| Objective:Due to the influence of environment and diet,the incidence of thyroid diseases such as thyroid adenoma and thyroid cyst is gradually increasing.At present,the most effective treatment method is still surgical treatment,and based on the professional characteristics of thyroid surgery,the use of day surgery mode to carry out thyroid surgery has gradually become a trend.The concept of enhancede recovery after surgery is applied to thyroid surgery to reduce stress reaction and postoperative complications,which is conducive to the development of day surgery mode and make patients benefit more fully.Therefore,how to promote enhancede recovery after surgery has become the focus of anesthesiologists.In this study,the effects of different frequencies of transcutanclus electrical acupoint stimulation on enhancede recovery after surgery of thyroid surgery under general anesthesia were observed and evaluated,and the appropriate stimulation frequency was selected to provide favorable conditions for day surgery.Methods:Select 90 patients（ASA I-II）,aged 18-60 years,who underwent thyroid adenoma enucleation or subtotal thyroidectomy at the first time under general anesthesia at Baoding First Central Hospital from November 2019 to June2020.the patients were divided into 3 groups（n=30）by random number table method.Before the induction of general anesthesia,the three groups were given 30min with different frequencies of sparse and dense wave transcutanclus electrical acupoint stimulation,combined with general anesthesia for thyroid surgery.Group A selected 2/100Hz dense wave stimulation,group B selected 2/15Hz dense wave stimulation,group C as the control group,connected to the stimulator without electrical stimulation.The stimulation points were bilateral Neiguan,Hegu and Zusanli,the stimulation intensity was the maximum intensity that the patient could tolerate when awake,and the stimulation was stopped at the end of the operation.Observation indicators:（1）The mean arterial pressure（MAP）was recorded at the time of 5min after entering the operating room（T0）,30min after stimulation（T1）,intubation（T2）,skin incision（T3）,end of the operation（T4）and extubation（T5）;（2）The venous blood samples of patients with 5min after entering the operating room（T0）,skin incision（T3）,end of operation（T4）and leaving operating room（T6）were collected to determine the content of blood glucose（Glu）by glucose oxidase method;the venous blood of 5min after entering the operating room（T0）and 6 hours after operation（T8）were collected,and the content of cortisol（Cor）was determined by chemical light method;（3）The dosage of sufentanil citrate and remifentanil hydrochloride,Visual analogue scale（VAS）and Ramsay sedation score were recorded at the time of leaving the room（T6）,2 hours after operation（T7）,6 hours（T8）and 12hours（T9）after operation.If the VAS score was more than 4,30mg of ketorolac tromethamine was given,and the number of postoperative salvage analgesia cases in each group was recorded;（4）Record the times of nausea and vomiting in the three groups of patients within 24 hours after surgery.if there were unbearable nausea and vomiting,10mg metoclopramide was given,and the number of cases of antiemetic drugs in each group was recorded.The postoperative complications such as postoperative bleeding and incision infection were recorded;（5）Record the 15-item Quality of Recovery Rating Scale（QOR-15）scores at the preoperative visit,24 hours and 36 hours after operation.The hig--er the score is,the better the recovery quality is.Results:1.There was no significant difference in general data（sex,age,ASA grade,BMI,operation time）among the three groups.2.Blood flow dynamics:At T0,there was no significant difference in MAP among the three groups（P>0.05）.At T1,T2,T3,and T5,the MAP of group C was significantly higher than that of group A and group B（P<0.05）.Compared with T0,the MAP of group A and B decreased slightly at T1（P<0.05）;at T2,T3,and T5,the MAP of three groups A,B,and C increased significantly（P<0.05）,the increase in group C was greater than that in groups A and B（P<0.05）,and the increase in group A was greater than that in group B（P<0.05）.3.Stress response:there was no significant difference in Glu and Cor among the three groups at T0（P>0.05）.（1）Blood glucose:compared with T0,the concentration of Glu in group A,B and C increased significantly at T3,T4and T6（P<0.05）.In comparison between groups,at T3,T4,and T6,the Glu concentration of A and B groups were lower than that of group C（P<0.05）,and the Glu concentration of group B was lower than that of group A（P<0.05）.（2）Cortisol:compared with T0,at T8,the Cor concentration of groups A,B,and C was significantly higher than that at T0（P<0.05）.At T8,the increase in Cor concentration of group A and B was significantly lower than that of group C（P<0.05）,and the increase of Cor concentration in group B was smaller than that of group A（P<0.05）.4.Analgesia and sedation:there was no significant difference in VAS score and Ramsay score among the three groups at each time point,and there was no case of remedial analgesia.5.Application of opioids:the intraoperative dosage of remifentanil in group C was more than that in group A and B,and that in group A was more than that in group B（P<0.05）.6.Recovery quality:there was no significant difference in Qo R-15 score among the three groups during preoperative visit（P>0.05）.Compared with the preoperative visit,the Qo R-15 score at 24h after operation in group An and B was lower than that at 24h and 36h after operation in),C group（P<0.05）.The Qo R-15 score at 24h and 36h after operation in group A and B was lower than that before operation（P<0.05）.Compared with group C,the Qo R-15 scores of group A and group B at 24h and 36h after operation were higher than those in group C（P<0.05）.Compared with group B,the Q0R-15score at 24h after operation in group A was lower than that in group B（P<0.05）.7.Nausea and vomiting:there was no significant difference in the incidence of postoperative nausea among groups A,B and C（P>0.05）.The incidence of postoperative vomiting in group C was higher than that in group A and B,and no antiemetic drugs were used in the three groups.There were no other serious complications such as postoperative bleeding,incision infection and so on.Conclusion:The 2/15Hz percutaneous acupoint electrical stimulation is more conducive to rapid recovery after thyroid surgery under general anesthesia,more stable hemodynamics,more effective reduction of stress response,and higher quality of postoperative recovery. |
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