摘要
目的:观察经皮穴位电刺激对老年人膝关节置换术松止血带引发的血流动力学波动是否有正向干预效果。方法:60例择期行人工膝关节置换手术的老年患者,随机分为穴位刺激组和对照组,每组30例。两组均采用全凭静脉麻醉。穴位刺激组予双侧心俞、肺俞、合谷、内关穴经皮电刺激,疏密波,2 Hz/100 Hz,强度8~20mA,刺激30min后开始静脉诱导,直至松止血带后15min;对照组只贴电极,不刺激。记录松止血带前1min(T1)、松止血带后5min(T2)、松止血带后15min(T3)的平均动脉压(MAP)、心脏指数(CI)、动脉血气分析[包括酸碱度(pH)、二氧化碳分压(PaCO_2)、氧分压(PaO_2)、剩余碱(BE)、乳酸(Lac)],计算瑞芬太尼、松止血带后麻黄碱用量。结果:(1)T2与T1比较:两组MAP、CI、pH、PaO_2、BE均下降,PaCO_2和Lac均升高,对照组较穴位刺激组MAP、CI下降及Lac升高更显著(P<0.05)。(2)T3与T2比较:两组MAP、CI、pH、PaCO_2、PaO_2、BE均在恢复,Lac继续升高,穴位刺激组较对照组MAP、CI升高更显著(P<0.05),对照组较穴位刺激组Lac升高更显著(P<0.05)。(3)穴位刺激组的瑞芬太尼用量、松止血带后麻黄碱用量明显少于对照组(P<0.05)。结论:经皮穴位电刺激对老年人膝关节置换术松止血带导致的血流动力学波动具有正向调节作用,松止血带后麻黄碱用量减少,节俭瑞芬太尼的用量。
Objective To observe the effect of transcutaneeus acupoint electrical stimulation （TAES） on hemodynamic fluctuation caused by loosing tourniquet in the elderly patients undergoing knee joint replacement. Methods A total of 60 ASA （America Society Anesthesiolegist） Ⅰ or Ⅱ elderly patients for elective knee joint replacement surgery were randomly divided into control group （30 cases） and TAES group （30 cases）. Patients of both groups were treated by intravenous anesthesia, and monitored with bispectral index （BIS, between 45-60） for anesthesia depth, stroke volume variation （SVV） for fluid management, mean arterial pressure （MAP） and cardiac index （CI） for hemodynamic fluctuation evaluation, and with analgesia nociception index （ANI, between 50-707 for remifentanil dosage adjustment. TAES （2 Hz/100 Hz, 8- 20 mA） was applied to bilateral Xinshu （BL 15）, Feishu （BL 13）, Neiguan （PC 6） and Hegu （LI 4） acupoints for 30 min first （followed by anesthesia induction and operation）, and given continuously until 15 min after tourniquet loosing. Patients of the control group were only given with electrodes attachment without electrical stimulation. The levels of MAP, CI, and arterial blood pH, PaCe2, PaO2 , base excess （BE） and lactic acid （Lac） 1 rain before, and 5 and 15 min after tourniquet loosing, and the dosages of remifentanil and ephedrine after tourniquet loosing were recorded. Results The changed levels of MAP, CI and blood Lac at 5 rain after tourniquet loosing （relevant to the baseline levels）, and blood Lac content at 15 min after tourniquet loosing （relevant to 5 rain after tourniquet loosing） were significantly lower in the TAES group than in the control group （ P〈0.05）, but the levels of MAP and CI at 15 min after tourniquet loosing （relevant to 5 min following tourniquet loosing） were significantly higher in the TAES group than in the control group （ P〈0.05）, suggesting an improvement of blood pressure, cardiac
出处
《针刺研究》
CAS
CSCD
北大核心
2017年第6期522-526,共5页
Acupuncture Research
基金
国家重点基础研究发展计划("973"计划
No.2013CB 531903)
北京大学人民医院研究与发展基金(No.RDC 2013-09)
关键词
经皮穴位电刺激
膝关节置换术
老年患者
松止血带
血流动力学
Transcutaneous acupoint electrical stimulation（TAES）
Knee joint replacement
The elderly patient
Tourniquet loosing
Hemodynamics
