针刺联合硬膜外麻醉在胸腔镜肺切除手术中应用的随机对照研究  

A Randomized Controlled Trial on Acupuncture Combined with Epidural Anesthesia in Patients Undergoing Video-assissted Thoraeoscopic Pulmonectomy

作　　者：吕广春[1] 陈彤宇[1] 周嘉[1] 王珂[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

出　　处：《上海中医药大学学报》2016年第4期35-38,42,共5页Academic Journal of Shanghai University of Traditional Chinese Medicine

基　　金：国家重点基础研究发展计划("973"计划)资助项目(2013CB531900);上海市市级医院新兴前沿技术联合攻关项目(SHDC12013120);上海市中医药事业发展三年行动计划(重大研究)资助项目(ZY3-CCCX-2-1003);国家中医药管理局中医药重点学科建设项目(中西医结合外科学)

摘　　要：目的:观察针刺联合硬膜外麻醉在胸腔镜肺切除手术围手术期应用的临床效果。方法:40例择期行胸腔镜肺切除手术患者随机分为硬膜外麻醉组(简称"硬膜外组")和硬膜外麻醉+针刺镇痛组(简称"联合麻醉组"),每组20例。所有患者均行胸腔镜肺切除手术治疗,术中采用常规硬膜外麻醉,联合麻醉组在硬膜外麻醉基础上加用电针针刺镇痛,硬膜外组加用模拟电针。观察两组术后疼痛、恶心程度及追加杜冷丁情况,比较两组患者术中麻醉药物用量及术后住院天数、住院总费用。结果:术后24 h、48 h、72 h,联合麻醉组患者的疼痛、恶心情况均优于硬膜外组,两组比较差异均有统计学意义(P<0.05)。术后硬膜外组追加杜冷丁人数为7例,联合麻醉组为1例,联合麻醉组追加杜冷丁人数明显少于硬膜外组(P<0.05)。术中两组患者利多卡因、甲磺酸罗哌卡因用量比较,差异无统计学意义(P>0.05),硬膜外组右美托咪定用量明显多于联合麻醉组(P<0.05)。两组患者的术后住院天数及住院总费用比较,差异均无统计学意义(P>0.05)。结论:针刺镇痛能够有效减轻硬膜外麻醉下胸腔镜肺切除手术患者的术后疼痛和恶心程度,改善术后不良应激。Objective： To evaluate the clinical effect of acupuncture combined with epidural anesthesia in patients undergoing video-assissted thoraeoscopic pulmonectomy at perioperative period. Methods： Forty patients who underwent the video-assisted thoraeoscopic pulmonectomy were randomly divided into the epidural anesthesia group（ referred to as＂epidural group＂） and acupuncture combined with epidural anesthesia group（ referred to as ＂combined anesthesia group ＂） with 20 cases in each group. All the patients were treated with video-assissted thoraeoscopic pulmonectomy and the epidural anesthesia was applied during the surgery. In addition,the patients in the combined anesthesia group were treated with electroacupuncture and the patients in the epidural group were treated with analog electroacupuncture. The postoperative pain,nausea and the use of pethidine were observed,and the anesthesia drug dosage during the surgery,the hospitalization days after surgery and the total hospitalization cost of the two groups were compared. Results： At 24 h,48 h and 72 h after surgery,the syndrome of pain and nausea of patients in the combined anesthesia group was better than that in the epidural group,with statistical differences between the two groups（ P 〈 0. 05）. The numbers of patients who use the pethidine after surgery in the epidural group and the combined anesthesia group were 7 cases and 1 cases respectively,and the number of patients who use the pethidine after surgery in the combined anesthesia group was less than that in the epidural group（ P 〈 0. 05）. There were no statistical differences on the dosage of ropivacaine and lidocaine applied during surgery between the two groups（ P 〉 0. 05）,and the dosage of dexmedetomidine used by patients in the epidural group was more than that in the combined anesthesia group（ P 〈 0. 05）. There were no statistical differences on the postoperative hospitalization days and the total hospitalization cost between the two groups（ P 〉 0. 05）. Con

关 键 词：针刺 硬膜外麻醉 胸腔镜 肺部手术 随机对照研究 

分 类 号：R614[医药卫生—麻醉学]