| 张爽,甘建辉,涂青,等.经皮穴位电刺激对胸腔镜肺切除术病人拔管期应激反应的影响[J].安徽医药,2020,24(7):1407-1411. |
| 经皮穴位电刺激对胸腔镜肺切除术病人拔管期应激反应的影响 |
| Effects of transcutaneous electrical acupoint stimulation on stress response during extubation period in patients undergoing thoracoscope pneumoresection |
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| DOI：10.3969/j.issn.1009?6469.2020.07.035 |
| 中文关键词: 胸腔镜检查/方法 肺切除术 电针 气管插管拔除 经皮穴位电刺激 双腔气管导管 应激反应 |
| 英文关键词: Thoracoscopy/methods Pneumonectomy Electroacupuncture Airway extubation Transcutaneous electrical acupoint stimulation Double lumen tube Stress response |
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| 摘要点击次数: 2150 |
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| 中文摘要: |
| 目的观察经皮穴位电刺激( TEAS)对胸腔镜肺切除术病人拔管期应激反应的影响。方法按排除标准筛选 2017年 11月至 2018年 3月在唐山市人民医院需要进行胸腔镜肺部分切除术的病人，共有 84例入选，并统一按照全麻标准使用双腔气管导管( DLT)通气，按随机数字表法分成两组:与刺激器连接完整且予以有效电流刺激的为电刺激组，连接中断未有实际刺激产生的为假刺激组，每组 42例，从诱导前 30 min开始两组分别予以有效刺激或假刺激在双侧内关( PC6)、合谷( LI4)、列缺(LU7)、尺泽( LU5)穴持续至术毕。在入室 5 min(T1)后记录病人未接受任何刺激时的基础状态下的平均动脉压( MAP)和心率(HR)在接受 30 min刺激或假刺激后( T2)、拔除 DLT即刻( T3)、拔除 DLT后 5 min(T4)和 10 min(T5)分别测量 MAP和 HR；在上述各时刻，检测肾上腺素( E)、去甲肾上腺素( NE)和皮质醇的浓度。结果在 T1和接受 30 min的电刺激或假刺激后的 T2时刻两组 MAP和 HR差异无统计学意义( P＞0.05)；电刺激组和假刺激组在受到拔管强烈刺激时( T3)MAP分别骤升至( 106.81±13.04) mmHg、(113.26±9.92)mmHg，均明显高于基础时刻( P＜0.05)，且接受有效刺激的电刺激组明显低于接受假刺激的假刺激组( P＜0.05)电刺激组和假刺激组在拔除 DLT时 HR分别提高到( 87.69±14.00)次 /分、(94.21±15.27)次 /分，均明显较未接受刺激的 T1时升高(，P＜0.05)，且电刺激组升高程度明显低于假刺激组( P＜0.05)；电刺激组儿茶酚胺中的 E、NE在刺激最高时刻( T3)提升到( 114.31±6.77)ng/mL、(428.07±44.74)pg/mL，明显高于 T1水平( P＜0.05)，但明显低于假刺激组的( 170.64±13.97)ng/mL、(466.45±59.37)pg/mL(P＜0.05)电刺激组皮质醇浓度升至( 548.64±48.57)nmol/L，明显高于基础水平( P＜0.05)也明显较假刺激组的( 664.71±57.22)nmol/L假刺激组在拔管完成后 10 min内 MAP、 E、 皮质醇仍显于 T1减少，(P＜0.05)；HR、 NE、著高，(P＜0.05)；而电刺激组在拔除 DLT后的 T4~T5虽然儿茶酚胺和皮质醇浓度仍处于明显高于 T1的水平( P＜0.05)但是 MAP、HR出现了明显的回落，与 T1比较差异无统计学意义( P＞0.05)；电刺激组在完成拔除 DLT后的 T4、T5两次测量血力学指标和血浆流动，应激激素浓度均低于接受假刺激的假刺激组( P＜0.05)。结论术中有效应用 TEAS不会改变未接受剧烈刺激病人的内环境，而对于胸腔镜肺部分切除手术病人能有效改善经历拔除 DLT期间过度刺激引发的交感激素调动，减缓生理应激。 |
| 英文摘要: |
| Objective To explore effects of transcutaneous electrical acupoint stimulation on stress response during extubation peri?od in patients undergoing thoracoscope pneumoresection.Methods According to the exclusion criteria，a total of 84 patients who needed thoracoscopic lung surgery in Tangshan People’s Hospital from November 2017 to March 2018 were selected，and DLT(double lumen tube)ventilation was used in accordance with the general anesthesia standard.The TEAS group(group T)was com? pletely connected to the stimulator and was effectively stimulated；the sham stimulation group(group S)was not given actual stimu? lation in which the connection is interrupted by random number table method，42 cases in each group.30 min before induction of anesthesia，the group T and S were given effective stimulation or sham stimulation in Neiguan(PC6)Hegu(LI4)，Lieqiu(LU7)， andChize(LU5)pointstotheendofthesurgery.MAP(meanarterialpressure)andHR(heartrate)o，f basal state when patients did not receive any stimulation 5 minutes after patient admission(T1)，after receiving 30 minutes of stimulation or false stimulation(T2)，immediately after removal DLT(T3)5 min(T4)and 10 min(T5)after removal DLT were recorded.So were the concentra? tions of E(epinephrine)，NE(norepinephrine)a，nd cortisol.Results There was no significant difference between the two groups at T1 and T2after receiving 30 minutes of electrical stimulation or sham stimulation(P＞0.05)； The MAP of group T and group S rose to(106.81±13.04)mmHg and(113.26±9.92)mmHg respectively when patients were strongly stimulated by extubation(T3)，both group were significantly higher than basic time of T(1P＜0.05)，and the group T receiving effective stimulation was significantly low? er than the group S receiving false stimulation(P＜0.05)，the difference was statistically significant.The HR of group T and S in? creased to(87.69±14.00)times/min and(94.21±15.27)times/min when DLT was removed，which were significantly higher than those at T(1P＜0.05)，and the increase level in group T was significantly lower than group S(P＜0.05)，there was statistical differ? ence.The E and NE of catecholamines in group T increased to(114.31±6.77)ng/mL and(428.07±44.74)pg/mL at the highest stimu? lation time(T3)，which was significantly higher than T1 level(P＜0.05)，but significantly lower than(170.64±13.97)ng/mL and(466.45±59.37)pg/mL in group S(P＜0.05)； the cortisol concentration in group T rose to(548.64±48.57)nmol/L，although signifi? cantly higher the basal level(P＜0.05)，but also significantly decreased than(664.71±57.22)nmol/L in group S(P＜0.05)，the dif? ference was statistically significant；The MAP，HR，E，NE，cortisol in group T 10 minutes after removal DLT were still significantly (P＜0.05)； while the concentrations of catecholamine and cortisol in group T at T4-T5 after extubation were still sig? higher than T1， no significant difference compared with T1 nificantly higher than T1，(P＜0.05)but MAP and HR showed a significant drop，(P＞ 0.05)； The hemodynamic indicators and plasma stress hormone concentrations measured in group T after DLT removal(T4-T5)were lower than group S which receiving false stimulation(P＜0.05).Conclusion The effective application of TEAS during operationwill not change the internal environment of patients who have not received severe stimulation，and it can effectively improve sympa?thetic hormone mobilization caused by excessive stimulation during the removal of DLT and reduce physiological stress. |
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