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| 经皮穴位电刺激对腹腔镜腹股沟疝修补术患儿术后行为改变的影响 |
| Effect of percutaneous acupoint electrical stimulation on postoperative maladaptive behavior in children undergoing laparoscopic inguinal hernia repair |
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| DOI：10.12089/jca.2020.04.004 |
| 中文关键词: 经皮穴位电刺激 患儿 腹腔镜腹股沟疝修补术 术后行为改变 |
| 英文关键词: Transcutaneous electric acupoint stimulation Children Laparoscopic inguinal hernia repair Postoperative maladaptive behavior |
| 基金项目:内蒙古自治区自然基金(2017MS0865) |
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| 中文摘要: |
目的 评价经皮穴位电刺激(TEAS)在腹腔镜腹股沟疝修补术(LIHR)中的应用,探讨其对患儿术后行为改变的影响。
方法 择期行LIHR患儿80例,男48例,女32例,年龄6～12岁,体重20～32 kg,ASA Ⅰ或Ⅱ级,采用随机数学表法分为TEAS 组和对照组(C组),每组40例。TEAS组麻醉诱导前30 min取两侧合谷和内关穴行TEAS至手术结束,设定频率2/100 Hz疏密波交替,电流强度6～10 mA为患儿能够耐受,有较强震颤感但无刺痛感。C组不贴电极片。记录手术时间、术中丙泊酚及瑞芬太尼用量、苏醒时间、PACU停留时间及PACU期间躁动发生情况。若患儿出现不能安抚的躁动,静脉注射芬太尼1 μg/kg,维持VAS评分≤3分,记录芬太尼使用及PONV发生情况。术后l 周进行行为量表(PHBQ)评分,记录行为改变的发生情况。
结果 两组手术时间和术中丙泊酚用量差异无统计学意义。与C组比较,TEAS组术中瑞芬太尼用量明显减少,苏醒时间、PACU停留时间明显缩短,苏醒期躁动发生率明显降低，PONV发生率明显降低,PACU期间使用芬太尼例数明显减少（P<0.05）。但两组PHBQ量表中术后行为改变情况差异无统计学意义。
结论 TEAS可减少LIHR患儿术中及术后阿片类药物用量,降低PONV发生率，但对患儿术后行为改变无明显影响。 |
| 英文摘要: |
Objective To evaluate the application of transcutaneous electric acupoint stimulation (TEAS) in laparoscopic inguinal hernia repair (LIHR) and to investigate the effect on postoperative maladaptive behavior in children.
Methods Eighty children of the elective LIHR, including 48 males and 32 females, aged 6-12 years, weighing 20-32 kg, ASA physical status Ⅰ or Ⅱ, were randomly divided into 2 groups using random number table (n = 40): TEAS group (group TEAS) and control group (group C). The patients in group TEAS received TEAS (disperse-dense waves, frequency 2/100 Hz) at the points of Neiguan and Hegu from 30 minutes before anesthesia induction to the end of surgery. The optimal intensity was 6-10 mA which could be tolerated by the patients including strong tremor but no tingling. Group C was not given TEAS. The operation time, propofol and remifentanil dosage, the emergence time and length of PACU stay were recorded. The development of agitation during stay in the PACU were also recorded. If the patient had inconsolable agitation after operation, fentanyl 1 μg/kg was infused, maintaining VAS score ≤ 3 points, the number of patients using fentanyland the occurrence of PONV were recorded. Postoperative maladaptive behaviors were assessed with the Post-Hospital Behavior Questionnaire (PHBQ) at 1 week after surgery, and the occurrence of behavioral changes was recorded.
Results There were no significant differences in the operation time and propofol comsumption between the two groups. Compared with group C, the dosage of remifentanil was significantly decreased, the emergence time and length of PACU stay were shortened, the incidence of emergence agitation was significantly decreased, the occurrence of PONV was significantly reduced, the number of patients using fentanyl was significantly reduced (P < 0.05). There was no significant difference in the incidence of behavioral changes after surgery between the two groups.
Conclusion TEAS can reduce the dosage of opioids during and after surgery, reduce the occurrence of PONV and the incidence of emergence agitation, whereas postoperative behavior does not change too much in children undergoing laparoscopic inguinal hernia repair. |
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