针刺经穴与非经穴对胆囊切除术患者围术期影响的对照观察

Influence of acupuncture at acupoints and non-acupoints on the perioperative analgesic effect in patients with laparoscopic cholecystectomy

目的:探讨全麻、针刺经穴复合全麻、针刺非经非穴复合全麻对腹腔镜胆囊切除术患者围术期的影响。方法:选取择期行腹腔镜胆囊切除术患者90例,随机分为全麻+经穴组、全麻+非经非穴组、全麻组,每组30例。3组患者均采用芬太尼、异丙酚、维库溴铵进行全麻诱导,术中以静脉输注异丙酚,间断静脉注射芬太尼、维库溴铵维持麻醉。全麻+经穴组选取双侧合谷、内关、足三里、阳陵泉,全麻+非经非穴组选取经穴组每个经穴所在经脉与外侧相邻经脉连线的中点、与经穴相平处持续电针刺激。比较3组患者术中麻醉药用量、术后睁眼时间、拔除气管导管时间及定向时间,观察记录术后4,6,8,24,44h镇痛泵用量和疼痛视觉模拟评分(VAS)。结果:全麻+经穴组芬太尼用量明显少于全麻+非经非穴组和全麻组(均P<0.05),全麻+经穴组维库溴铵与异丙酚用量明显少于全麻组(P<0.05,P<0.01)。全麻+经穴组睁眼时间、拔除气管导管时间及定向时间明显短于全麻+非经非穴组及全麻组(均P<0.01);全麻+经穴组患者镇痛泵用量在术后4,6h明显少于全麻+非经非穴组(均P<0.05),术后4,6,8h明显少于全麻组(均P<0.05);术后第44h全麻+经穴组VAS评分低于全麻+非经非穴组与全麻组(均P<0.05)。结论:针刺经穴能增强复合全麻后麻醉效应,延长镇痛时效,而针刺非经非穴虽起一定效果,但不如针刺经穴。经穴具有特异性,准确取穴是影响镇痛效果的关键因素。

ABSTRACT Objective To explore the effect of general anesthesia, acupuncture at acupoints compound general anesthesia and acupuncture at non-acupoints compound general anesthesia on the perioperative analgesic effect in patients with laparoseopic cholecystectomy. Methods Ninety patients scheduled to undergo laparoscopic cholecystectomy were randomly divided into a general anesthesia group （group A）, an acupuncture at acupoints compound general anesthesia group （group B） and an acupuncture at non-acupoints compound general anesthesia group （group C）, 30 cases in each group. General anesthesias were all induced by Fentanyl, Propofot and Vecuronium Bromide. The bilateral Hegu （L1 4）, Neiguan （PC 6）, Zusanli （ST 36） and Yanglingquan （GB 34） were selected in the group B, and the middle points of the line connecting the meridians where every acupoint mentioned above belonged and their lateral neighbor meridians selected in the group C. The dosage of anesthetics, the time of goggle and the time of evulsion eannulation and direction location in all the patients were compared, and the dosage of analgesia pump within 4, 6, 8, 24 and 44 hours and Visual Analogue Scale （VAS） of pain were recorded after surgery. Results The dosage of Fentanyl in the group B was obviously lower than that in both the group A and the group C （both P〈0.05）, and the dosages of Propofol and Vecuronium Bromide in the group B were obviously lower than those in the group A （P〈0.05,P%0.0t）. The time of goggle, evulsion cannulation and direction location in the group B were significantly shorter than those in the other groups （all P〈0.01）. After surgery, the dosage of analgesia pump in the group B was significantly fewer than that in the group C within 4 and 6 hours （both P〈0. 05）, and it was significantly fewer than that in the group A within 4, 6, 8 hours （all P〈0.05）. The scores of VAS of pain at 44th hour after surgery in the group B were obviously lower than those in the other groups （both P〈0.05）. Conclusion Acupuncture at aeupoints can enhance the anesthetic effect of compound general anesthesia and prolong the analgesia period. Acupuncture at non-points has a certain effect, but their effectiveness is less than that of acupoints. Thus, the acupoint has the specificity and accurate acupoint selection is the key factor affecting analgesia effect.