针药复合麻醉对肠癌患者术后镇痛效果的影响  

Influence of Combined Acupuncture and Drug Anesthesia on Postoperative Analgesic Effect in Intestinal Cancer Patients

作　　者：沈利荣[1] 顾陈怿[2] 丁依红[2] 楼怡[2] 吴焕淦[1] 施征[1] 马晓芃[1] 

机构地区：[1]上海市针灸经络研究所,上海200030 [2]上海中医药大学附属岳阳中西医结合医院麻醉科,上海200437

出　　处：《上海针灸杂志》2011年第2期77-79,共3页Shanghai Journal of Acupuncture and Moxibustion

基　　金：国家自然科学基金资助项目(30772832)

摘　　要：目的观察针药复合麻醉对肠癌患者术后镇痛效果的影响。方法选取择期行肠癌根治术患者27例,年龄40～80岁,随机分成全麻组12例,针药组15例。两组患者均采用芬太尼3μg/kg、异丙酚2 mg/kg、维库溴铵0.1 mg/kg进行全麻诱导,术中以静脉输注异丙酚,间断静脉注射芬太尼、维库溴铵维持麻醉。术后患者均行静脉自控镇痛(PCA)。经穴取双侧合谷、内关、足三里、阳陵泉,持续电针刺激。观察并记录两组患者术后4h、6h、8h、24h、44h镇痛泵用量,疼痛视觉模拟评分(VAS)及镇静评分;两组患者均于麻醉诱导前(基础值)、术后2h、术后第1天及术后第3天抽取外周静脉血3 mL,采用放射免疫法测量血浆β-内啡肽(β-EP)、皮质醇、肿瘤坏死因子-α(TNF-α)水平。结果针药组患者术后4h镇痛泵用量明显少于全麻组(P<0.05);两组术后4h、6h、8h、24h及44h VAS及镇静评分无统计学差异(P>0.05);术后第3天针药组患者血浆TNF-α水平明显低于全麻组(P<0.05),两组患者各时间点血浆β-内啡肽、皮质醇水平无显著性差异(P>0.05)。结论全麻患者术后早期需要更大剂量的芬太尼来缓解疼痛,而针药复合麻醉能产生一定的镇痛效应,但其程度较弱。Objective To explore the influence of combined acupuncture and drug anesthesia on postoperative analgesic effect in intestinal cancer patients.Methods Twenty-seven patients who were aged 40-80 and would undergo an elective radical operation for intestinal cancer were enrolled and randomly allocated to a general anesthesia group of 12 cases and an acupuncture-drug anesthesia group of 15 cases.In the both groups,Fentanyl 3μg/kg,Propofol 2 mg/kg and Vecuronium bromide 0.1 mg/kg were used to induce general anesthesia.Intravenous injection of Propofol and intermittent intravenous injections of Fentanyl and Vecuronium bromide were administered to maintain anesthesia during the operation.Intravenous patient-controlled analgesia（PCA） was used after the operation.Meridian points selected bilaterally were Hegu（LI4）,Neiguan（PC6）,Zusanli（ST36） and Yanglingquan（GB34）.They were stimulated continuously with electroacupuncture.The analgesic dosage was examined and the Visual Analogue Scale（VAS） score and the sedation score were counted at 4,6,8,24 and 44 hrs postoperatively in the two groups.Peripheral venous blood 3 mL was taken before anesthesia induction（baseline） and at 2 hrs,1 day and 3 days postoperatively in the two groups.Plasma β-endorphin（β-EP）,hydrocortisone and tumor necrosis factor-α（TNF-α） levels were measured by radioimmunoassay.Results At 4 hrs postoperatively,the analgesic dosage was significantly lower in the acupuncture-drug anesthesia group of patients than in the general anesthesia group（P0.05）.At 4,6,8,24 and 44 hrs postoperatively,there were no statistically significant difference in the VAS and sedation scores between the two groups（P0.05）.At 3 days postoperatively,plasma TNF-α levels were significantly lower in the acupuncture-drug anesthesia group of patients than in the general anesthesia group（P0.05）.At different time points,there were no statistically significant difference in plasma β-endorphin and hydrocortisone levels between the two groups（

关 键 词：针药复合麻醉 肿瘤 针刺镇痛 

分 类 号：R246.2[医药卫生—针灸推拿学]