针药复合麻醉在颅脑功能区手术中的应用  

Electroacupuncture Intervention Combined with General Anesthesia for Craniocerebral Operations

作　　者：张珏[1] 费智敏[1] 书国伟[1] 蔡佩浩[1] 王静予[1] 许乐宜[1] 孔令军[1] 邱锋[1] 龚立[1] 陈丽[1] 顾国山[1] 

机构地区：[1]上海中医药大学附属曙光医院神经外科,上海201203

出　　处：《针刺研究》2014年第1期12-15,共4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);上海市中医药事业发展三年行动计划(重大研究)项目"研究型中医院建设"(ZYSNXD-CC-YJXYY-JS 19);上海高校青年教师培养资助计划(Zzszy 13025)

摘　　要：目的:验证针药复合麻醉在颅脑功能区手术中应用的安全性、有效性。方法:20例颅脑功能区肿瘤切除手术患者随机分为2组,对照组10例患者采取气管插管静脉复合全麻手术,试验组10例患者在无气管插管的针药复合麻醉下行病灶切除术,电针风池、率谷,针刺颧髎、足临泣、太冲,诱导30min。观察患者疼痛耐受情况、麻醉药物用量、神经功能评分及安全性。结果:所有患者均成功实施肿瘤切除手术。试验组患者均成功在无气管插管的针药复合麻醉下行病灶切除术,患者能耐受术中疼痛,能配合行神经功能监测,术后均无神经功能障碍加重。试验组较对照组麻醉药物用量减少(P<0.05),手术前后神经功能评分差值与对照组相比差异无统计学意义(P>0.05)。结论:针药复合麻醉切除脑部功能区肿瘤安全有效。术中患者能清醒配合,可最大限度保护神经功能。Objective To determine the safety and effectiveness of electroacupuncture （EA） intervention combined with general anesthesia （GA） for craniocerebral tumor-removal surgery involving cerebral eloquent areas. Methods A total of 20 patients with cerebral tumors （durosarcoma, neurogliocytoma, metastatic tumor） involving the cerebral eloquent areas were re- cruited in the present summary. They were equally divided into general anesthesia （GA） group and EA＋ GA group. Patients of the EA＋ GA group were treated with EA stimulation （2 Hz/100 Hz） of the bilateral Fengchi （GB 20）, Shuaigu （GB 8） and acupuncture stimulation of Quanliao （SI 18）, Zulinqi （GB 41 ） and Taichong （LR 3）, and not given intubation during surgery. Patients of the GA group were treated with intravenous administration of Propofol, Fentanyl, Midazolam, Isopropanol, etc. In addition, all the pa- tients were given with controlled hypotension by intravenous injection of Propofol and Fentanyl. Dosages of Propofol and Sulfenta- nyl used were recorded. Karnefsky performance status scale was used to assess the patient＇s general well-being and activities of daily life. Results The craniocerebral tumor-removal surgery was successful in all the 20 patients. Compared with the GA group, the dosages of Sulfentanyl and Propofol of the EA ＋ GA group were significantly lower （P〈0.05）. No significant difference was found between the GA and EA＋ GA groups in Karnofsky performance scores （P〉0.05）. Patients of the EA-t-GA group expe- rienced successful tumour-remeval surgery without trachea cannula, were awake and could make a good cooperation with the operator during surgery. They had no aggravation of neurofunctional disturbance following the operation. Conclusion EA combined with general anesthesia is safe and effective for patients with craniocerebral tumor-removal operations involving ce- rebral eloquent areas.

关 键 词：针刺辅助全麻 颅脑肿瘤切除手术 颅脑功能区 无气管插管 

分 类 号：R246.2[医药卫生—针灸推拿学]