经耳迷走神经刺激对前交叉韧带重建术患者止血带相关高血压的影响
Effect of transcutaneous auricular vagus nerve stimulation on tourniquet-induced hypertension in patients undergoing anterior cruciate ligament reconstruction
周琦 1高明阳 1于丽丽 2李亚南 1陈旭光 1于沛霞 1张亚辉 1董江涛 3王秋筠1
作者信息
- 1. 河北医科大学第三医院麻醉科,石家庄 050051
- 2. 沧州市中心医院麻醉科,沧州 061000
- 3. 河北医科大学第三医院关节科,石家庄 050051
- 折叠
摘要
目的 评价经耳迷走神经刺激(taVNS)对前交叉韧带重建术患者止血带相关高血压(TIH)的影响.方法 拟在全身麻醉联合股神经阻滞下行前交叉韧带重建术患者74例,性别不限,年龄18～60岁,ASA分级Ⅰ或Ⅱ级,BMI 18～30 kg/m2.采用随机数字表法分为2组(n=37):假刺激组(SS组)和taVNS组.SS组电刺激左侧耳垂和耳轮尾;taVNS组电刺激左侧耳甲艇和耳垂.2组均从麻醉诱导前1 h进行电刺激至手术结束(频率30 Hz,脉宽300 µs,振幅为患者在不感觉到疼痛情况下能耐受的最强电流振幅).止血带充气压力为280 mmHg,充气时间60～90 min.于止血带充气前记录SBP、DBP和HR,评估术中TIH的发生情况.记录术中丙泊酚、瑞芬太尼、硝酸甘油、艾司洛尔、去甲肾上腺素和阿托品使用情况,记录术后恶心呕吐、皮肤瘙痒和头痛头晕的发生情况.结果 与SS组相比,taVNS组TIH发生率及硝酸甘油使用例数减少(P＜0.05),其他指标差异无统计学意义(P＞0.05).结论 taVNS可降低前交叉韧带重建术患者TIH的发生.
Abstract
Objective To evaluate the effect of transcutaneous auricular vagus nerve stimulation(taVNS)on tourniquet-induced hypertension(TIH)in the patients undergoing anterior cruciate ligament reconstruction.Methods Seventy-four patients of either sex,aged 18-60 yr,of American Society of Anes-thesiologists Physical Status classification Ⅰ or Ⅱ,with body mass index of 18-30 kg/m2,undergoing elec-tive anterior cruciate ligament reconstruction under general anesthesia combined with preoperative femoral nerve block,were divided into 2 groups(n=37 each)using a random number table method:sham stimula-tion group(group SS)and group taVNS.Group SS received stimulation on the ear lobe and the tail of the helix of the left ear.Group taVNS received stimulation on the cymba concha and the earlobe of the left ear.Both groups received stimulation from 1 h before induction of anesthesia until the end of the procedure(fre-quency of 30 Hz,pulse width of 300 μs,and amplitude of the strongest current that could be tolerated by the patient in the absence of pain).The tourniquet inflation pressure was 280 mmHg,with an inflation time of 60-90 min.Systolic blood pressure,diastolic blood pressure and heart rate were recorded before tourni-quet inflation to assess the development of intraoperative TIH.The consumption of intraoperative propofol,remifentanil,nitroglycerin,esmolol,norepinephrine and atropine was recorded,and the occurrence of post-operative nausea and vomiting,skin itching and headache and dizziness was also recorded.Results Com-pared with group SS,the incidence of TIH and the number of patients used nitroglycerin were significantly reduced(P＜0.05),and no significant changes were found in the other parameters in group taVNS(P＞0.05).Conclusions taVNS can decrease the occurrence of TIH in the patients undergoing anterior cruciate ligament reconstruction.
关键词
耳/迷走神经刺激术/前交叉韧带重建/止血带/高血压Key words
Ear/Vagus nerve stimulation/Anterior cruciate ligament reconstraction/Tourni-quets/Hypertension引用本文复制引用
基金项目
河北省医学适用技术跟踪项目(GZ2024057)
出版年
2024
NETL
NSTL
维普
万方数据