针刺复合麻醉对肺切除术患者单肺通气期间肺氧合及肺内分流的影响  

Lung-protecting effect of acupuncture anesthesia on thoracic surgery patients during one-lung ventilation

作　　者：徐建俊[1] 陈彤宇[1] 周嘉[1,2] 王珂[1,2] 吕广春[1] 

机构地区：[1]上海中医药大学附属曙光医院胸外科,上海201203 [2]上海中医药大学特色诊疗技术研究所,上海201203

出　　处：《上海中医药杂志》2016年第4期11-14,共4页Shanghai Journal of Traditional Chinese Medicine

基　　金：科技部国家重点基础研究发展计划("973"计划)项目(2013CB531901);上海申康医院发展中心市级医院新兴前沿技术联合攻关项目(SHDC12013120);上海市科委科技支撑计划项目(12401903201);上海市卫计委中医药事业发展三年行动计划(重大研究)资助项目(ZYSNXD-CC-ZDYJ014);国家中医药管理局"十二五"重点学科建设项目(2012-2017)

摘　　要：目的观察针刺复合麻醉对胸腔镜下肺切除手术患者单肺通气期间肺氧合及肺内分流的影响。方法将60例择期行胸腔镜下肺切除手术的患者随机分为针刺复合麻醉组及全身麻醉组,每组30例。全身麻醉组予常规全身麻醉方法;针刺复合麻醉组在常规全身麻醉的基础上,取双侧后溪、支沟、内关、合谷穴,手术前30 min予2~100 Hz的疏密波进行电针刺激,直至手术结束。分别于麻醉后双肺通气30 min（T0）、单肺通气15 min（T_1）、单肺通气30 min（T_2）、单肺通气60 min（T_3）,抽取混合静脉血（本研究采用右心房血作为混合静脉血样）进行血气分析,计算肺内分流量（Qs/Qt）。结果 1双肺通气（T0）与单肺通气（T_1、T_2、T_3）期间比较,两组患者的MAP、HR、CVP、Paw以及p H、Pa CO_2、Pv O_2、Sa O_2、Sv O_2、Hb无显著性变化（P〉0.05）;组间相同时点比较,上述各指标差异均无统计学意义（P〉0.05）。2与双肺通气时（T0）比较,两组单肺通气各时点（T_1、T_2、T_3）Pa O_2明显下降（P〈0.05）。其中全身麻醉组在单肺通气30 min时（T_2）达到最低值,之后开始回升,而针刺复合麻醉组直到60 min时（T_3）才达到最低值;针刺复合麻醉组Pa O_2值在T_1、T_2、T_3时点明显高于全身麻醉组（P〈0.05）。两组单肺通气各时点（T_1、T_2、T_3）Sa O_2值差异无统计学意义（P〉0.05）。3两组患者术前Qs/Qt差异无统计学意义（P〉0.05）,且均在正常范围内;单肺通气后,Qs/Qt值明显增加（P〈0.05）。针刺复合麻醉组Qs/Qt峰值发生在单肺通气15 min（T_1）,而全身麻醉组肺内分流峰值发生在单肺通气30 min（T_2）;针刺复合麻醉组在T_1、T_2、T_3时点的Qs/Qt值均明显低于全身麻醉组,差异有统计学意义（P〈0.05）。结论针刺复合麻醉可以降低肺切除术患者单肺通气期间的肺内分流,改善肺的氧合作用,对围手术期的肺保护具有积极�Objective To investigate effects of Electroacupuncture（ EA） combined with general anesthesia（ GA） strategy on oxygenation and pulmonary shunt during one-lung ventilation in patients with thoracic surgery. Methods Sixty patients with thoracic surgery were randomly divided into EA group and GA group,with 30 cases in each group. Patients of the GA group received simple general anesthesia. EA（ 2 /100 Hz） was applied to bilateral Houxi（ SI03）,Zhigou（ SJ6）,Neiguan（ PC6）,and Hegu（ LI4） beginning about 30 min before the surgery in the EA group. Blood samples were obtained at four time points： two lung ventilation 0 min（ T0）,one-lung ventilation 15 min（ T_1）,one-lung ventilation 30 min（ T_2）,one-lung ventilation 60 min（ T_3） via internal jugular vein and radial artery to perform blood gas analysis. Intrapulmonary shunt（ Qs/ Qt） was calculated and detected. Results 1Compared to the two lung ventilation（ T0）,there was no significant difference in the MAP,HR,CVP,Paw,p H,Pa CO_2,Pv O_2,Sv O_2,and Hb in both group during the one-lung ventilation（ T_1-T_3）（ P 0. 05）; There was also no significant difference between the two groups at the same time points（ P 0. 05）. 2Compared to the T0,the partial pressure of oxygen（ Pa O_2） was significantly reduced at T_1,T_2,and T_3 in each group（ P 0. 05）; In GA group,the Pa O_2 was reached the lowest value at T_2 and then began to increase; However,in EA group,the Pa O_2 was reached the lowest value at T_3; Meanwhile,compared to the GA group,the Pa O_2 was significantly higher at the time points T_1,T_2,and T_3 in EA group（ P 0. 05）; During the one-lung ventilation,there was no significant difference in Sa O_2 between the two groups at T_1,T_2,and T_3（ P 0. 05）. 3There was no significant difference in Qs/ Qtbetween the two groups before surgery（ P 0. 05）,and both were in the normal range. After one lung ventilation,Qs/Qtvalue increased significantly（ P 0. 05）. The peak value of Qs/ Qtin EA group was at

关 键 词：针刺复合麻醉 单肺通气 血氧分压 肺内分流 肺保护 

分 类 号：R655.3[医药卫生—外科学]