经皮穴位电刺激辅助吸入麻醉对老年患者 腹腔镜胆囊切除术后认知功能的影响

Effects of transcutaneous electrical acupoint stimulation combined with inhalation anesthesia on postoperative cognitive function of aged patients with laparoscopic cholecystectomy

摘要:

目的 观察经皮穴位电刺激辅助吸入麻醉对老年患者腹腔镜胆囊切除术后认知功能的影响。 方法 拟行腹腔镜胆囊切除术患者100例随机分为实验组和对照组，每组50例。实验组应用韩氏穴位神经刺激仪电刺激30 min后吸入全身麻醉，电刺激持续至手术结束；对照组单纯吸入麻醉下完成手术，两组麻醉深度维持在脑电双频谱指数（BIS）40～60。记录麻醉前（T0）、插管后5 min（T1）、气腹建立后10 min（T2）、气腹结束即刻（T3）、术后24 h（T4）各时间点BP、HR、动脉血氧饱和度（SPO2）、呼气末二氧化碳分压（PetCO2），肾上腺素（E）、去甲肾上腺素（NE）、皮质醇含量（Cor）、血糖值（Glu）；记录患者手术后意识恢复时间；分别于手术前、手术后3及7 d对患者进行神经心理学测试，计算术后认知功能障碍（POCD）发生率。 结果 对照组气管插管后E、NE、Cor、Glu呈渐进性升高；实验组E、NE、Cor、Glu较术前水平差异无显著性，实验组围手术期各项监测指标明显平稳于对照组，差异存在显著性（P <0.05）；实验组手术后3及7 d发生认知功能障碍者分别为10和7例，对照组分别为15和13例；苏醒时间实验组（9.78±3.22） min，对照组（14.25±3.17） min，差异有显著性（P <0.05）。 结论 经皮穴位电刺激辅助吸入全身麻醉能明显降低围术期应激反应，有利于术后早期苏醒，减少老年患者腹腔镜胆囊切除术后认知功能障碍发生率。

Abstract:

【Objective】 To study effects of transcutaneous electrical acupoint stimulation (TEAS) combined with inhalation anesthesia on postoperative cognitive function of aged patients with laparoscopic cholecystectomy(LC). 【Methods】 A hundred patients underwent LC were randomly divided into control group(n =50) and treatment group (n =50). In the treatment group, TEAS was applied to Hans for 30 min following routine general inhalation anesthesia, and TEAS was continued until LC over. In the control group, only routine general inhalation anesthesia was given. The bispectral index(BIS) were maintained between 40~60 in both two groups. BP, HR, SPO2, PetCO2, and the concentration of plasma epinephrine(E), norepinephrine(NE), cortisol(Cor), and glucose(Glu) were measured before anesthesia(T0) and after intubation cannula 5 min(T1), pneumoperitoneum 10 min(T2) and pneumoperitoneum end(T3), and postoperative 24 h(T4). The time of wake was observed after the operation. Neuropsychological tests were carried out on patients before the operation and on the third and seventh day after the operation, and incidence of POCD was calculated. 【Results】 E, NE, Cor, Glu were gradually increased after intubation in the control group (P <0.01),but no significance difference in the treatment group (P >0.05). All monitoring indicators during perioperative period in the treatment group were more stable than in the control group(P <0.05). Number of patients underwent cognitive dysfunction on the third and seventh day after the operation were 10, 7 in the treatment group and 15, 13 in the control group. The time of wake was much more in the control group (14.25±3.17) min than in the treatment group (9.78±3.22) min(P <0.05). 【Conclusion】 Combined TEAS and general inhalation anesthesia for aged patients in LC can reduce the stress reaction obviously and profit to wake up earlier and decrease the incidence of POCD during perioperative period.