体表电刺激在正常和麻醉状态下肌松作用的研究

MUSCULAR RELAXATION INDUCED BY TRANSCUTANEOUS ELECTRIC NERVE STIMULATION IN AWAKE AND ANESTHETISED HUMAN SUBJECTS

摘要:

目的：应用韩氏穴位神经刺激仪（ＨＡＮＳ）进行１００Ｈｚ体表电刺激，观察是否有肌松作用。方法和结果：（１）抬腿读秒试验：健康自愿受试者２０例，分别在０Ｈｚ、２Ｈｚ、１００Ｈｚ和２／１００ＨｚＨＡＮＳ刺激前后进行４５°抬腿试验。发现２／１００Ｈｚ和１００ＨｚＨＡＮＳ刺激３０ｍｉｎ后抬腿时间较刺激前减少２０．７％和４０．９％（Ｐ＜０．０５和Ｐ＜０．０１）；（２）临床麻醉观察：选择需全麻的腹部手术ＡＳＡⅠ～Ⅱ级患者６０例，随机分成ＨＡＮＳ组（静脉全麻＋ＨＡＮＳ）和对照组（单纯静脉全麻），每组３０例。两组的首次全麻药和肌松药的用量及一般麻醉方法均一致，并全程进行肌松和生命体征监测，当肌松的ＴＲ值＞０．２５或麻醉机气道压力＞２ｋＰａ时，追加首次肌松药和全麻药量的半量，使手术始终处于良好的肌松和平稳的麻醉状态。ＨＡＮＳ组于全麻诱导前２０ｍｉｎ开始１００ＨｚＨＡＮＳ体表电刺激。结果表明，ＨＡＮＳ组的肌松药用量较对照组减少３５％（Ｐ＜０．０１），全麻药较对照组减少２０％（Ｐ＜０．０５）。结论：健康受试者抬腿读秒试验和腹部手术临床麻醉的观察结果表明，ＨＡＮＳ确有明显的肌松作用，具有临床应用前景。

Abstract:

Aim: To observe the effect of muscular relaxation induced by transcutaneous electric nerve stimulation (TENS) by Han's Acupoint Nerve Stimulator (HANS). Method and Result: (1) straight leg raising test: the time periods of straight leg raising for 45 in 20 healthy volunteers were accessed before and after transcutaneous electrical stimulation of 0 (control), 2,100,and 2/100 Hz with HANS. We found that the straight leg raising time was reduced for 20.7% and 40.7% (P<0.05 and P<0.01) by 2/100 and 100Hz Stimulation respectively. (2) Clinical observation: Sixty patients who needed abdominal operations (ASA ) were included. Patients were randomly assigned to HANS (intravenous general anesthesia plus HANS) and control group (intravenous general anesthesia only), with 30 patients in each group. The first dose of general anesthetics and muscular relaxant were identical for both groups. The muscle tension and life signs were monitored during the operation. Whenever the TR value for muscular relaxation raised over 0.25 or the air passage pressure of the anesthesia apparatus was over 2 kPa, 50% of the first dose of anesthetics and muscular relaxant were aded, thus maintaining the operation under optimal anesthesia and muscular relaxation conditions. In HNAS group, 100Hz stimulation were given 20 min before the induction of general anesthesia. The result showed that in HANS group, the total dose of muscular relaxation and anesthesia were reduced for 35% and 20% (P<0.01 and P<0.05),respectively. Conclusion: HANS shows clear muscular relaxation effect in both normal and anesthetized human subjects, which may have a good prospect of clinical application.