小剂量氯胺酮复合腰俞穴麻醉在经吻合器痔上黏膜环状切除术中的应用

Application of low-dose Ketamine combined with Yaoshu acupoints anesthesia in PPH

目的:探讨小剂量氯胺酮复合腰俞穴麻醉应用于经吻合器痔上黏膜环状切除术(PPH)中的可行性和优越性。方法:120例拟行PPH术的患者按照随机数字法分为实验组和对照组,每组60例,实验组患者行腰俞穴麻醉+小剂量氯胺酮(0.2 mg/kg),对照组仅给予腰俞穴麻醉,观察两组患者行PPH术吻合前后平均动脉压(MAP)、心率(HR)、血氧饱和度(SpO2)的变化,并观察术中疼痛、牵拉反射及不良反应发生情况。结果:实验组PPH术吻合后HR、MAP较吻合前升高[(89.02±8.20)次/min对(83.34±10.01)次/min,t=2.305,P<0.05;(97.56±8.09)mm Hg对(92.27±10.40)mm Hg,t=2.520,P<0.05],对照组吻合后MAP较吻合前下降[(77.60±9.03)mm Hg对(92.02±8.91)mm Hg,t=2.706,P<0.05]。实验组吻合后HR、MAP较对照组高[(89.02±8.20)次/min对(77.73±10.80)次/min,t=2.290,P<0.05;(97.56±8.09)mm Hg对(77.60±9.03)mm Hg,t=3.478,P<0.01]。两组吻合前后SpO2均无显著变化(P>0.05)。实验组术中疼痛程度显著低于对照组[(7.87±0.62)分对(9.71±0.20)分,t=2.420,P<0.05]。实验组抑制牵拉反射的有效率较对照组高(100.00%对71.67%,χ2=14.230,P<0.01),且不良反应发生率较对照组低(3.33%对46.67%,χ2=10.43,P<0.01)。结论:小剂量氯胺酮复合腰俞穴麻醉应用于PPH术安全、有效,手术牵拉反射轻,优于单用腰俞穴麻醉,可在临床上推荐使用。

Objective：To explore the feasibility and advantages of low-dose Ketamine combined with Yaoshu acupoints anesthesia in PPH.Methods：120 patients performed PPH were randomly divided into experimental group and control group,with 60 patients in each group.The experimental group was performed Yaoshu acupoints anesthesia combined with low-dose Ketamine（0.2 mg/kg）,control group was performed Yaoshu acupoints anesthesia only,the MAP,HR and SpO2 before and after PPH were observed,and the pain,force reflection and adverse reactions of two groups were also observed.Results：The HR and MAP after PPH of experimental group were increased than those before PPH [（89.02±8.20） beats/min vs（83.34±10.01） beats/min,t=2.305,P0.05;（97.56±8.09） mm Hg vs（92.27±10.40） mm Hg,t=2.520,P0.05];the MAP after PPH of control group was decreased than that before PPH [（77.60±9.03） mm Hg vs（92.02±8.91） mm Hg,t=2.706,P0.05].The HR and MAP after PPH of experimental group were higher than those of control group [（89.02±8.20） beats/min vs（77.73±10.80） beats/min,t=2.290,P0.05;（97.56±8.09） mm Hg vs（77.60±9.03） mm Hg,t=3.478,P0.01].No significant difference in SpO2 before and after PPH was observed in two groups（P0.05）.The pain of experimental group was lighter than that of control group [（7.87±0.62） scores vs（9.71±0.20） scores,t=2.420,P0.05],and the effective rate of inhibiting force reflection was higher than that of control group（100.00% vs 71.67%,χ2=14.230,P0.01）,and the adverse reaction rate was lower than that of control group（3.33% vs 46.67%,χ2=10.43,P0.01）.Conclusion：Low-dose Ketamine combined with Yaoshu acupoints anesthesia is safe and effective,the force reflection is slight and better than single Yaoshu acupoints anesthesia in PPH,thus it is worthy of application in clinic.