电针复合颈丛阻滞对甲状腺手术病人应激反应的影响  

Effect of Electroacupuncture Combined with Cervical Plexus Block on Stress Responses in Patients Undergoing Thyroid Surgery

作　　者：张彩举[1] 杨帆[1] 李熳[2] 

机构地区：[1]河南省南阳市第一人民医院,南阳473000 [2]华中科技大学同济医学院神经生物学系,武汉430030

出　　处：《针刺研究》2013年第1期1-6,共6页Acupuncture Research

基　　金：国家自然科学基金资助项目(No.81173328)

摘　　要：目的:观察针刺复合麻醉在甲状腺手术中运用的效果。方法:选取拟行甲状腺切除术的患者40例,随机分为手针复合麻醉组和电针复合麻醉组,每组20例。手针复合麻醉组先行颈丛神经阻滞,然后针刺双侧合谷及内关穴,接电针仪不通电。电针复合麻醉组在颈丛神经阻滞的基础上针刺双侧合谷及内关穴,接电针仪,刺激参数为连续波、10Hz、强度(6±2)mA,持续20min。分别检测两组患者手术前后不同时间点的血压、心率、呼吸及血浆促肾上腺皮质激素(ACTH)、皮质醇(Cor)、肾上腺素(E)、血糖(Glu)、C-反应蛋白(CRP)水平的变化。结果:术中两组患者血压、心率与术前比较均明显增高(P<0.05),术中电针复合麻醉组血压、心率显著低于手针复合麻醉组(P<0.05)。与术前相比,两组术后ACTH、Cor、E、Glu、CRP水平均显著增高(P<0.05),电针复合麻醉组上述指标水平显著低于手针复合麻醉组(P<0.05)。结论:电针复合颈丛神经阻滞能显著降低甲状腺手术患者围术期的心血管应激反应,抑制手术中及术后异常升高的应激激素和免疫因子水平,是甲状腺手术较为理想的麻醉选择。Objective To observe the effect of electroacupuncture （EA） combined with cervical plexus block （CPB） on the stress response of patients undergoing thyroid surgery. Methods Forty thyroidectomy patients were randomly divided into sham EA plus CPB group （sham group） and EA＋OPB group （20 cases in each group）. For patients of the sham group, deep cer- vical plexus block （25% ropivacaine hydrochloride ＋ 1% lidocaine hydrochloride） was performed first, followed by inserting acupuncture needles into bilateral Hegu （LI 4） and Neiguan （PC 6）separately without needle manipulation and then connecting the output wires of the EA therapeutic instrument to the handles of the acupuncture needles but without electric current output. For pa- tients of the EA＋OPB group, deep cervical plexus block was performed first followed by EA stimulation [10 Hz, （6±2） mA] of the bilateral LI 4 and PC 6 for 20 min. Systolic blood pressure （SBP）, heart rate （HR） and breathing frequency were detected u- sing a multipurpose monitor. Plasma adrenocorticotropic hormone （AOTH） and cortisol （Oor） contents were determined using chemiluminescence method, plasma epinephrine （E） level was detected by enzyme-linked immunosorbent assay, glucose （Glu） assayed by oxidase method, and plasma C-reactive protein （ORP） level detected using immumofluorescence technique. Results （1） During surgery, the patients＇ SBP and HR of both sham and EA groups were increased significantly compared with their basic values （ P〈0.05）, but the levels of the increased SBP and HR of the EA group were obviously lower than those of the sham group （P〈0.05）. （2） The levels of plasma AOTH during surgery and at the immediate time after surgery, Cot level at the immediate time after surgery, plasma E and Glu contents during surgery, at the immediate time and on day 1 after surgery, and plasma ORP at the immediate time, and on day 1 and 3 after surgery in the sham group were upregulated considerably （P

关 键 词：电针 甲状腺手术 颈丛阻滞应激反应 

分 类 号：R246.2[医药卫生—针灸推拿学]