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| 预先经皮电刺激内关穴预防蛛网膜下腔阻滞剖宫产产妇术中低血压 |
| Effects of prophylactic transcutaneous electrical nerve stimulation at the Neiguan acupoint on hypotension during subarachnoid anesthesia for cesarean delivery |
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| DOI：10.12089/jca.2021.01.008 |
| 中文关键词: 经皮电刺激 内关穴 蛛网膜下腔阻滞 剖宫产 低血压 |
| 英文关键词: Transcutaneous electrical nerve stimulation Neiguan Subarachnoid anesthesia Cesarean delivery Hypotension |
| 基金项目:江苏省妇幼健康科研项目（F201544）；无锡市卫生计生委“科教强卫工程”项目（ZDRCPY004） |
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| 中文摘要: |
目的 探讨预先电刺激内关穴预防蛛网膜下腔阻滞剖宫产术中低血压的效果。
方法 选择择期在蛛网膜下腔阻滞下行剖宫产术的单胎足月妊娠产妇90例，年龄18～35岁，ASA Ⅱ或Ⅲ级，孕37～42周。随机分为三组：A组、B组和C组，每组30例。A组不给予电刺激；B组在蛛网膜下腔阻滞前20 min（摆左侧卧位）开始接受电刺激（连续波、50 Hz，持续到蛛网膜下腔阻滞后30 min）；C组在蛛网膜下腔阻滞即刻接受与B组相同的电刺激并持续30 min。蛛网膜下腔阻滞后2～30 min，每隔2 分钟记录一次SBP、DBP、HR和SpO2，术中如果出现低血压（SBP<基础值的80%），静脉注射去氧肾上腺素100 μg。分别于建立静脉通道时和蛛网膜下腔阻滞后30 min采静脉血2 ml，采用ELISA法测定血浆去甲肾上腺素和肾上腺素的浓度。胎儿娩出后即刻取胎儿脐动脉和脐静脉血行血气分析。记录产妇术中发生低血压、心动过缓、恶心、呕吐的情况。
结果 A组、B组和C组术中低血压发生率分别为56.7%、30.0%和40.4%，B组明显低于A组（P<0.05）。B组和C组术中恶心发生率均明显低于A组（P<0.05）。蛛网膜下腔阻滞后30 min B组去甲肾上腺素和肾上腺素浓度均明显高于A组，C组去甲肾上腺素浓度明显高于A组（P<0.05）。
结论 蛛网膜下腔阻滞前20 min预先电刺激内关穴可以有效预防剖宫产蛛网膜下腔阻滞后低血压的发生，同时缓解恶心呕吐。 |
| 英文摘要: |
Objective To explore the effect of prophylactic transcutaneous electrical nerve stimulation at the Neiguan acupoint to prevent the hypotension during subarachnoid anesthesia for cesarean delivery.
Methods Ninety mature panurient women, aged 18-35 years, ASA physical status Ⅱ or Ⅲ, 37-42 weeks gestation, with single-embryo scheduled for elective caesarean section were randomly divided into three groups: group A, group B, and group C, each group enrolled 30 patients. Group A: no electrical stimulation; group B: receiving electrical stimulation (continuous wave, 50 Hz, until 30 minutes after the subarachnoid injection) 20 minutes before the start of anesthesia (in the left decubitus position); group C: received the same electrical stimulation as group B simultaneously at the beginning of anesthesia until 30 minutes after the subarachnoid injection. Maternal BP, HR, and SpO2 were measured every 2 minutes intervals beginning 2 minutes after subarachnoid injection for 30 minutes. If hypotension (SBP < 80% of the base value) occurred during the operation, intravenous injection of phenylephrine 100 μg. Two ml of venous blood was collected at the time of establishing the venous channel and 30 minutes after the subarachnoid injection, and the plasma norepinephrine and epinephrine concentrations were determined by ELISA. After delivery, umbilical arterial and umbilical venous blood samples of fetal were withdrawn for the measurements of blood gases. The adverse reactions during the operation were recorded.
Results The incidences of intraoperative hypotension were 56.7%, 30%, and 40.4% in group A, group B, and group C, respectively. The incidence of intraoperative hypotension in group B was significantly lower than that in group A (P < 0.05). The incidences of intraoperative nausea in group B and group C were significantly lower than that in group A (P < 0.05). Compared with group A, the concentration of norepinephrine and epinephrine in group B increased significantly 30 minutes after subarachnoid injection, and the concentration of norepinephrine in group C increased significantly 30 minutes after subarachnoid injection (P < 0.05).
Conclusion The incidence of intraoperative hypotension after cesarean section can be more effectively prevented by transcutaneous electrical nerve stimulation at the Neiguan acupoint 20 minutes before spinal anesthesia, and the adverse reactions such as nausea and vomiting can be alleviated. |
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