摘要目的:评价经皮穴位电刺激对活体肾移植供者(LKDs)围术期焦虑和术后疼痛的影响。方法:选择拟行活体肾移植术的LKDs 72例，ASA分级Ⅰ或Ⅱ级，年龄18～64岁，BMI 18～28 kg/m 2，采用随机数字表法分为经皮穴位电刺激组(T组)和假刺激组(S组)，每组36例。T组LKDs于术前1 d上午(T 0)、术晨麻醉诱导前30 min(T 1)和术后第1天上午(T 2)在双侧内关穴、双侧太冲穴和印堂穴各行30 min经皮穴位电刺激，刺激频率2～100 Hz，疏密波，电流强度6～15 mA；S组仅在相同时点及穴位贴电极片而不进行刺激。2组均在每次刺激前抽取肱静脉血，测定血浆5-羟色胺(5-HT)浓度。T 0、T 1、T 2、术后第3天(T 3)和出院前(T 4)记录2组医院焦虑抑郁-焦虑量表(HADS-A)的评分。记录2组术中麻醉药用量、拔除喉罩时间、术后72 h内镇痛补救情况和术后并发症的发生情况。术后3个月(T 5)电话随访2组HADS-A及Leeds神经性症状和体征评估量表评分。 结果:与S组比较，T组T 1、T 2和T 3时焦虑发生率降低，术后72 h内镇痛补救率降低，T 1和T 2时血浆5-HT浓度升高，术后恶心呕吐发生率降低，术后首次排气时间缩短( P<0.05)。2组术中麻醉药用量、拔除喉罩时间、术后3个月内焦虑及神经病理性疼痛发生率比较差异无统计学意义( P>0.05)。 结论:经皮穴位电刺激可缓解LKDs术前和术后早期焦虑，减轻术后疼痛。

abstractsObjective:To evaluate the effect of transcutaneous electrical acupoint stimulation (TEAS) on perioperative anxiety and postoperative pain in living kidney donors (LKDs).Methods:Seventy-two American Society of Anesthesiologists physical status Ⅰ or Ⅱ LKDs, aged 18-64 yr, with body mass index of 18-28 kg/m 2, undergoing living kidney transplantation, were selected, and divided into 2 groups ( n=36 each) using a random number table method: TEAS group (group T) and sham stimulation group (group S). In group T, TEAS was performed on the forenoon at 1 day before surgery (T 0), at 30 min before anesthesia induction on the morning of the operation day (T 1) and on the forenoon at 1 day after surgery (T 2) at bilateral Neiguan, Taichong and Yintang with a frequency 2-100 Hz, disperse-dense waves and current intensity 6-15 mA, and each TEAS lasted for 30 min.Only electrode patches were applied at the same acupoint and at the same time point, but no stimulation was applied in group S. In T and S groups, brachial venous blood samples were collected before each stimulation for measurement of the plasma 5-hydroxytryptamine (5-HT) concentration.The Hospital Anxiety Depression Scale-Anxiety subscale (HADS-A) scores at T 0, T 1, T 2, on day 3 after surgery (T 3) and before discharge (T 4) in the 2 groups were recorded.The consumption of anesthetics during operation, laryngeal mask airway removal time, requirement for rescue analgesia within 72 h after surgery and the development of postoperative complications were recorded.The LKDs were followed up by telephone at 3 months after surgery (T 5) to record the scores of HADS-A and Leeds Assessment of Neuropathic Symptoms and Sign (LANSS) scale. Results:Compared to group S, the incidence of anxiety was significantly decreased T 1, T 2 and T 3, the incidence of rescue analgesia within 72 h after surgery was decreased, plasma concentration of 5-HT was increased at T 1 and T 2, the incidence of postoperative nausea and vomiting was decreased, and the time to first flatus was shortened in group T ( P<0.05). There was no significant difference in the consumption of anesthetics during operation, laryngeal mask airway removal time, and the incidence of anxiety and neuropathic pain within 3 months after surgery between the 2 groups ( P>0.05). Conclusion:TEAS can relieve early preoperative and postoperative anxiety and alleviate postoperative pain in LKDs.