针刺辅助麻醉用于妇科腹腔镜手术的临床研究  

The clinical study of acupuncture-assisted anesthesia in gynecologic laparoscopy surgery

作　　者：杨琼卉[1] 马武华[1] 沙雪帆[1] 郑俊奕[1] 罗艳霞[1] 蔡诚毅[1] 

机构地区：[1]广州中医药大学第一附属医院麻醉科,广州510405

出　　处：《广东医学》2008年第8期1263-1266,共4页Guangdong Medical Journal

摘　　要：目的观测针刺辅助静吸复合全麻在妇科腹腔镜手术中的麻醉效果。方法90例ASA评级Ⅰ～Ⅱ级择期妇科腹腔镜手术患者随机分为3组，每组30例。Ⅰ组单纯静吸复合全麻；Ⅱ组采用HANS仪行穴位刺激20～30min后再全麻；Ⅲ组则全麻后再行穴位刺激。术中调节七氟醚浓度，维持AAI值在15～25。记录术中七氟醚吸及浓度、心率和血压，观察术毕苏醒和拔管时间，以及苏醒期躁动、寒战和疼痛等反应，术后随访询问患者术中麻醉的舒适度、满意度及术中知晓等。结果术中七氟醚吸入浓度Ⅰ组最高，Ⅱ组最低，其中Ⅱ组比Ⅰ组降低减少33％，Ⅲ组比Ⅰ组减少21％（P〈0．05）；术中Ⅱ组和Ⅲ组的血压和心率较Ⅰ组更为稳定；术毕苏醒睁眼和拔管时间Ⅱ组最短，Ⅰ组最长，两组对比差异有显著性（P〈0．05）。苏醒期躁动和疼痛的发生率Ⅰ组最多，Ⅱ组最少，两组对比差异有显著性（P〈0．05）。术后随访3组均无术中知晓，Ⅱ组与Ⅲ组的满意度较Ⅰ组高（P〈0．05）。结论妇科腹腔镜手术中穴位电刺激具有一定的麻醉作用，且以全麻前20～30min开始效果最佳，可减少复合全麻中七氟醚用量21％～33％并使术后苏醒更快、更平稳。Objective To investigate the effects of acupuncture - assisted anesthesia. Methods Ninety patients undergoing elective gynecologic laparoseopy, ASA Ⅰ- 11, were randomly divided into 3 groups, with 30 cases in each group. Group Ⅰ received only general anesthesia, group Ⅱ received general anesthesia after 20 - 30 minutes of HANS and Group Ⅲ received general anesthesia after HANS. Both Hegu and Taizhong were selected for acupuncture anesthesia, with 2/100 Hz, 12 - 15 mA（ in group Ⅱ , the strength range was 3 -6mA that patient could bear） acupuncture until end of surgery. The concentration of seveflurine was adjusted to maintain AAI value at 15 - 25 during surgery to observe stability of hemodynamics. HR and BP were recorded before and after of induction anesthesia and at the time of tracheal intubation, the skin incision, tracheal extubation. Adverse events such as postoperative pain, restlessness, shivering, respiratory depression, nausea and vomiting were observed to evaluated the analgesia quality. The time from the end of operation to extubation and awake time were recorded;The awakness of patient in operation and satisfaction of patients after surgery were also recorded. Results The Sev - MAC value change was a significance different in all groups （ P 〈 0. 05 ）. Group Ⅰ was the highest, Group Ⅲ was lower and group Ⅱ was the lowest. BP and HR was more stabile in group Ⅱ and Group Ⅲ（ P 〈 0. 05 ）. The time from the end of operation to extubation and the time from the end of operation to open eye on command was the longest in Group Ⅰ was （ P 〈 0. 05）, longer in Ⅲ and shortest in Group Ⅱ. The rate of postoperative pain and restless ness in analgesia was the higgest in Group Ⅰ（P 〈0. 05）. Satisfaction of patient after surgery was higher（P 〈0. 05） in group Ⅱ and Group Ⅲ. Conclusion HANS has adjuvant action for anesthesia and analgesia, and acupuncture before general anesthesia has a better action. HANS has a stable effect on perioperative hemodynamics a

关 键 词：妇科腹腔镜手术 针刺辅助麻醉 听觉诱发电位指数 

分 类 号：R713[医药卫生—妇产科学] R246.2[医药卫生—临床医学]