TEAS联合喉罩全麻对纤维支气管镜诊治病人应激反应和术后早期恢复质量的影响

    Effects of TEAS combined with laryngeal mask general anesthesia on stress response and quality of early postoperative recovery in patients undergoing fiberoptic bronchoscopic diagnosis and treatment

    • 摘要:
      目的 观察经皮穴位电刺激(TEAS)联合喉罩全麻对纤维支气管镜(纤支镜)诊治病人应激反应和术后早期恢复质量的影响。
      方法 选择80例拟行无痛纤支镜诊治病人,采用随机数字表法均分为对照组(喉罩全麻组)和观察组(TEAS联合喉罩全麻组), 每组40例。观察组在麻醉诱导前30 min选择双侧合谷穴、内关穴、列缺穴和天突穴行TEAS,持续刺激至术毕拔出喉罩;对照组同样时间点、同样穴位处,粘贴电极片,但不进行刺激。记录病人麻醉诱导前30 min(T1)、麻醉诱导前(T2)、纤支镜进入即刻(T3)、退镜时(T4)的平均动脉压(MAP)、心率(HR)的数值变化;记录麻醉时间、手术时间、苏醒时间、瑞马唑仑和瑞芬太尼的使用总剂量;记录术前、术后的应激指标皮质醇、C反应蛋白、血管紧张素Ⅱ的变化;记录术前1 d(T0)、术后1 d(T5)的恢复质量量表(QoR-15)评分;记录围术期呛咳、呼吸抑制、恶心呕吐、眩晕等不良反应的发生率。
      结果 与对照组比较,观察组病人苏醒时间缩短、瑞马唑仑和瑞芬太尼使用量减少、不良反应发生率降低,术后观察组病人的应激因子指标降低,差异均有统计学意义(P < 0.05~P < 0.01);观察组病人T2、T3、T4时刻的HR和MAP低于对照组和T1时刻,观察组病人术后QoR-15量表评分高于对照组,差异均有统计学意义(P < 0.05~P < 0.01)。
      结论 TEAS联合喉罩全麻应用于纤支镜诊治病人,具有抑制气道刺激应激反应、维持术中血流动力学稳定、促进术后恢复等优势,可以提高麻醉安全性,提高病人舒适度。

       

      Abstract:
      Objective To observe the effects of transcutaneous electrical acupoint stimulation (TEAS) combined with laryngeal mask general anesthesia on the stress response and quality of early postoperative recovery in patients undergoing fiberoptic bronchoscopy.
      Methods Eighty patients were selected to undergo painless fiberoptic bronchoscopy, and were divided into a control group (laryngeal mask general anesthesia group) and an observation group (TEAS combined with laryngeal mask general anesthesia group) by using a randomized numerical table method, with 40 patients in each group. In the observation group, TEAS was performed on bilateral Hegu, Neiguan, Leshu and Tiantu acupoints 30 min before induction of anesthesia, and the laryngeal mask was continuously stimulated until the laryngeal mask was withdrawn at the end of the operation; in the control group, electrodes were pasted on the same acupoints and the same time points, but no stimulation was performed. The changes in the values of mean arterial pressure (MAP) and heart rate (HR) of the patients were recorded 30 min before the induction of anesthesia (T1), before the induction of anesthesia (T2), at the moment of fiberscope entry (T3), and at the time of withdrawal of the fiberscope (T4). The time of anesthesia, time of surgery, and time of awakening were recorded. The total dose of anesthetic drugs remazolam and remifentanil used was recorded. Changes in preoperative and postoperative stress indicators cortisol, C-reactive protein, and angiotensin Ⅱ were recorded. Quality of recovery scale scores (QoR-15) were recorded 1 d preoperatively (T0) and 1 d postoperatively (T5). Perioperative choking, respiratory depression, cachexia were recorded cardiac vomiting, vertigo and other adverse reactions.
      Results Compared with the control group, the recovery time of the observation group was significantly shortened, the use of remimazolam and remifentanil was significantly reduced, the incidence of adverse reactions was significantly reduced, the stress factor indexes of the observation group were significantly reduced (P < 0.05 to P < 0.01), and the T2, T3, The HR and MAP at T4 were significantly lower than those in the control group and T1, and the postoperative QoR-15 scale score in the observation group was significantly higher than that in the control group (P < 0.05 to P < 0.01).
      Conclusions TEAS combined with laryngeal mask general anesthesia applied to patients with fiberoptic bronchoscopic diagnosis and treatment has the advantages of inhibiting airway irritation stress response, maintaining intraoperative hemodynamic stability, and promoting postoperative recovery, which can improve the anesthetic safety and enhance the comfort of patients.

       

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