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| 经皮穴位电刺激对髋关节置换术患者术后苏醒期躁动的影响 |
| Effect of transcutanclus acupoint electrostimulation on emergence agitation of the patients after hip replacement |
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| DOI：10.12089/jca.2021.11.004 |
| 中文关键词: 经皮穴位电刺激 髋关节置换术 苏醒期躁动 |
| 英文关键词: Transcutanclus electrical acupoint stimulation Hip replacement Emergence agitation |
| 基金项目:南京中医药大学第二附属医院院级课题（SEZ2019017） |
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| 中文摘要: |
目的 观察经皮穴位电刺激对髋关节置换术患者术后苏醒期躁动的影响。
方法 选择择期全身麻醉下行髋关节置换术的患者60例，男38例，女22例，年龄60～85岁，BMI 18～28 kg/m 2，ASA Ⅱ或Ⅲ级。随机分为两组：经皮穴位电刺激组（T组）和对照组（C组），每组30例。T组于麻醉诱导前30 min开始经皮穴位电刺激患侧合谷、内关穴持续至手术结束。C组不予电刺激。两组术中均采用全凭静脉麻醉。记录入室时、拔管时、拔管后5、30 min的MAP、HR以及血浆肾上腺素、去甲肾上腺素、β-内啡肽浓度。采用Riker镇静-躁动评分（SAS）评估苏醒期躁动发生情况。记录麻醉相关不良事件的发生情况。
结果 与入室时比较，拔管时、拔管后5、30 min时C组MAP明显升高（P<0.05），拔管时、拔管后5 min时HR明显增快（P<0.05）。与C组比较，T组拔管时、拔管后5、30 min时MAP明显降低（P<0.05），拔管时、拔管后5 min时HR明显减慢（P<0.05）。与入室时比较，拔管时、拔管后5、30 min时两组血浆肾上腺素、去甲肾上腺素浓度明显升高（P<0.05），T组 β-内啡肽浓度明显升高（P<0.05）。与C组比较，拔管时、拔管后5、30 min时T组血浆肾上腺素和去甲肾上腺素浓度明显降低（P<0.05），β-内啡肽浓度明显升高（P<0.05）。T组有2例（7%）发生苏醒期躁动，明显少于C组的10例（30%）（P<0.05）。两组麻醉相关不良事件的发生情况差异无统计学意义。
结论 经皮穴位电刺激有利于增加内源性阿片类物质释放，减轻应激反应，有利于苏醒期血流动力学平稳，可有效预防髋关节置换术患者苏醒期躁动。 |
| 英文摘要: |
Objective To observe the effect of transcutanclus electrical acupoint stimulation (TEAS) on postoperative agitation during recovery period after hip replacement.
Methods Sixty patients undergoing elective hip replacement surgery under general anesthesia, 38 males and 22 females, aged 60-85 years, BMI 18-28 kg/m 2, ASA physical status Ⅱ or Ⅲ, were divided into two groups randomly: TEAS group (group T) and control group (group C), 30 cases in each group. Patients in group T were treated with TEAS for 30 minutes before anesthesia induction, which lasted until the end of surgery. Group C received no stimulation. After anesthesia induction, anesthesia was maintained intravenously in both groups, and the same postoperative analgesia pump was used for postoperative analgesia. MAP, HR and plasma concentrations of epinephrine, norepinephrine and β-endorphin were recorded at the time of entry, extubation and 5 and 30 minutes after extubation. The incidence of agitation was assessed by Riker sedation agitation score (SAS). The occurrence of adverse events related to anaesthesia were recorded.
Results Compared with upon entering the room, MAP of group C was significantly increased at extubation and 5 and 30 minutes after extubation (P < 0.05), and HR increased significantly at extubation and 5 minutes after extubation (P < 0.05). Compared with group C, MAP of group T was significantly decreased at extubation, 5 and 30 minutes after extubation (P < 0.05), and HR was significantly decreased at extubation and 5 minutes after extubation (P < 0.05). Compared with upon entering the room, the concentrations of plasma adrenaline and norepinephrine were significantly increased at extubation and 5 and 30 minutes after extubation (P < 0.05), and the concentration of β-endorphin in group T was significantly increased (P < 0.05). Compared with group C, the concentration of epinephrine and norepinephrine in group T at extubation and 5 and 30 minutes after extubation were significantly decreased (P < 0.05), and the concentration of β-endorphin was significantly increased (P < 0.05). EA occurred in 2 patients (7%) in group T, which was significantly lower than that in 10 patients (30%) in group C (P < 0.05). There was no significant difference in the occurrence of anaesthesia related adverse events between the two groups.
Conclusion Percutaneous acupoint electrical stimulation is beneficial to increase the release of endogenous opioids, reduce stress response, stabilize hemodynamics and effectively prevent agitation during recovery of patients undergoing hip replacement. |
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