针药复合麻醉在妇科宫腔镜手术中镇痛及镇静作用的临床研究

Clinical study of analgesic and sedative effects of combined acupuncture-drug anesthesia in gynecological hysteroscopy

目的观察针药复合麻醉在妇科宫腔镜术中及术后的镇痛及镇静作用。方法将76例拟行宫腔镜手术的患者,按随机数字表法分为对照组与试验组。对照组予假针刺麻醉联合静脉麻醉,试验组予针药复合麻醉。观察术中及术后VAS评分,术中改良OAA/S评分、Ramsay镇静评分、BCS评分,以及术中、术后麻醉安全指标(心率、平均动脉压、氧饱和度),内啡肽系统指标血清β-内啡肽(β-EP)、强啡肽(Dyn)水平,比较不良反应的发生情况。结果①术中VAS评分虽然试验组与对照组有统计学差异(P<0.05),但在患者完全可以忍受的程度之内,仅(2.80±1.76)分。术后两组VAS评分差异无统计学意义(P>0.05)。②试验组Ramsay镇静评分显著低于对照组(P<0.05),改良OAA/S评分显著高于对照组(P<0.05),BCS评分显著低于对照组(P<0.05)。③除术后12 h的SpO2水平外,两组各时间点的HR、MAP、SpO2水平比较,差异均有统计学意义(P<0.05);但此类差异均无临床意义。④对照组、试验组不良反应发生率分别为53.13%、34.29%,组间不良反应发生率差异有统计学意义(P<0.05),试验组明显低于对照组。结论针药复合麻醉下行宫腔镜手术的镇痛、镇静效果患者可耐受,术后不良反应发生更少,可更好地改善患者的手术应激状态。

Objective To observe the analgesic and sedative effects of combined acupuncture-drug anesthesia during and after gynecological hysteroscopy.Methods Seventy-six cases undergoing hysteroscopic surgery were divided into control group and experimental group according to random number table.The control group was treated with sham acupuncture anesthesia combined with intravenous anesthesia,and the experiment group was treated with combined acupuncture-drug anesthesia.The VAS score during and after operation,modified OAA/S score during operation,Ramsay sedation score,BCS score,anesthesia safety indexes(heart rate,mean arterial pressure,oxygen saturation)during and after operation,serum levels ofβ-endorphin(β-EP)and dynorphin(Dyn)were observed in both groups,and the incidence of adverse reactions were compared.Results①There was statistically significant difference in intraoperative VAS score between the experimental group and the control group(P<0.05),but the patients could tolerate,and the score was only(2.80±1.76)point.After operation,there was no statistically significant difference in VAS score between the experimental group and the control group(P>0.05).②The Ramsay sedation score in the experimental group was significantly lower than that in the control group(P<0.05),the modified OAA/S score in the experimental group was significantly higher than that in the control group(P<0.05),and the BCS score in the experimental group was significantly lower than that in the control group(P<0.05).③Except the SpO2 level at 12 hours after operation,there were statistically significant differences in HR,MAP and SpO2 levels between the two groups at each time point(P<0.05),but with no clinical significance.(4)The incidence rate of adverse reactions in the control group and the experimental group were 90.6%and37.1%respectively.There was statistically significant difference in the incidence rate of adverse reactions between the two groups(P<0.05).The incidence rate of adverse reactions in the experimental group was significantly lower than that in the control group.Conclusion The analgesic and sedative effects of hysteroscopic surgery under combined acupuncture-drug anesthesia is tolerable for patients.The postoperative adverse reactions are less,and the stress state of patients can be better improved.