经皮穴位电刺激对丙泊酚闭环麻醉输注系统麻醉手术患儿血流动力学、应激反应和炎症反应的影响
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摘要
目的:观察经皮穴位电刺激对丙泊酚闭环麻醉输注系统麻醉手术患儿血流动力学、应激反应和炎症反应的影响。方法:选择2016年6月至2018年6月期间在本院接受手术治疗的160例患儿为研究对象,采用随机数字表法分为对照组和观察组,每组80例。对照组应用丙泊酚闭环麻醉输注系统进行手术麻醉,观察组在对照组的基础上联合经皮穴位电刺激治疗。观察两组患儿丙泊酚使用剂量以及麻醉前至拔管不同时间段血流动力学、应激反应和炎症反应的变化情况。结果:手术期间,对照组丙泊酚使用剂量为(23.08±4.10) mg·(kg·h)~(-1),观察组丙泊酚使用剂量为(19.85±3.77) mg·(kg·h)~(-1),观察组丙泊酚使用剂量少于对照组,差异有统计学意义(t=5.187,P=0.000);对照组在不同时间段血流动力学指标CI、MAP水平均高于观察组,差异有统计学意义(P<0.05);对照组在不同时间段应激反应指标HR、NE水平均高于观察组,差异有统计学意义(P<0.05);对照组在不同时间段炎症反应指标IL-6、IL-1β水平均高于观察组,差异有统计学意义(P<0.05)。结论:经皮穴位电刺激可降低手术患儿血流动力学波动,减少丙泊酚闭环麻醉系统药物使用剂量,减轻围术期应激反应及炎症反应。
Objective:To observe the influence of percutaneous acupoint electrical stimulation on hemodynamics and stress response and inflammatory response in children under closed-loop propofol anesthesia and infusion system.Methods:One hundred and sixty children who underwent surgical treatment in our hospital from June 2016 to June 2018 were selected as the subjects and divided into the ontrol group and the observation group according to random number table method,with 80 cases in each group.The control group was anesthetized with propofol closed-loop anesthesia infusion system,while the observation group was treated with percutaneous acupoint electrical stimulation on the basis of the control group.The dosage of propofol,the changes of hemodynamics,stress response and inflammation were observed before anesthesia and at different stages of extubation in two groups were observed.Results:During the operation period,the dosage of propofol in the control group was(23.08±4.10)mg·(kg·h)~(-1),and that in the observation group was(19.85±3.77)mg·(Kg·h)~(-1),and the dosage of propofol in the observation group was better than that in the control group,with a significant difference(t=5.187,P=0.000).The cardiac output index and mean arterial pressure of hemodynamics in the control group were higher than those of the observation group at different time points with significant differences(P<0.05).The heart rate and norepinephrine levels of stress response in the control group were higher than those of the observation group at different time points with significant differences(P<0.05).The levels of IL-6 and of interleukin-1β in the control group were higher than those of the observation group at different time points with significant differences(P<0.05).Conclusion:Percutaneous acupoint electrical stimulation can reduce the fluctuation of hemodynamic parameters,the dosage of propofol used in closed-loop anesthesia system,and alleviate perioperative stress and inflammation.
Objective:To observe the influence of percutaneous acupoint electrical stimulation on hemodynamics and stress response and inflammatory response in children under closed-loop propofol anesthesia and infusion system.Methods:One hundred and sixty children who underwent surgical treatment in our hospital from June 2016 to June 2018 were selected as the subjects and divided into the ontrol group and the observation group according to random number table method,with 80 cases in each group.The control group was anesthetized with propofol closed-loop anesthesia infusion system,while the observation group was treated with percutaneous acupoint electrical stimulation on the basis of the control group.The dosage of propofol,the changes of hemodynamics,stress response and inflammation were observed before anesthesia and at different stages of extubation in two groups were observed.Results:During the operation period,the dosage of propofol in the control group was(23.08±4.10)mg·(kg·h)~(-1),and that in the observation group was(19.85±3.77)mg·(Kg·h)~(-1),and the dosage of propofol in the observation group was better than that in the control group,with a significant difference(t=5.187,P=0.000).The cardiac output index and mean arterial pressure of hemodynamics in the control group were higher than those of the observation group at different time points with significant differences(P<0.05).The heart rate and norepinephrine levels of stress response in the control group were higher than those of the observation group at different time points with significant differences(P<0.05).The levels of IL-6 and of interleukin-1β in the control group were higher than those of the observation group at different time points with significant differences(P<0.05).Conclusion:Percutaneous acupoint electrical stimulation can reduce the fluctuation of hemodynamic parameters,the dosage of propofol used in closed-loop anesthesia system,and alleviate perioperative stress and inflammation.
引文
[1] 鹿曼曼,杨改生,李晓晶.丙泊酚全自动闭环靶控输注全静脉麻醉在胃肠道肿瘤手术中的应用[J].中国临床药理学杂志,2016,32(11):975-977.
[2] 潘守东,谢洁,张弦,等.丙泊酚闭环靶控输注麻醉用于不同年龄段患儿手术效果的比较[J].中华麻醉学杂志,2017,37(10):1257-1260.
[3] 刘配配,郑吉建,白洁,等.采用灌注指数监测小儿全身麻醉期间伤害性刺激反应的临床观察[J].上海交通大学学报(医学版),2018,38(1):67-70.
[4] 吴佳腾,崔晓光.小儿全身麻醉苏醒期躁动的研究进展[J].实用药物与临床,2017,20(3):357-360.
[5] 胡璟,王芳,张建敏,等.丙泊酚闭环靶控输注麻醉用于学龄前及学龄患儿体表手术的效果[J].中华麻醉学杂志,2017,37(7):800-803.
[6] 杨翼,左云霞.闭环靶控输注系统用于全凭静脉麻醉维持的控制性能研究[J].四川大学学报(医学版),2016,47(6):952-956.
[7] 金宁,李真,黄昕,等.丙泊酚闭环靶控输注系统在小儿耳鼻喉手术中的应用[J].中国医科大学学报,2015,44(10):873-876.
[8] 郑荃菁,杜小宜,陈虹宇,等.BIS监测下丙泊酚闭环靶控输注用于胆胰手术麻醉的临床效果[J].临床麻醉学杂志,2017,33(6):529-533.
[9] 赵春美,谢思宁,张晴,等.经皮穴位电刺激和电针复合局部麻醉对颈动脉支架置入术患者术中及术后恢复的影响[J].国际麻醉学与复苏杂志,2018,39(5):434-439.
[10] 陈方园,杨悦,孙雪晨,等.经皮穴位电刺激对小儿电子耳蜗植入术苏醒期躁动的影响[J].中国医科大学学报,2017,46(4):298-401,305.
[11] 白文娅,黄昕,滕秀飞,等.经皮穴位电刺激对甲状腺手术后围拔管期应激反应的影响[J].现代生物医学进展,2017,17(1):96-99.
[12] 高军龙,李玉兰.浅谈经皮穴位电刺激在围麻醉期的多种作用[J].中国针灸,2015,35(3):269-273.
[13] 金宁,杨延超,滕秀飞,等.经皮穴位电刺激对小儿闭环麻醉系统中药物用量的影响[J].中国中西医结合杂志,2016,36(8):916-921.
[14] 滕秀飞,杨延超,李阳,等.不同频率经皮穴位电刺激对小儿全麻术后疼痛及围术期应激反应的影响[J].国际儿科学杂志,2016,43(2):156-158.
[15] 牟玉庆,刘兴山,魏彦龙.经皮穴位电刺激的临床应用进展[J].长春中医药大学学报,2017,33(1):169-171.
[2] 潘守东,谢洁,张弦,等.丙泊酚闭环靶控输注麻醉用于不同年龄段患儿手术效果的比较[J].中华麻醉学杂志,2017,37(10):1257-1260.
[3] 刘配配,郑吉建,白洁,等.采用灌注指数监测小儿全身麻醉期间伤害性刺激反应的临床观察[J].上海交通大学学报(医学版),2018,38(1):67-70.
[4] 吴佳腾,崔晓光.小儿全身麻醉苏醒期躁动的研究进展[J].实用药物与临床,2017,20(3):357-360.
[5] 胡璟,王芳,张建敏,等.丙泊酚闭环靶控输注麻醉用于学龄前及学龄患儿体表手术的效果[J].中华麻醉学杂志,2017,37(7):800-803.
[6] 杨翼,左云霞.闭环靶控输注系统用于全凭静脉麻醉维持的控制性能研究[J].四川大学学报(医学版),2016,47(6):952-956.
[7] 金宁,李真,黄昕,等.丙泊酚闭环靶控输注系统在小儿耳鼻喉手术中的应用[J].中国医科大学学报,2015,44(10):873-876.
[8] 郑荃菁,杜小宜,陈虹宇,等.BIS监测下丙泊酚闭环靶控输注用于胆胰手术麻醉的临床效果[J].临床麻醉学杂志,2017,33(6):529-533.
[9] 赵春美,谢思宁,张晴,等.经皮穴位电刺激和电针复合局部麻醉对颈动脉支架置入术患者术中及术后恢复的影响[J].国际麻醉学与复苏杂志,2018,39(5):434-439.
[10] 陈方园,杨悦,孙雪晨,等.经皮穴位电刺激对小儿电子耳蜗植入术苏醒期躁动的影响[J].中国医科大学学报,2017,46(4):298-401,305.
[11] 白文娅,黄昕,滕秀飞,等.经皮穴位电刺激对甲状腺手术后围拔管期应激反应的影响[J].现代生物医学进展,2017,17(1):96-99.
[12] 高军龙,李玉兰.浅谈经皮穴位电刺激在围麻醉期的多种作用[J].中国针灸,2015,35(3):269-273.
[13] 金宁,杨延超,滕秀飞,等.经皮穴位电刺激对小儿闭环麻醉系统中药物用量的影响[J].中国中西医结合杂志,2016,36(8):916-921.
[14] 滕秀飞,杨延超,李阳,等.不同频率经皮穴位电刺激对小儿全麻术后疼痛及围术期应激反应的影响[J].国际儿科学杂志,2016,43(2):156-158.
[15] 牟玉庆,刘兴山,魏彦龙.经皮穴位电刺激的临床应用进展[J].长春中医药大学学报,2017,33(1):169-171.
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