摘要
目的观察不同麻醉方法对腹腔镜胆囊切除术围术期患者血流动力学及内啡肽的影响。方法选择90例腹腔镜胆囊切除术患者,按美国麻醉医师协会(American Society of Anesthesiologists,ASA)病情分级Ⅰ～Ⅱ级,年龄29～80岁,随机分为3组:A组(电针经穴复合全麻组)、B组(电针非经非穴复合全麻组)、C组(全麻组),每组30例。3组患者均采用芬太尼3μg/kg、异丙酚2mg/kg、维库溴铵0.1mg/kg进行全麻诱导,脑电双频指数(bispectral index,BIS)(40～65)处于全麻状态下,术中以静脉血浆靶控输注异丙酚,间断静脉注射芬太尼、维库溴铵维持麻醉。术后患者均静脉自控镇痛(patient controlled intravenous analgesia,PCIA)。在此基础上,A组选取双侧合谷、内关、曲池、足三里、阳陵泉,B组选用A组每个经穴所在经脉与外侧相邻经脉与经穴相平处连线的中点取穴,两组均于全麻诱导前15～30min持续电针刺激至术毕。分别于麻醉诱导前、腹腔开始CO2充气即刻、CO2充气后5min、胆囊切除、术毕时连续监测心率(heart rate,HR)、平均动脉压(mean arterial pressure,MAP)、心脏指数(cardiac index,CI)、心排量(cardiac output,CO)、体血管阻力指数(systemic vascular resistance index,SVRI)、加速度指数(acceleration index,ACI)。记录停药至自主呼吸恢复、呼之睁眼、拔除气管导管时间,并分别于麻醉诱导前、术毕2h、术后第1天及术后第3天采集患者静脉血3mL,送检β-内啡肽(β-endorphin,β-EP)。观察并记录3组患者术后4、6、8、24及44h疼痛视觉模拟评分(visu alanalogue scale,VAS)。结果 (1)与本组麻醉诱导前比较,各组的CI、CO、ACI在CO2充气后5min及胆囊切除时均显著降低(P<0.01,P<0.05),B组和C组HR、MAP、SVRI在各时段均有明显上升(P<0.05,P<0.01),A组则变化较小;与C组比较,A组的MAP在充气后5min上升幅度较小,差异有统计学意义(P<0.05)。(2)A组患者从停药到呼之睁眼、拔除气管导管时间显著短于B、C两组(P<0.05,P<0.01)。(3)A组术后第1天β-EP水平明显低于B组(P<0.05)和C组(P<0.01)。(4)A组术后44hVAS评分明显低于B、C两组(P<0.05)。结论电针经穴复合全麻能维持血流动力学的稳定,减轻CO2气腹后及术后应激反应,并可延长至术后早期,增强术后镇痛效果,术后恢复迅速,安全可靠。
Objective To observe the effects of different anesthesia ways on endorphin and he- modynamics of laparoscopic cholecystectomy patients in the perioperative phase. Methods A total of 90laparoscopic cholecystectomy patients, 29 to 80 years old, were randomly assigned to Group A （treated with electroacupuncture at acupoints combined general anesthesia）, Group B （treated with electroacu- puncture at non-acupoints combined general anesthesia）, and Group C （treated with general anesthesia） according to American Society of Anesthesiologists （ASA） Ⅰ-Ⅱ, 30 cases in each group. All patients were induced by 3 μg/kg Fentanyl （Fen）, 2 mg/kg Propofol （Pro）, and 0.1 mg/kg Vecuronium （Vcr）. Bispectral index （BIS）, being 40 -65, indicated the state of general anesthesia. The anesthesia was maintained by in- travenous injecting Pro, interruptedly intravenous injecting Fen and Vcr. Each patient recieved patient con- trolled intravenous analgesia （PCIA） after operation. On these bases, patients in Group A received electri- cal acupuncture at bilateral Hegu （LI4）, Neiguan （PC6）, Quchi （LI11）, Zusanli （ST36）, and Yanglingquan （GB34）. Patients in Group B received electrical acupuncture at the points beside acupoints. The electroacu- puncture was lasted from 15 -30 min before anesthesia induction to the end of the operation in Group A and B. The heart rate （HR）, mean arterial pressure （MAP）, cardiac index （CI）, cardiac output （CO）, system- ic vascular resistance index （SVRI）, and acceleration index （ACI） were recorded before anesthesia induc- tion, immediate before pneumoperitoneum, 5 min after pneumoperitoneum, excision of gallbladder, and at the end of operation. The time consumption from discontinuation to spontaneously breathing recovery, an- alepsia, and extubation were recorded. The blood samples （3 mL each time） were collected from the pe- ripheral vein before anesthesia induction, 2 h after operation, the 1st day after operation, and the 3rd day after operation to detect the β-endorphin （β-EP） level. The visual analogue scale （VAS） were observed and recorded in the 3 groups at post-operative 4,6, 8,24, and 44 h, respectively. Results （1） Compared with before anesthesia induction in the same group, the Cl, CO, ACI of all patients decreased significantly at 5 min after pneumoperitoneum and at excision of gallbladder （P 〈0.01, P 〈0.05）. The HR, MAP, SVRI obvi- ously increased in Group B and Group C at each time point （P 〈0.05, P 〈0.01 ）. Less change happened in Group A. Compared with Group C, the increment of MAP was less in Group A at 5 min after pneumoperito- neum, showing statistical difference （P 〈0.05）. （2） The time consumption from discontinuation to analep- sia and extubation was obviously shorter in Group A than in Group B and Group C （P 〈0.05, P 〈0.01 ）. （3） The level of 15-EP on the 1st day of operation was significantly lower in Group A than in Group B （P 〈0.05） and Group C （P 〈0.01 ）. （4） The VAS score at post-operative 44 h was significantly lower in Group A than in Group B and Group C （P 〈0. 05）. Conclusions Electroacupuncture at acupoints combined general anes- thesia could maintain the stabilization of haemodynamics, and relieve the stress reaction after pneumoper- itoneum and operation, and prolong it to early post-operative period, and strengthen the effects of post-op- erative analgesia. The post-operative recovery was fast, safe, and reliable.
出处
《中国中西医结合杂志》
CAS
CSCD
北大核心
2013年第6期761-765,共5页
Chinese Journal of Integrated Traditional and Western Medicine
基金
上海市卫生局中医药科研基金资助项目(No.2008L054A)
关键词
电针复合全麻
腹腔镜
胆囊切除术
血流动力学
内啡肽
acupuncture combined general anesthesia
laparoscope
cholecystectomy
hemody-namics
endorphin
