| Objective:To explore the clinical value of transcutaneous acupoint electrical stimulation (TAES) combined with general intravenous anesthesia in endoscopic thyroidectomy.Methods:60 patients (ASAⅠ-Ⅱ)undergoing endoscopic thyroidectomy were randomly divided into 2 groups with 30 patients in each group.Treatment groups:TAES combined with general intravenous anesthesia and control group: total intravenous anesthesia.Before induction of anesthesia, treatment group was stimulated at hibateral Hegu and Neiguan acupoint for 30 min by han's acupoint nerve stimulator(HANS) and control group was reposed for 30 min in operating room.Then anesthesia was induced with midazolam 0.04mg/kg,fentanyl 4μg/kg,atracurium 0.08mg/kg,propofol TCI (C=2.5μg/ml) started instantly. Treatment group was sustaining electrical stimulated at hibateral Hegu and Neiguan acupoint until extubation. BIS was maintained at 50±5 by adjustment of target concentration of propofol during the operation.Constant pumped infusion of remifentanil and atracurium and stop using all anesthetics when the operation was end.The BIS value,HR,MAP were monitored continuously in the perioperative period.The concentration of IL-6,TNF-a were measured after entering the operating room,before induction of anesthesia,30 min after pneumoperitoneum and the end of the surgery. The time from the end of surgery to recovering consciousness,extubation and leaving the operating room were recorded.We also record the target concentration of propofol during the operation.Results:Compared with baseline value, the BIS value of two group were lower before induction of anesthesia(P<0.01). The BIS value in treatment group were lower significantly than those in control group before induction of anesthesia (P<0.01).The hemodynamics in treatment group was more stable than control group during surgery(P<0.05).Compared with baseline value,the concentration of IL-6 in treatment group increased slightly during surgery(P>0.05).The concentration of IL-6 in control group were higher than baseline values(P<0.01) and compared with the same time points of treatment group(P<0.05).The target concentration of propofol in treatment group were significantly lower than those in control group during surgery. The time from the end of surgery to recovering consciousness,extubation and leaving the operating room were shorter in treatment group than those in control group(P<0.05).Conclusion:TAES combined with general intravenous anesthesia can maintain the hemodynamics more stable and depress the stress response of endoscopic thyroidectomy.Meanwhile, it can shorten the time of leaving the operating room and reduce the total dosage of anesthetic and the cost of anaesthesia. TAES combined with general intravenous anesthesia is a safe and cost-effective method. |
