电针复合药物全麻对围术期腹腔镜胆囊切除术患者血流动力学及内啡肽的影响  

Effects of Acupuncture Combined General Anesthesia on Endorphin and Hemodynamics of Laparoscopic Cholecystectomy Patients in the Perioperative Phase

作　　者：丁依红[1] 顾陈怿[1] 沈利荣[2] 吴凉森[2] 施征[3] 陈跃来 

机构地区：[1]上海中医药大学附属岳阳中西医结合医院麻醉科,上海200437 [2]上海中医药大学针灸推拿系,上海201203 [3]上海市针灸经络研究所,上海200030 [4]上海市中医药大学科研处,上海201203

出　　处：《中国中西医结合杂志》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)

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�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

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 

分 类 号：R246.2[医药卫生—针灸推拿学]