电针疗法联合全麻诱导对老年下肢关节置换手术患者血流动力学和术后恢复的影响

摘要 目的：评估电针预处理对行下肢关节置换术的老年患者术中血流动力学、术后心血管不良事件、恢复质量的影响。方法：选择择期行下肢关节置换术（膝关节置换或髋关节置换）的老年患者70例，采用随机数字表法分为试验组和对照组。试验组在全麻诱导前30 min于手术准备间予双侧内关、列缺、足三里电针治疗，对照组单纯行全身麻醉。两组全麻诱导后均采用静吸复合麻醉。记录气管插管时（T1）、手术开始后10 min（T2）、拔管后10 min（T3）时的血流动力学参数（HR、MAP、RPP），术后24 h的心血管不良事件、VAS评分、恢复质量（QoR40）的情况。结果：与对照组相比，试验组T1、T2、T3三个时间点的HR、MAP、RPP均明显降低（P＜0.05）；试验组术后24 h心血管不良事件发生率高于对照组（P＜0.05），VAS评分以及术后QoR40比较无差异（P>0.05）。结论：麻醉前电针预处理内关、列缺、足三里可以有效的降低患者心率、血压和心肌氧耗量，降低机体对围术期应激的反应，从而降低围术期不良心血管事件的发生率，提高麻醉的安全和质量。

Effect of Electroacupuncture Therapy Combined with General Anesthesia Induction on Hemodynamics and Postoperative Recovery in Elderly Patients Undergoing Lower Limb Arthroplasty Surgery

ABSTRACT Objective: To evaluate the effect of electroacupuncture preconditioning on hemodynamics, postoperative cardiovascular adverse events and quality of recovery in elderly patients undergoing lower limb joint replacement. Methods: Seventy elderly patients who underwent elective lower limb arthroplasty (knee replacement or hip replacement) were selected and divided into a test group and a control group using the random number table method. In the experimental group, bilateral electrical acupuncture treatment was given to Neiguan, Lijiu and Lisanli 30 min before induction of general anesthesia in the surgical preparation room, while the control group was treated with general anesthesia alone. After induction of general anesthesia in both groups, a combination of static and suction anesthesia was used. The hemodynamic parameters (HR, MAP, RPP) at the time of tracheal intubation (T1), 10 min after the start of surgery (T2) and 10 min after extubation (T3), and the cardiovascular adverse events, VAS scores and quality of recovery (QoR40) at 24 h after surgery were recorded. Results: Compared with the control group, HR, MAP, and RPP at T1, T2, and T3 time points were significantly lower in the test group (P<0.05); the incidence of cardiovascular adverse events at 24 h after surgery was higher in the test group than in the control group (P<0.05), and there was no difference in VAS scores and postoperative QoR40 (P>0.05). Conclusion: Electroacupuncture pretreatment before anesthesia can effectively reduce the heart rate, blood pressure and myocardial oxygen consumption of patients, reduce the body''s response to perioperative stress, thereby reducing the incidence of adverse cardiovascular events during perioperative period, and improve the safety and quality of anesthesia.