Objective To observe the effectiveness of transcutaneous acupoint electrical stimulation (TAES) or electroacupuncture (EA) stimulation of different acupoints in combination with anesthetics in the management of thyroidectomy patients, so as to choose a better stimulating method and most effective acupoints for thyroidectomy.Methods A total of 216 thyroidectomy patients (ASA Ⅰ-Ⅱ grades) with thyroid gland adenoma, thyroid cyst or thyroid nodules from 3 hospitals (3 research centers) were randomized into 6 groups, i.e., local anesthesia (LA, n=34), Futu (LI 18)-EA (n=36), Hegu (LI 4)-Neiguan (PC 6)-TAES (n=34), LI 4-PC 6-EA (n=36), Yanglingquan (GB 34)-EA (n=36) and non-acupoint (NA, about 1.5 cm latero-posterior to KI 9)-EA (n=34) groups according to the hospitalizition sequence.For patients of the LI 18-EA, LI 4-PC 6-TAES/EA, GB 34 and non-acupoint-EA groups, EA or TAES (2 Hz/100 Hz) was applied to the abovementioned bilateral acupoints or non-acupoint till the termination of the surgical operation.The surgery was conducted under anesthesia by local injection of 0.5% lidocaine and midazolam, and intravenous injection of fentanyl (for severe pain cases) 20 min after beginning of TAES or EA.The patients'' scores of visual analogue scale (VAS),mean arterial pressure (MAP) and heart rate (HR) at the time-points of pre-anesthesia (T 0), skin-incision (T 1), skin flap-freeing (T 2), anterior cervical muscle traction (T 3), thyroid upper/lower-pole-sectioning (T 4/T 5), and thyroidectomy (T 6), and the dosages of the administered fentanyl and lidocaine were recorded.Results Compared with the corresponding time-points of the non-acupoint group, the VAS scores at T 1 and T 4 time-points in the LI 18-EA group and LI 4-PC 6-EA group, at T 1, T 5 and T 6 time-points in the LI 4-PC 6-TAES group were significantly lower (P<0.05).Compared with the corresponding time-points of the LA group, the VAS scores at T 2, T 3, T 5 and T 6 time-points in the LI 18-EA group and LI 4-PC 6-EA group, at T 3, T 5 and T 6 in the LI 4-PC 6-TAES group, and the MAP levels at T 2, T 3, T 4 and T 6 time-points in the LI 18-EA group, at T 3, T 4 in the LI 4-PC 6-EA group, at T 3, T 4, T 6 in the LI 4-PC 6 TAES group, as well as the HR levels at T 4, T 5 and T 6 in the LI 18-EA group, and at T 5, T 6 in the LI 4-PC 6-TAES group were significantly lower (P<0.05).The dosages of fentanyl in the LI 18-EA and LI 4-PC 6-TAES groups, and those of lidocaine in the LI 18-EA, LI 4-PC 6-EA and TAES groups were significantly lower relevant to the LA group and non-acupoint group (P<0.05).No significant differences were found between the LA and GB 34-EA groups, and between the LA and non-acupoint groups, as well as between the LI 4-PC 6-EA and LI 4-PC 6-TAES groups in the VAS scores, the MAP and HR levels, the dosages of lidocaine and fentanyl consumption (P>0.05).Conclusion EA stimulation of both LI 18 and LI 4-PC 6 and TAES of LI 4-PC 6 combined with anesthetics have a better effect in inducing analgesia and controlling MAP and HR, and need lower dosages of anesthetics for patients undergoing thyroidectomy, for which LI 18 and LI 4-PC 6 are evidently superior to GB 34 and non-acupoint.Hence, combined EA or TAES and anesthetics is highly recommended for thyroidectomy%目的:通过比较电针、经皮穴位电刺激扶突等不同穴位辅助药物麻醉用于甲状腺手术病人的效果,探索针麻选择的最佳刺激方法和穴位.方法:216例美国麻醉师协会Ⅰ-Ⅱ级的择期甲状腺手术患者随机分为局麻组、扶突组、内关加合谷组、内关加合谷经皮电刺激组、阳陵泉组、非经非穴组.所有病人术前均静脉注射咪哒唑伦、芬太尼,局麻组切口局部多次给予利多卡因.除经皮电刺激组外,电针刺激上述各穴或穴组或非穴位(2 Hz/100 Hz,电流强度为病人感觉阈值的两倍,电针刺激20 min后开始手术,至手术结束停止).比较6组麻醉前(T 0)、切皮时(T 1)、游离皮瓣(T 2)、牵开颈前肌(T 3)、处理甲状腺上极(T 4)、处理甲状腺下极(T 5)和切除甲状腺时(T 6)等几个时点平均动脉压(MAP)、心率(HR)的变化,视觉模拟量尺评分(VAS, 疼痛程度)和术中辅助用药的剂量.结果:与非经非穴组比较,扶突组和内关加合谷组T 1、T 4时点,及内关加合谷经皮电刺激组T 1、T 5、T 6时点的VAS评分降低(P<0.05).与局麻组比较,扶突组和内关加合谷组T 2、T 3、T 5、T 6时点,内关加合谷经皮电刺激组T 3、T 5、T 6时点的VAS评分均明显降低(P<0.05).扶突组及内关加合谷经皮电刺激组芬太尼使用量,以及扶突组、内关加合谷组及内关加合谷经皮电刺激组利多卡因使用量均显著少于局麻组及非经非穴组(P<0.05).扶突组T 2、T 3、T 4、T 6时点,内关加合谷组T 3、T 4时点,内关加合谷经皮电刺激组T 3、T 4、T 6时点MAP的水平, 以及扶突组T 4、T 5、T 6时点,内关加合谷经皮电刺激组T 5、T 6时点HR的水平均明显低于局麻组(P<0.05).结论:电针扶突和内关加合谷及经皮电刺激内关加合谷辅助麻醉药对甲状腺手术病人具有较强的镇痛效果,可减少局麻药用量,抑制血压和心率的增加,与阳陵泉及非经非穴电针比较,具有相对特异性,可在临床中应用.
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