术中电针镇痛对全麻甲状腺手术患者气管插管应激反应的影响  

Effect of intraoperative electroacupuncture analgesia on stress response to tracheal intubation in patients undergoing thyroid surgery under general anesthesia

作　　者：王保 马树霖 尧新华 杨帆 温凯 罗思静 甘英 鲁义 WANG Bao;MA Shulin;YAO Xinhua;YANG Fan;WEN Kai;LUO Sijing;GAN Ying;LU Yi(Department of Anesthesiology,the Affiliated TCM Hospital of Guang-zhou Medical University,Guangzhou 510130,China;不详)

机构地区：[1]广州医科大学附属中医医院麻醉科,广州510130 [2]广州医科大学研究生院,广州511495

出　　处：《实用医学杂志》2024年第8期1132-1136,共5页The Journal of Practical Medicine

基　　金：广东省自然科学基金面上项目(编号:2023A1515011117);广州市科技计划项目(编号:2023A03J0310,202201010712);广州市荔湾区科技计划项目(编号:20230712)。

摘　　要：目的 探讨术中电针镇痛对全麻甲状腺手术患者气管插管应激反应的影响。方法 选择2022年6月至2023年6月广州医科大学附属中医医院择期行静吸复合全麻甲状腺手术患者共60例,随机分为对照组(Ctr组)和电针组(EA组)。两组均采用气管插管全麻麻醉完成手术。EA组于常规全麻麻醉镇痛的基础上,在气管插管前、气管拔管前选择双侧内关、曲池、列缺穴进行电针镇痛,每次治疗15 min。观察两组患者不同时间点[插管前(T_(0)),插管后1、5、10、15、30 min(T_(1)、T_(5)、T_(10)、T_(15)、T_(30)),拔管前1 min(EXBT_(1)),拔管后1、5 min(EXAT_(1)、EXAT_(5))]的血流动力学指标(SBP、MAP、DBP、HR);记录两组患者术中使用阿片类镇痛药药物总量以及不良反应等。结果 EA组和Ctr组的SBP分别在T_(1)-T_(15)、EXAT_(1)和EXAT_(5)出现统计学差异;MAP在T_(5)-T_(15)、EXAT_(1)时出现统计学差异;DBP在T_(15)和EXAT_(1)时出现统计学差异;HR在T_(1)、T_(5)、EXAT_(1)和EXAT_(5)时出现组间统计学差异(P <0.05)。T_(1)-T_(15)期间,EA组SBP、MAP、DBP、HR呈下降趋势,且均较Ctr组低,EA组SBP、MAP、DBP波动幅度比Ctr组小,EA组HR在插管后波动幅度较Ctr组大,拔管后波动幅度更小;两组患者术中使用阿片类镇痛药药物总量差异无统计学意义(P> 0.05);不良反应恶心、呕吐的发生率差异有统计学意义(P <0.05),皮疹和高血压的发生率差异无统计学意义(P> 0.05)。结论 术中电针镇痛能有效减轻甲状腺手术患者气管插管与气管拔管引起的血管应激反应,减少阿片类药不良反应的发生。Objective To investigate the effects of intraoperative electroacupuncture analgesia on the stress response to tracheal intubation in patients undergoing general anesthesia for thyroid surgery.Methods A total of 60 patients scheduled for elective combined general anesthesia and thyroid surgery at the Affiliated TCM Hospital of Guangzhou Medical University from June 2022 to June 2023 were randomly assigned to either the control group(Ctr group) or the electroacupuncture group(EA group).Both groups underwent tracheal intubation under general anesthesia.In the EA group,electroacupuncture was applied at bilateral Neiguan(PC6),Quchi(LI11),and Lieque(LU7) acupoints for 15 minutes before tracheal intubation and before extubation,in addition to routine general anesthesia and analgesia.Hemodynamic parameters including systolic blood pressure(SBP),mean arterial pressure(MAP),diastolic blood pressure(DBP),and heart rate(HR) were observed at different time points in both groups(before intubation:T_(0);1,5,10,15,and 30 minutes after intubation:T_(1),T_5,T_(10),T_(15),T_(30);1 minute before extubation:EXBT_(1);1 and 5 minutes after extubation:EXAT_(1),EXAT_5).The total amount of opioid analgesics used intraoperatively and any adverse reactions were recorded.Results Significant statistical differences were observed between the EA group and Ctr group in SBP at T_(1)-T_(15),EXAT_(1),and EXAT_5;MAP at T_5-T_(15) and EXAT_(1);DBP at T_(15) and EXAT_(1);HR at T_(1),T_5,EXAT_(1),and EXAT_5(P < 0.05).During T_(1)-T_(15),the SBP,MAP,DBP,and HR in the EA group showed a decreasing trend and were lower compared to the Ctr group.The SBP,MAP,and DBP fluctuations were smaller in the EA group compared to the Ctr group,while the HR fluctuations were larger in the EA group after intubation but smaller after extubation.There was no significant difference in the total amount of opioid analgesics used intraoperatively between the two groups(P > 0.05).The incidence of adverse reactions such as nausea and vomiting differed significantly(P < 0.05),whi

关 键 词：电针镇痛 甲状腺手术 气管插管 应激反应 血流动力学 

分 类 号：R619[医药卫生—外科学]