lac at 5 min after tourniquet loosing (relevant to the baseline levels), and blood Lac content at 15 min after tourniquet loosing (relevant to 5 min after tourniquet loosing) were significantly lower in the TAES group than in the control group (<0.05), but the levels of MAP and CI at 15 min after tourniquet loosing (relevant to 5 min following tourniquet loosing) were significantly higher in the TAES group than in the control group (<0.05), suggesting an improvement of blood pressure, cardiac function and substance metabolism after TAES. Moreover, the dosages of remifentanil and ephedrine after tourniquet loosing were considerably lower in the TAES group than in the control group (<0.05), suggesting a better stabilization of hemodynamics after TAES. No significant differences were found between the two groups in the levels of blood pH, PaCO, PaO and BE at 5 and 15 min after tourniquet loosing (>0.05).

CONCLUSIONS

TAES has a positive effect on hemodynamics fluctuation caused by loosing tourniquet in the aged patients undergoing knee joint replacement.

摘要

目的

观察经皮穴位电刺激（TAES）对老年膝关节置换患者松止血带引起的血流动力学波动的影响。

方法

选取60例择期行膝关节置换手术的美国麻醉医师协会（ASA）Ⅰ或Ⅱ级老年患者，随机分为对照组（30例）和TAES组（30例）。两组患者均采用静脉麻醉，通过脑电双频指数（BIS，45 - 60）监测麻醉深度，通过每搏量变异度（SVV）进行液体管理，通过平均动脉压（MAP）和心脏指数（CI）评估血流动力学波动，通过镇痛伤害感受指数（ANI，50 - 70）调整瑞芬太尼剂量。首先对双侧心俞（BL 15）、肺俞（BL 13）、内关（PC 6）和合谷（LI 4）穴位施加TAES（2 Hz/100 Hz，8 - 20 mA）30分钟（随后进行麻醉诱导和手术），并持续至松止血带后15分钟。对照组患者仅粘贴电极但不进行电刺激。记录松止血带前1分钟、松止血带后5分钟和15分钟时的MAP、CI水平，以及动脉血pH、PaCO₂、PaO₂、碱剩余（BE）和乳酸（Lac）水平，以及松止血带后瑞芬太尼和麻黄碱的用量。

结果

TAES组松止血带后5分钟时MAP、CI的变化水平（与基线水平相比）以及松止血带后15分钟时血Lac含量（与松止血带后5分钟相比）均显著低于对照组（P<0.05），但TAES组松止血带后15分钟时的MAP和CI水平（与松止血带后5分钟相比）显著高于对照组（P<0.05），提示TAES后血压、心功能和物质代谢得到改善。此外，TAES组松止血带后瑞芬太尼和麻黄碱的用量显著低于对照组（P<0.05），提示TAES后血流动力学更稳定。两组在松止血带后5分钟和15分钟时的血pH、PaCO₂、PaO₂和BE水平差异无统计学意义（P>0.05）。