Study on the Applicability of Combined Transcutaneous Electrical Acupoint Stimulation and Routine Anesthesia for Cerebral Operation under Isoflurane-Controlled Hypotension
XIE Wen-xia,WANG Jun-lu(The First Affiliated Hospital of Wenzhou Medical College, Wenzhou,325000)
Objective: To study the applicability of combined transcutaneous electrical acupoint stimulation (TEAS) and general anesthesia for cerebral surgical operation under Isoflurane-induced hypotension. Methods: Forty-two patients with brain tumor were randomly divided into Isoflurane anesthesia (control group,n=21) and combined TEAS and general anesthesia (treatment group,n=21). In treatment group, TEAS (2/100 Hz, 8～12 mA) was applied to Quanliao (SI 18), Yuyao (EX-HN 4), Fengchi (GB 20) and Hegu (LI 4) for 20 min following routine anesthesia with intravenous injection of Droperidol (5 mg), Fentanyl (4～6 μg), 2.5% sodium pentothal (5～7 mg/kg) and Pancuronium (0.1～0.15 mg/kg) and inhaling Isoflurane. For patients of control group, only routine general anesthesia was given. During the operation, the concentration of Isoflurane was elevated to reduce mean arterial pressure (MAP) 30～40% for 30～40 min. The main items for observation are 1) changes of hymodynamic parameters, blood gas and arterial blood lactic acid (ABL) concentration before, during and after hypotension; 2) changes of the end tidal Isoflurane concentration before, during and after hypotension; and 3) the restoration state of autonomous respiration and awakening from anesthesia. Results: There were no significant differences between treatment and control groups in arterial blood pH (pHa), partial pressure of arterial oxygen (PaO_2), saturation of O_2 (SaO_2) and partial pressure of CO_2 (PaCO_2), pulmonary mixed venous blood pH (pHv), PvO_2 and PvCO_2, and hemoglobin (Hb) before, during and after lowering blood pressure, and all the values were in the normal range. Compared with pre-hypotension, the dissolved oxygen (DO_2) and SvO_2 decreased significantly (P0.05), O_2 extraction ratio (ERO_2) and ABL increased obviously (P0.05) in these two groups. Thirty minutes after lowering blood pressure, the decreased values of stroke volume (SV), stroke index (SI) and left ventricular stroke work index (LVSWI) of treatment group were significantly lower than those of control group (P0.05). Before and during lowering and elevating blood pressure, the end tidal Isoflurane concentrations (vol%) in treatment group was significantly lower than those in control group (P0.05). After operation, the time for the restoration state of autonomous respiration and awakening from anesthesia of treatment group was significantly shorter than that of control group (P0.05). Conclusion: Combined transcutaneous electrical acupoint stimulation with isoflurane induced hypotension for surgical operation can maintain stable oxygenic metabolism, lower physiological interference and reduce the side effects of the inhaled high concentration of Isoflurane, is superior to general anesthesia and thus suitable to be used for neurosurgical anesthesia.
【Fund】： 浙江省中医药管理局基金资助课题 (No .2 0 0 0 -C -60 )
【CateGory Index】： R614
【CateGory Index】： R614