针药复合麻醉下心脏瓣膜置换手术80例报道  

Electroacupuncture Intervention Combined with General Anesthesia for 80 Cases of Heart Valve Replacement Surgery Under Cardiopulmonary Bypass

作　　者：池浩[1] 周文雄[1] 吴瑶瑶[1] 陈彤宇[1] 葛文[1] 袁岚[2] 沈卫东[3] 周嘉[1] 

机构地区：[1]上海中医药大学附属曙光医院心胸外科,上海201203 [2]上海中医药大学附属曙光医院麻醉科,上海201203 [3]上海中医药大学附属曙光医院针麻研究室,上海201203

出　　处：《针刺研究》2014年第1期1-6,共6页Acupuncture Research

基　　金：上海市中医药事业发展三年行动计划(重大研究)项目"针药复合麻醉优选方案及临床疗效评价研究"(ZYSNXD-CC-ZDYJ 014);上海市科学技术委员会科研项目"基于心脏瓣膜手术的针药复合麻醉技术规范化"(No.12401903200)

摘　　要：目的:通过比较针药复合麻醉与常规全身麻醉下心脏瓣膜手术的效果,探索针药复合麻醉在心脏瓣膜手术中的应用方法。方法:将160例心脏瓣膜置换病人随机分为针麻组80例和全麻组80例。针麻组病人采用双侧中府、尺泽和郄门电针持续刺激,摒弃气管插管,病人在自主呼吸状态下,仅使用少量的麻醉药物进行心脏瓣膜手术;全麻组则按常规麻醉手术。比较两组间的手术成功率、麻醉药物使用量、手术时间、主动脉阻断时间、心脏自动复跳例数、术后出血量、引流量、肺部感染、声带损伤、初次下床活动时间、术后初次进食时间、监护室滞留时间、抗生素使用天数、术后住院天数、医疗总费用等项目的差别。结果:心脏瓣膜手术患者采用针药复合麻醉与常规全身麻醉相比,有同样满意的手术成功率,而在麻醉药的使用量、术后输血例数、初次下床活动时间、监护室滞留时间、术后住院天数、医疗总费用、肺部感染例数、术后初次进食时间、抗生素使用天数方面两组差异具有统计学意义(P<0.05,P<0.01),针麻组优于全麻组。结论:针药复合麻醉下的心脏瓣膜置换手术安全,效果满意。由于术中无气管插管,麻醉药物用量少,术后可早期进食、早期活动,故术后并发症明显减少,与之相关的医疗费用明显降低。Objective To determine whether electroacupuncture （EA） intervention combined with general anesthesia （GA） strategy can reduce early post-operative morbidity and medical costs in patients undergoing heart valve replacement opera- tion under cardiopulmonary bypass. Methods A total of 160 heart valve replacement surgery patients undergoing cardiopulmo- nary bypass were randomly divided into GA and EA-I- GA groups （n = 80 in each group）. Patients of the GA group were given with intravenous injection of Fentanyl, Midazolam, Vecuronium Bromide, etc. and routine tracheal intubation. EA （3- 4 Hz, 2.0- 2.2 mA） was applied to bilateral Zhongfu （LU 1）, Chize （LU 5） and Ximen （PC 4） beginning about 20 min before the surgery in the EA-t-GA group. Endotracheal intubation was not employed but only prepared as a standby for patients of the EA＋ GA group. The dosage of narcotic drugs, duration of surgery, duration of aortic blockage, rate of cardiac re-beating, volumes of post-opera- tive blood transfusion, discharge volume, cases of post-operative pulmonary infection, vocal cord injury, and the time of first bed- off, first eating and duration in intensive care unit （ICU） residence, etc. were recorded. Results The successful rates of heart valve replacement surgery were similar in both GA and EA-I-GA groups. Compared with the GA group, the dosages of Fentanyl, Midazolam and Vecuronium of the EA-t-GA group were significantly lower （P〈O. 05, P〈O. 01）, the numbers of patients needing blood-transfusion, antibiotics treatment, and suffering from pulmonary infection were fewer, the time of first bed-off and duration of hospitalization and ICU residence were considerably shorter （P〈0. 05, P〈0. 01） and the total medical cost was obviously lower （P〈0.05） in the EA-t-GA group. Conclusion EA combined with general anesthesia strategy for heart valve replacement sur- gery without endotracheal intubation is safe and can reduce post-operative morbidity and medical costs in patients undergo

关 键 词：心脏瓣膜置换手术 针刺复合麻醉 全麻 无气管插管 术后发病率 医疗费用 

分 类 号：R246.2[医药卫生—针灸推拿学]