PDF(Pubmed)
Abstract：
BACKGROUND: High doses of long-acting opioids were used to facilitate off-pump coronary artery bypass grafting procedure, which may result in opioid-related adverse events after surgery. Transcutaneous electrical acupoint stimulation (TEAS) had been reported to be effective in reducing intraoperative opioids consumption during surgery. The aim of this study is to assess whether TEAS with difference acupoints can reduce the doses of opioid analgesics.
METHODS: This was a multicenter, randomized, controlled, double-blind trial. Patients underwent off-pump coronary artery bypass grafting under general anesthesia were enrolled. Eligible patients were randomly and equally grouped into sham acupuncture group (n = 105), regional acupoints combination group (n = 105), or distal-proximal acupoints combination group (n = 105) using a centralized computer-generated randomization system. Transcutaneous electrical acupoint stimulation was applied for 30 min before anesthesia induction. The primary outcome was the doses of sufentanil during anesthesia. Secondary outcomes included the highest postoperative vasoactive-inotropic scores within 24 h, intraoperative propofol consumption, length of mechanical ventilation, duration of cardiac care unit and postoperative hospital stay, incidence of postoperative complications, and mortality within 30 days after surgery.
RESULTS: Of the 315 randomized patients, 313 completed the trial. In the modified intention-to-treat analysis, the doses of sufentanil were 303.9 (10.8) μg in the distal-proximal acupoints group, significantly lower than the sham group, and the mean difference was - 34.9 (- 64.9 to - 4.9) μg, p = 0.023. The consumption of sufentanil was lower in distal-proximal group than regional group (303.9 vs. 339.5), and mean difference was - 35.5 (- 65.6 to - 5.5) μg, p = 0.020. The distal-proximal group showed 10% reduction in opioids consumption comparing to both regional and sham groups. Secondary outcomes were comparable among three groups.
CONCLUSIONS: Transcutaneous electrical acupoint stimulation with distal-proximal acupoints combination, compared to regional acupoints combination and sham acupuncture, significantly reduced sufentanil consumption in patients who underwent off-pump coronary artery bypass grafting surgery.
METHODS: This was a multicenter, randomized, controlled, double-blind trial. Patients underwent off-pump coronary artery bypass grafting under general anesthesia were enrolled. Eligible patients were randomly and equally grouped into sham acupuncture group (n = 105), regional acupoints combination group (n = 105), or distal-proximal acupoints combination group (n = 105) using a centralized computer-generated randomization system. Transcutaneous electrical acupoint stimulation was applied for 30 min before anesthesia induction. The primary outcome was the doses of sufentanil during anesthesia. Secondary outcomes included the highest postoperative vasoactive-inotropic scores within 24 h, intraoperative propofol consumption, length of mechanical ventilation, duration of cardiac care unit and postoperative hospital stay, incidence of postoperative complications, and mortality within 30 days after surgery.
RESULTS: Of the 315 randomized patients, 313 completed the trial. In the modified intention-to-treat analysis, the doses of sufentanil were 303.9 (10.8) μg in the distal-proximal acupoints group, significantly lower than the sham group, and the mean difference was - 34.9 (- 64.9 to - 4.9) μg, p = 0.023. The consumption of sufentanil was lower in distal-proximal group than regional group (303.9 vs. 339.5), and mean difference was - 35.5 (- 65.6 to - 5.5) μg, p = 0.020. The distal-proximal group showed 10% reduction in opioids consumption comparing to both regional and sham groups. Secondary outcomes were comparable among three groups.
CONCLUSIONS: Transcutaneous electrical acupoint stimulation with distal-proximal acupoints combination, compared to regional acupoints combination and sham acupuncture, significantly reduced sufentanil consumption in patients who underwent off-pump coronary artery bypass grafting surgery.
摘要：
背景：高剂量的长效阿片类药物用于促进非体外循环冠状动脉旁路移植术，这可能导致术后阿片类药物相关的不良事件。据报道，经皮穴位电刺激（TEAS）可有效减少手术过程中阿片类药物的消耗。这项研究的目的是评估不同穴位的TEAS是否可以减少阿片类镇痛药的剂量。
方法：这是一个多中心，随机化，控制,双盲审判.纳入在全身麻醉下接受非体外循环冠状动脉旁路移植术的患者。符合条件的患者被随机平均分组为假针刺组（n=105），区域穴位组合组(n=105)，或远端-近端穴位组合组（n=105）使用集中的计算机生成的随机系统。麻醉诱导前应用经皮穴位电刺激30min。主要结果是麻醉期间舒芬太尼的剂量。次要结果包括24小时内最高的术后血管活性-正性肌力评分，术中丙泊酚消耗，机械通气的长度，心脏监护病房的持续时间和术后住院时间，术后并发症的发生率，手术后30天内死亡率。
结果：在315名随机患者中，313完成了审判。在修改后的意向治疗分析中，远端-近端穴位组的舒芬太尼剂量为303.9（10.8）μg，明显低于假手术组，平均差为-34.9（-64.9至-4.9）μg，p=0.023。远端-近端组的舒芬太尼消耗量低于区域组（303.9vs.339.5),平均差异为-35.5（-65.6至-5.5）μg，p=0.020。与区域组和假手术组相比，远端-近端组的阿片类药物消耗量减少了10％。三组之间的次要结果具有可比性。
结论：经皮穴位电刺激与远端-近端穴位组合，与局部穴位组合和假针刺相比，在接受非体外循环冠状动脉旁路移植术的患者中,舒芬太尼的消耗量显著减少.
方法：这是一个多中心，随机化，控制,双盲审判.纳入在全身麻醉下接受非体外循环冠状动脉旁路移植术的患者。符合条件的患者被随机平均分组为假针刺组（n=105），区域穴位组合组(n=105)，或远端-近端穴位组合组（n=105）使用集中的计算机生成的随机系统。麻醉诱导前应用经皮穴位电刺激30min。主要结果是麻醉期间舒芬太尼的剂量。次要结果包括24小时内最高的术后血管活性-正性肌力评分，术中丙泊酚消耗，机械通气的长度，心脏监护病房的持续时间和术后住院时间，术后并发症的发生率，手术后30天内死亡率。
结果：在315名随机患者中，313完成了审判。在修改后的意向治疗分析中，远端-近端穴位组的舒芬太尼剂量为303.9（10.8）μg，明显低于假手术组，平均差为-34.9（-64.9至-4.9）μg，p=0.023。远端-近端组的舒芬太尼消耗量低于区域组（303.9vs.339.5),平均差异为-35.5（-65.6至-5.5）μg，p=0.020。与区域组和假手术组相比，远端-近端组的阿片类药物消耗量减少了10％。三组之间的次要结果具有可比性。
结论：经皮穴位电刺激与远端-近端穴位组合，与局部穴位组合和假针刺相比，在接受非体外循环冠状动脉旁路移植术的患者中,舒芬太尼的消耗量显著减少.
