经皮穴位电刺激镇痛在乳腺癌根治术中的应用

目的 观察经皮穴位电刺激(Transcutaneous electrical acupoint stimulation,TEAS)用于乳腺癌根治术的镇痛效果.方法 择期行乳腺癌根治术患者60例,ASA分级Ⅰ或Ⅱ级,年龄30～60岁,体重50～80kg,采用随机数字表法,按1∶1比例分为对照组(GA组)和经皮穴位电刺激组(EA组),各30例.GA组在进行手术操作前,选择双侧合谷穴(LI4)、内关穴(PC6)和足三里(ST36)连接华佗电子治疗仪(V型),不进行穴位电刺激;EA组连接华佗电子治疗仪(V型)进行穴位电刺激30min.麻醉诱导:靶控输注异丙酚,血浆靶浓度4μg/ml,静脉注射芬太尼3μg/kg和维库溴铵0.1mg/kg.喉罩插管后行机械通气,维持PETCO2 35～45mmHg.麻醉维持:靶控输注异丙酚,血浆靶浓度2～4μg/ml,微量泵输注瑞芬太尼10～25μg·kg-1·h-1,维持Narcotrend在D2～E1 (46～20)之间,根据Narcotrend监测结果及血流动力学调整异丙酚和瑞芬太尼泵注速度.分别于电针前(T0)、电针结束时(T1)、诱导前(T2)、插管后5min(T3)、切皮前即刻(T4)、手术结束(T5)、拔管后即刻(T6)、拔管后5min (T7),记录HR、MAP、PETCO2、SpO2、Narcotrend数值.记录患者苏醒时间、拔管时间、术中麻醉药物瑞芬太尼和异丙酚用量、术后VAS评分及术后恶心呕吐(PONV)的发生率.结果 与GA组比较,EA组T3～T5时HR、MAP更平稳,瑞芬太尼用药量明显减少,苏醒时间、拔管时间缩短,PONV发生率降低(P＜0.05).结论 在乳腺癌改良根治手术中,TEAS复合全麻有良好的镇痛镇静作用,能减少麻醉药用量,减轻全麻术后的不良反应.

Application of transcutaneous electrical acupoint stimulation for analgesia in patients with breast cancer radical mastectomy

Objective To observe the analgesic effect of transcutaneous electrical acupoint stimulation in breast cancer radical mastectomy. Methods Sixty patients with breast cancer ASA physical status Ⅰ or Ⅱ,aged 30-60 years,weighting 50- 80kg,scheduled radical mastectomy operations,were randomly divided into two groups （n=30）： control group （GA group） and transcutaneous electrical acupoint stimulation group （EA group）. Before operation, selected bilateral Hegu （LI4）,Neiguan （PC6） and Zusanli （ST36） acupuncture points, connected the Hua-Tuo electronic therapy device （V-type）, didn＇t stimulate in GA group, connected the Hua-Tuo electronic therapy device （V-type） and stimulated for 30 minutes in EA group. Anesthesia was induced with target-controlled infusion （TCI） of propofol with the effect-site concentration （Ce） of 4μg/ml,and intravenous injection of fentanyl 3μg/kg and roeuronium 0.1mg/kg. Underwent mechanical ventilation after laryngeal mask airway. PnCO2 was maintained at 35~45mmHg. Anesthesia was maintained with TCI of propofol with the Ce of 2--4μg/ml in combination with intra- venous iv infusion of remifentanil at 10~25μg·kg^-1·h^-1 The depth of anesthesia was controlled by the Nareotrend EEG monitor, Nareotrend values were maintained at D2~E1 （46~20） during operation,adjusted the propofol and remifentanil iv infusion rate according to intraoperative hemodynamic and Narcotrend values. Before TEAS （T0） ,at the end of TEAS （T1） ,before induction （112） ,at 5min after intubation （T3）,immediately before skin incision （T4）,at the end of operation （T5）,immediately after extubation （T6） and at 5min after extubation （T1）, HR, MAP, PETCO2, SpO2 and Nareotrend value were recorded. The recovery time and extubation time,the consumption of remifentanil and propofol were recorded. VAS scores after operation and the incidence of post-operative nausea and vomiting （PONV） were measured. Results Compared with group GA, MAP and HR at T3-T5 ke