文章摘要
经皮穴位电刺激对选择性脊神经后根切断术患儿苏醒期躁动的影响
Effect of transcutaneous electrical acupoint stimulation on emergence agitation in children undergoing selective posterior rhizotomy
  
DOI：10.12089/jca.2024.07.007
中文关键词: 经皮穴位电刺激  选择性脊神经后根切断术  脑瘫  儿童  苏醒期躁动
英文关键词: Transcutaneous electrical acupoint stimulation  Selective posterior rhizotomy  Cerebral palsy  Child  Emergence agitation
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作者单位E-mail
利雪阳 100020,首都医科大学附属北京朝阳医院麻醉科  
吴安石 100020,首都医科大学附属北京朝阳医院麻醉科  
昝京伟 北京中医药大学东直门医院麻醉科  
徐凯 北京中医药大学东直门医院麻醉科  
刘国凯 北京中医药大学东直门医院麻醉科  
任惠龙 北京中医药大学东直门医院麻醉科 18612923335@163.com 
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中文摘要:
      
目的： 探讨经皮穴位电刺激（TEAS）对选择性脊神经后根切断术（SPR）患儿苏醒期躁动（EA）的影响。
方法： 选择择期在全麻下行SPR的脑瘫患儿42例，男20例，女22例，年龄6～12岁，BMI 13～24 kg/m2，ASA Ⅰ或Ⅱ级。将患儿随机分为两组：经皮穴位电刺激组（T组）和对照组（C组），每组21例。T组于麻醉诱导前30 min给予TEAS双侧合谷穴及内关穴，持续至手术结束。C组在相同的穴位放置电极片，但不予电刺激。所有患儿均采用全凭静脉麻醉。记录入室时、拔管即刻、拔管后5、15、30 min的HR、MAP。记录术中瑞芬太尼和丙泊酚的用量、手术时间、拔管时间。记录拔管后15 min的Wong-Baker面部疼痛表情（FPS-R）评分和儿童麻醉苏醒期躁动评估量表（PAED）评分，并计算苏醒期躁动（EA）发生率。记录术后恶心呕吐（PONV）发生情况。
结果： 与入室时比较，C组拔管即刻、拔管后5、15 min HR明显增快，拔管即刻、拔管后5、15、30 min MAP明显升高（P＜0.05）；T组拔管即刻、拔管后5、15 min HR明显增快，MAP明显升高（P＜0.05）。与C组比较，T组拔管即刻、拔管后5、15、30 min HR明显减慢，MAP明显降低（P＜0.05）；术中瑞芬太尼用量明显减少，拔管时间明显缩短，术后FPS-R评分、PAED评分和EA发生率明显降低（P＜0.05）。两组手术时间、术中丙泊酚用量和PONV发生率差异无统计学意义。
结论： TEAS可有效预防行SPR的脑瘫患儿EA发生，有利于维持血流动力学平稳，减少阿片类药物用量，减轻患儿术后疼痛，加快麻醉复苏时间。
英文摘要:
      
Objective: To investigate the effect of transcutaneous electrical acupoint stimulation(TEAS) on emergence agitation (EA) in children undergoing selective posterior rhizotomy (SPR).
Methods: Forty-two children with cerebral palsy undergoing SPR were selected, 20 males and 22 females, aged 6-12 years, BMI 13-24 kg/m2, ASA physical status Ⅰ or Ⅱ, randomly divided into two groups: TEAS group (group T) and control group (group C), 21 children in each group. Children in group T received TEAS at the bilateral acupoints of Neiguan and Hegu from 30 minutes before anesthesia induction to the end of surgery. In group C, electrodes were placed on the same acupoints without electrical stimulation. All children in both groups received total intravenous anesthesia. HR and MAP were recorded at the time of entry, extubation, 5, 15, 30 minutes after extubation. The consumption of remifentanil and propofol during the procedure were recorded. The time of operation and extubation were recorded. The Wong-Baker faces pain scale-revised (FPS-R) and the pediatric anesthesia emergence delirium (PAED) were recorded at 15 minutes after extubation, and the incidence of EA was assessed by PAED. While, the occurrence of postoperative nausea and vomiting (PONV) was recorded.
Results: Compared with that at the time of entry, HR at the time of extubation, 5, 15 minutes after extubation and MAP at the time of extubation, 5, 15, 30 minutes after extubation in group C were significantly increased (P < 0.05), HR and MAP at the time of extubation, 5, 15 minutes after extubationin group T were significantly increased (P < 0.05). Compared with group C, HR was significantly slower and MAP was significantly lower in group T at the time of extubation, 5, 15, 30 minutes after extubation (P < 0.05). Compared with group C, the consumption of remifentanil during operation was reduced, the time of extubation was significantly shortened, the FPS-R and PAED were significantly decreased, and the incidence of EA were significantly reduced (P < 0.05). There were no significant differences in the time of operation, the consumption of propofol during operation and the incidence of PONV.
Conclusion: TEAS is beneficial to prevent the occurrence of EA in pediatric patients undergoing SPR, stabilize hemodynamics, reduce the dosage of opioids during surgery, reduce the postoperative pain, andaccelerate the time of anesthesia resuscitation.
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