Objective: To observe the effects of transcutaneous electrical acupoint stimulation (TEAS) at different times on the stress response during anesthesia and operation in the patients undergoing open posterior lumbar surgery.
Methods: A total of 94 patients undergoing open posterior lumbar surgery were randomly assigned to preoperative TEAS group(32 cases), intraoperative TEAS group(31 cases) and sham-TEAS group(31 cases). The same anesthetic method was used in the patients of 3 groups. Four electrodes were attached to the bilateral Hegu (LI4) and Neiguan (PC6) and connected to the electronic acupuncture instrument when patients entered the operation room. In the preoperative TEAS group, the patients received TEAS (10 to 20 mA) for 30 min before the anesthetic induction. TEAS (15 mA) was provided immediately when the operation starts till the end of ope-ration for the patients of the intraoperative TEAS group. In the sham-TEAS group, the electronic acupuncture instrument was switched on during the whole procedure of operation, but no electric current was output. Separately, at the moment of entering the operation room (T0), before endotracheal intubation (T1), at the time of endotracheal intubation (T2), 10 min after skin resection (T3), at the end of surgery (T4), recovery from anesthesia (T5) and at the time of extubation (T6), the heart rate (HR) and mean arterial pressure (MAP) were recorded. Using ELISA, the concentrations of epinephrine (E), norepinephrine (NE), dopamine (DA), cortisol (Cor) in serum were assayed at T0, T3, and T4; and blood glucose was tested with blood sugar paper at the same time points.
Results: Compared with T0 of the same group, HR was increased at T2 and decreased at T3 of the patients in the sham-TEAS group and the intraoperative TEAS group (P<0.05). Compared with the sham-TEAS group at the same time points, HR was decreased at T2 and increased at T3 of the patients in the preoperative TEAS group (P<0.05), and it was decreased at T6 of patients in the intraoperation TEAS group (P<0.05). HR was reduced at T2 in the preoperative TEAS group when compared with the intraoperative TEAS group. Compared with T0 of the same group, MAP was elevated at T2 and reduced at T3 and T4 in the sham-TEAS group (P<0.05); it decreased at T3, T4 and T5 in the preoperative TEAS group (P<0.05); it rose at T2 and was reduced at T3, T4 and T5 in the intraoperative TEAS group (P<0.05). When compared with the sham-TEAS group at the same time points, MAP decreased at T2 in the preoperative TEAS group (P<0.05), and at T6 in the intraoperative TEAS group (P<0.05). MAP was reduced at T2 and elevated at T6 in the preoperative TEAS group in comparison with the intraoperative TEAS group (P<0.05) at the same time points. Compared with T0 of the same group, the contents of E was increased at T3 in the sham-TEAS group and the intraoperative TEAS group (P<0.05); it was increased in all of the three groups at T4 (P<0.05); the contents of NE, DA, Cor and the blood glucose were increased at T4 in the sham-TEAS group (P<0.05). Compared with the sham-TEAS group at the same time points, the contents of E, DA at T3 and T4 and Cor at T3 in serum of the preoperative TEAS group were decreased (P<0.05); and the contents of E, NE, DA and Cor at T4 in the intraoperative TEAS group were decreased (P<0.05).
Conclusion: TEAS-assisted general anesthesia can better maintain the stability of HR and MAP during anesthesia and operation in patients undergoing open posterior lumbar surgery, and reduce surgical stress response.
目的：观察不同时机应用经皮穴位电刺激(TEAS)对后路开放性腰椎手术患者麻醉和手术过程中应激反应的影响。方法：将择期行后路开放性腰椎手术患者随机分为术前TEAS组32例、术中TEAS组31例和假TEAS组31例。3组患者麻醉方法相同，并均于进入手术室后将两组电极片贴于患者双侧合谷和内关，连接电子针疗仪，术前TEAS组于麻醉诱导前给予TEAS 30 min(强度10~20 mA)，术中TEAS组于手术开始即刻给予TEAS至术毕(强度15 mA)，假TEAS组全程开启电子针疗仪但无电流输出。分别记录患者进入手术室时(T0)、气管插管前(T1)、气管插管时(T2)、切皮后10 min(T3)、手术结束时(T4)、麻醉苏醒时(T5)和气管拔管时(T6)的心率(HR)和平均动脉压(MAP)。采用ELISA法检测T0、T3、T4时血清肾上腺素(E)、去甲肾上腺素(NE)、多巴胺(DA)和皮质醇(Cor)含量，并使用血糖试纸检测同时刻血糖值。结果：与本组T0比较，假TEAS组和术中TEAS组患者HR在T2时升高，在T3时降低(P<0.05)。与同时点假TEAS组比较，术前TEAS组患者HR在T2时降低、T3时升高(P<0.05)；术中TEAS组HR在T6时降低(P<0.05)。与同时点术中TEAS组比较，术前TEAS组患者HR在T2时降低(P<0.05)。与本组T0比较，假TEAS组MAP在T2时升高，在T3、T4时降低(P<0.05)；术前TEAS组MAP在T3、T4、T5时降低(P<0.05)；术中TEAS组MAP在T2时升高，在T3、T4、T5时降低(P<0.05)。与同时点假TEAS组比较，术前TEAS组MAP在T2时降低(P<0.05)；术中TEAS组MAP在T6时降低(P<0.05)。与同时点术中TEAS组比较，术前TEAS组MAP在T2时降低，在T6时升高(P<0.05)。与本组T0比较，T3时假TEAS组和术中TEAS组E含量升高(P<0.05)；T4时3组E含量均升高(P<0.05)；T4时假TEAS组血清NE、DA、Cor含量及血糖升高。与同时点假TEAS组比较，术前TEAS组在T3和T4时血清E、DA和T3时血清Cor含量降低(P<0.05)；术中TEAS组T4时血清E、NE、DA、Cor含量降低(P<0.05)。结论：TEAS辅助全麻可更好地维持后路开放性腰椎手术患者麻醉手术过程中HR和MAP稳定，降低手术应激反应。.
Keywords: Assisted anesthesia; Lumbar surgery; Stress response; Transcutaneous electrical acupoint stimulation.