经皮穴位电刺激对单侧双通道脊柱内镜手术患者应激反应的影响OA

Objective To explore the effect of transcutaneous electrical acupoint stimulation(TEAS)on stress response in patients undergoing unilateral biportal endoscopy(UBE)and to identify optimal TEAS parameters.Methods A total of 96 patients undergoing UBE were randomly grouped into total intravenous anesthesia(TIVA)group,acupuncture-assisted anesthesia with continuous waves(AACW)group,and acupuncture-assisted anesthesia with sparse-dense waves(AASDW)group,with 32 patients per group.All groups were given a standardized TIVA protocol.In the AACW group(100 Hz continuous wave stimulation)and the AASDW group(2/100 Hz sparse-dense wave stimulation),TEAS intervention was applied to both bilateral Zusanli(ST36)and Sanyinjiao(SP6)30 minutes before TIVA induction and continued until the end of the surgery.In the TIVA group,electrodes were only connected without electrical stimulation.The stress response indicators including cortisol(Cor)and adrenocorticotropic hormone(ACTH),heart rate(HR),mean arterial pressure(MAP),and bispectral index(BIS)at before anesthesia induc-tion(T0),after tracheal intubation(T1),during laminectomy(T2),and 1 hour after surgery(T3)were compared across groups.The operation duration,anesthesia duration,extubation and recovery duration were recorded,as well as pain intensity including visual analogue scale(VAS),and sedation level(by Ramsay sedation score)at 2,6,12 hours after surgery,and postoperative complications.Results The AACW group and AASDW group had lower ACTH and COR levels at T1,T2 and T3,as well as lower HR and MAP levels at T1 and T2 than TIVA group,with AASDW group being lower than AACW group(P＜0.05).At T3,the AASDW group had higher BIS than TIVA group and AACW group(P＜0.05).No significant difference in operation duration was observed(P＞0.05).The AACW group and AASDW group had shorter anesthesia,extubation and recovery duration than TIVA group,with AASDW group being the shortest(P＜0.05).The VAS scores at 2 h,6 h,and 12 h after surgery in the AACW and AASDW groups were lower than those in the TIVA group,with the AASDW group showing significantly lower scores than the AACW group(P＜0.05).The Ramsay sedation scores in the AASDW group were lower than those in the AACW group at 2 h and 6 h after surgery(P＜0.05).The total incidence of complications in the AASDW group was 6.25％(2/32),significantly lower than 28.13％(9/32)in the TIVA group(P＜0.05).Conclusion TEAS can effectively suppresses stress response in patients undergoing UBE,with the 2/100 Hz sparse-dense wave parameter being most effective,which can stabilize hemodynamics,accelerate recovery,improve postoperative sedation and analgesia quality,and reduces complications.