文章摘要
经皮穴位电刺激联合腰方肌阻滞对老年患者腹腔镜肾部分切除术后主要心血管不良事件的影响
Effect of transcutaneous electrical acupoint stimulation combined with quadratus lumborum block on major cardiovascular adverse events in elderly patients undergoing laparoscopic partial nephrectomy
  
DOI：10.12089/jca.2026.05.009
中文关键词: 经皮穴位电刺激  腰方肌阻滞  肾部分切除术  主要心血管不良事件  术后感染  老年
英文关键词: Transcutaneous electrical acupoint stimulation  Quadratus lumborum block  Partial nephrectomy  Major adverse cardiovascular events  Postoperative infection  Aged
基金项目:山西省中医药管理局科研课题（2024ZYY2C073）
作者单位E-mail
姜晓瑞 030001,太原市,山西医科大学第二医院麻醉科  
张忠成 030001,太原市,山西医科大学第二医院麻醉科  
李晓稀 030001,太原市,山西医科大学第二医院麻醉科  
马欢 030001,太原市,山西医科大学第二医院麻醉科  
吉嘉炜 030001,太原市,山西医科大学第二医院麻醉科  
景颜 030001,太原市,山西医科大学第二医院麻醉科  
张林忠 030001,太原市,山西医科大学第二医院麻醉科 zhanglz@sxmu.edu.cn 
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中文摘要:
      
目的：探究经皮穴位电刺激（TEAS）联合腰方肌阻滞（QLB）对老年患者肾部分切除术后主要心血管不良事件（MACE）的影响。
方法：选择择期在全身麻醉下行腹腔镜肾部分切除术的老年患者，年龄≥65岁，BMI 18.5～25.0 kg/m2，ASA Ⅰ—Ⅲ级。采用随机数字表法将患者分为两组：TEAS联合QLB组（TQ组）和对照组（C组）。TQ组麻醉诱导前40 min在超声引导下行术侧QLB，阻滞药物为0.33%罗哌卡因20 ml；麻醉诱导前30 min取双侧内关穴、合谷穴行TEAS，持续30 min；术后回病房后继续进行TEAS，每日2次，每次20 min，持续3 d。C组麻醉诱导前40 min超声引导穿刺到位后给予生理盐水20 ml；麻醉诱导前30 min在相同穴位上贴电极片并连接电针刺激仪，但不予电刺激。主要指标为术后30 d内MACE发生率。次要指标包括术后30 d内感染发生率，术后1、4、12、24、48 h静息时VAS疼痛评分，镇痛泵总按压次数、镇痛泵有效按压次数和镇痛泵首次按压时间。
结果：共纳入患者160例，每组80例。与C组比较，TQ组术后30 d内MACE（6% vs. 19%）和术后感染（10% vs. 20%）发生率明显降低，术后1、4、12 h静息时VAS疼痛评分明显降低，镇痛泵总按压次数、镇痛泵有效按压次数明显减少，镇痛泵首次按压时间明显延长（P＜0.05）。
结论：TEAS联合QLB可明显降低老年患者肾部分切除术后30 d内MACE和感染发生率，减轻术后疼痛，利于患者术后恢复。
英文摘要:
      
Objective: To explore the effect of transcutaneous electrical acupoint stimulation (TEAS) combined with quadratus lumborum block (QLB) on major cardiovascular adverse events (MACE) in elderly patients undergoing laparoscopic partial nephrectomy.
Methods: Elderly patients aged ≥ 65 years, BMI 18.5-25.0 kg/m2, ASA physical status Ⅰ-Ⅲ, undergoing laparoscopic partial nephrectomy with general anesthesia were selected. The patients were divided into two groups by a random number table method: TEAS combined with QLB group (group TQ) and control group (group C). In group TQ, QLB was performed 40 minutes before anesthesia induction under ultrasound guidance, with a drug dose of 0.33% ropivacaine 20 ml. Thirty minutes before anesthesia induction, bilateral Neiguan and Hegu acupoints were stimulated by TEAS for 30 minutes before anesthesia induction. TEAS was continued after returning to the ward, and it was performed twice a day, each session lasting 20 minutes, for a total of 3 days. In group C, ultrasound-guided puncture was performed 40 minutes before the induction of general anesthesia, and the needle was inserted accurately. Then, normal saline 20 ml was administered. Eelectrode patches were placed at the same acupuncture points 30 minutes before the induction, and the electro-acupuncture stimulator was connected, but no electrical stimulation was applied. The primary outcome was the incidence of MACE within 30 days postoperatively. Secondary outcomes included occurrence of infection within 30 days postoperatively, VAS pain scores at 1, 4, and 12 hours postoperatively, the number of total pressings, effective pressings, and the first pressing time of analgesia pumps.
Results: A total of 160 patients were included, 80 patients in each group. Compared with group C, the incidence of MACE (6% vs. 19%) and infection (10% vs. 20%) within 30 days postoperatively in group TQ was significantly lower, the VAS pain scores at 1, 4, and 12 hours postoperatively were significantly lower, the number of total pressings and effective pressings were significantly lower, and the first pressing time was significantly prolonged (P < 0.05).
Conclusion: TEAS combined with QLB can significantly reduce the incidence of MACE and infection after partial nephrectomy in elderly patients, alleviate postoperative pain, and facilitate the recovery of patients.
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