电针刺激内关足三里穴位用于痔上黏膜环切术的临床观察  

Clinical effectiveness of electro-acupuncture Neiguan and Zusanli acupoint in procedure for prolapsed and hemorrhoids operation

作　　者：昝京伟[1] 张捷[1] 刘阳[1] 庄延[1] 雷园[1] 刘国凯[1] 

机构地区：[1]北京中医药大学东直门医院麻醉科,100700

出　　处：《北京医学》2016年第3期237-239,共3页Beijing Medical Journal

基　　金：北京中医药大学自主选题资助项目(2014-JYBZZ-JS-039)

摘　　要：目的 评价电针刺激内关、足三里穴位抑制腰麻下吻合器痔上黏膜环切术（PPH）患者牵拉反射的效果。方法 选择美国麻醉医师协会麻醉风险评分（ASA）Ⅰ~Ⅱ级择期行腰麻下PPH手术患者,随机分为芬太尼组（F组）和电针刺激组（P组）。F组于腰麻前5 min静脉注射芬太尼0.8μg/kg,P组于腰麻前电针刺激内关穴与足三里穴直至术毕。观察2组患者在术前（T0）、麻醉后（T1）、吻合器击发即刻（T2）、击发后5 min（T3）、手术结束（T4）的心率、收缩压（SBP）和舒张压（DBP）,以及T2、T3、T4时间点腹部牵拉痛的视觉模拟评分（VAS）,并观察恶心呕吐等不良反应。结果 共100例患者纳入本研究,每组50例。T1~T4时间点2组患者的心率、SBP、DSP的组间比较,差异均无统计学意义。同组患者的SBP与DSP在T2、T3、T4时间点与T1相比,差异无统计学意义（P〉0.05）,T2、T3时间点的心率均下降（P〈0.05）。2组患者T2、T3、T4时间点VAS评分比较,差异无统计学意义（P〉0.05）。F组5例患者有轻度恶心症状,P组无一例出现恶心症状,差异有统计学意义（P〈0.05）。结论 电针刺激内关穴与足三里穴减轻腰麻下PPH术中牵拉痔上黏膜导致的牵拉痛效果与芬太尼作用效果相近,且可减少恶心的发生率。Objective To evaluate the effectiveness of electro-acupuncture Neiguan and Zusanli acupoint to miti- gate the stress reaction of procedure for prolapsed and hemorrhoids （ PPH ） operation under spinal anaesthesia. Methods Patients with ASA I - II for PPH operation under spinal anaesthesia were randomly divided into the Fentanyl group （group F） and the electro-acupuncture group（group P）. Patients in group F received intravenous injection of 0.8 μg/kg fentanyl 5 min before spinal anaesthesia. Patients in group P were electro-acupunctured at Neiguan and Zusanli from the beginning of the surgery to the end of the procedure.The heart rate, systolic blood pressure （SBP） and diastolic blood pressure（DBP）were observed before surgery （TO）, after anesthesia （T1）, firing the anastoma immediately （T2）, 5 min after firing （T3）, the end of surgery （T4）. Visual analog scale （VAS） of abdominal pain caused by stress at T2, T3, T4 time points and adverse reactions of nausea and vomiting were recorded. Results The difference of heart rate, SBP, DBP between the two groups at T1- T4 was no statistically significant. The SBP and DSP at T2, T3, T4 was no statistically sig- nificantly different from those at T1 in each group（P 〉 0.05）. The heart rate at T2, T3 were lower than T1 in both groups （P 〈 0.05）. The VAS scores at T2, T3, T4 were not significantly different between the two groups. Five patients in group F had slightly symptoms of nausea, while there were no case of nausea in group P, the difference was statistically signifi- cant（P 〈 0.05）. Conclusion Electro-acupuncturing Neiguan and Zusanli to mitigate the abdominal pain caused by stress at surgery for PPH under spinal anaesthesia is as effective as the use of fentanyl, and can reduce the incidence of nausea.

关 键 词：电针 吻合器痔上黏膜环切术 牵拉反射 

分 类 号：R657.18[医药卫生—外科学]