不同频率电针辅助麻醉对甲状腺手术应激反应的影响  

Effects of electroacupuncture anesthesia of different frequencies on stress reaction in thyroid surgery

作　　者：马武华[1] 黎玉辉[1] 高晓秋[1] 罗艳霞[1] 陈鸶[1] 王心田[1] 温科辉[1] 

机构地区：[1]广州中医药大学第一附属医院麻醉科,广东广州510405

出　　处：《中国针灸》2010年第10期849-852,共4页Chinese Acupuncture & Moxibustion

基　　金：广东省科学技术厅社会发展计划项目:2006B35602004;广东省中医药局支持项目:2007046

摘　　要：目的:探寻电针辅助麻醉中可达到最佳麻醉效果的电针频率。方法:将60例择期甲状腺手术患者随机分为A、B、C组,每组20例。A组选用2Hz/100Hz疏密波刺激,B组选用2Hz/15Hz疏密波刺激,C组为不接电针的对照组。刺激双侧合谷、内关穴。针刺诱导15min后行颈丛神经阻滞。观察各组镇痛效果,比较各组患者在麻醉前(T1)、诱导后切皮前(T2)、术中牵拉甲状腺时(T3)、术毕(T4)4个时间点血浆皮质醇(COR)、β-内啡肽(β-EP)浓度的变化。结果:镇痛效果显著率以B组(80.0%,16/20)为最高,A组(50.0%,10/20)居中,C组(10.0%,2/20)最低。T2时间点A组COR含量最高;T3时间点B组COR含量最低。术毕时3组COR含量均达到最高水平,仍然以B组最低。B组血浆β-EP在T3、T4两个时间点较前明显降低(均P<0.05)。结论:在电针辅助麻醉中2Hz/15Hz的疏密波刺激频率比2Hz/100Hz的麻醉效果更佳,更能抑制手术麻醉带来的应激反应。Objective To probe into the optimal frequency of electroacupuncture for the access to the best anesthesia. Methods Sixty cases of optional thyroid surgery were randomly divided into group A, group B and group C, 20 cases in each group. In group A, 2 Hz/100 Hz disperse-dense wave was selected in stimulation. In group B, 2 Hz/15 Hz disperse-dense wave was selected. Group C was the control group without electric stimulation applied. Hegu （LI 4） and Neiguan （PC 6） were stimulated bilaterally. Cervical plexus block was produced after 15 min acu- puncture. The concentration changes in plasma cortisone （COR） and β-endorphin （β-EP） were compared among 4 time-points, named before anesthesia （T1）, before skin incision after induction （T2）, thyroid traction in surgery （T3） and the end of surgery （T4）. Results Group B achieved the highest significant rate of analgesia （50. 0%, 10/20） and that in group C was the lowest （10.0%, 2/20）. COR content was the highest at T2 in group A and that was the lowest at T3 in group B. At the end of surgery, COR content was up the maximum in 3 groups, but still COR content was the lowest in groupβ in comparison. The plasma β-EP content decreased apparently at T3 and T4 in group B as compared with the value before （both P〈0.05）. Conclusion In electroacupuncture-assisted anesthesia, 2 Hz/15 Hz disperse-dense wave achieves the optimal anesthesia compared with 2 Hz/100 Hz disperse-dense wave, and moreover inhibits stress reaction induced by anesthesia surgery.

关 键 词：甲状腺手术 电针麻醉 频率 皮质醇 Β-内啡肽 

分 类 号：R246.2[医药卫生—针灸推拿学]