针刺不同穴位辅助全麻在妇科腹腔镜术中的作用比较

Comparison of effects of acupuncture-assisted anesthesia with different acupoint combination in gynecologic laparoscopy operation

目的:探讨针刺辅助全麻在妇科腹腔镜术中的最佳穴位配伍。方法:将90例ASA(美国麻醉医师协会)评级为Ⅰ—Ⅱ级的择期妇科腹腔镜术患者随机分为3组,每组30例。Ⅰ组为单纯静吸复合全麻;Ⅱ组和Ⅲ组为韩式穴位神经刺激(HANS)仪辅助全麻,HANS仪刺激30min后,再全麻,电针刺激直到术毕,Ⅱ组取双侧足三里和三阴交,Ⅲ组取双侧合谷和太冲。术中调节七氟醚浓度(ETsev),维持麻醉趋势分级(NTS)在D1—D2,记录呼气末ETsev的变化;观察术中心率和血压变化;观察苏醒期相关反应,记录术毕至拔除气管导管的时间和呼之睁眼的时间;记录苏醒期患者躁动、寒战、疼痛和恶心呕吐评分;记录拔管后出现呼吸困难的例数以及术后恢复情况(如意识评分等);记录患者术后第1次肛门排气的时间、患者的舒适度和满意度、有无术中知晓等,综合评价针麻效果。结果:3组患者术中ETsev变化,与Ⅰ组比较,Ⅱ组ETsev减少35%(P<0.05),Ⅲ组ETsev减少25%(P<0.05),且Ⅱ组较Ⅲ组减少更加显著(P<0.05);Ⅱ组与Ⅲ组血压和心率较稳定,Ⅱ组最稳定;Ⅰ组患者苏醒期呼之睁眼时间和拔管时间最长(均P<0.05),Ⅲ组次之,Ⅱ组最短。苏醒期躁动评分、疼痛评分、呕吐评分、需托下颌的发生率Ⅰ组最高(均P<0.05),Ⅲ组次之,Ⅱ组最少;意识评分Ⅰ组最低(P<0.05);3组患者均无术中知晓,Ⅱ组与Ⅲ组较Ⅰ组满意度高(均P<0.05);患者术后第1次肛门排气的时间,Ⅱ组与Ⅲ组较Ⅰ组明显缩短(均P<0.05)。结论:HANS仪辅助全麻有一定的麻醉镇痛辅助作用,且以取穴足三里和三阴交组效果最佳,可明显减少全麻药用量,围术期血压、心率更趋平稳,苏醒质量更高。

Objective To explore the best acupoint combination of acupuncture-assisted anesthesia in gyneco-logic laparoscopy operation.Methods Ninety patients,with American Society of Anesthesiologists（ASA）physi-cal statusⅠ—Ⅱ,and scheduled for elective gynecologic laparoscopy operation,were randomly divided into 3groups,30cases in each group.Group I received only general anesthesia,group Ⅱ and group Ⅲ received generalanesthesia after Han’s acupoint nerve stimulator（HANS） administered for 30min,bilateral Zusanli（ST 36） and Sanyinjiao（SP 6）were selected for group Ⅱ,and bilateral Hegu（LI 4）and Taichong（LR 3）were selected for group Ⅲ.During operation,the concentration of Seveflurine was adjusted to maintain NTS at D1-D2.The change of ETsev value was recorded,the heart rate（HR）and blood pressure（BP）were observed,and the time from the end of operation to extubation,awake time were recorded adverse events such as restlessness,shivering,postoperative pain,nausea and vomiting,cases of respiratory depression,the analepsia quality,the time of first anus exhaust,the awaking of patient in operation and satisfactory of patients after surgery were recorded so as to evaluatethe effect of acupuncture anesthesia.Results Compared with groupⅠ,the ETsev in group Ⅱ was decreased 35%（P0.05）,group Ⅲ was decreased 25%（P0.05）,with a significant difference between group Ⅱ and group Ⅲ （P0.05）.BP and HR had more stability in group Ⅱ and group Ⅲ,the best in group Ⅱ.As for thetime from the end of operation to extubation and the time from the end of operation to open the eye on command,groupⅠwas the longest（all P0.05）,group Ⅲ was longer,groupⅡwas the shortest.The score of restlessness,post-operative pain,vomiting and in analepsia were the highest in groupⅠ（all P0.05）,higher in group Ⅲ and the lowest in group Ⅱ.Consciousness score was lowest in groupⅠ（P0.05）.As for the satisfactory of patient after operation,it was higher in group Ⅱ and group Ⅲ （both P0.05）than groupⅠ.The time of first anus exhaust in group Ⅱ and group Ⅲ were significantly shorter than that in groupⅠ（both P0.05）.Conclusion Han＇s acupoint nerve stimulator has a certain adjuvant action for general anesthesia and analgesia and acupuncture point combination with both Zusanli（ST 36）and Sany-injiao（SP 6）have the best effect in gynecologic laparoscopy operation.It can decrease the dosage of anaesthetic,has a sta-ble effect on HR and BP during the surgery and has a better quality of analepsia.