针刺经穴对全身麻醉患者维库溴铵肌松效应及镇痛效应的影响

Effects of acupuncture on neuromuscular block of vecuronium and analgesia under general anesthesia

目的评价针刺经穴对全身麻醉患者维库溴铵肌松效应及镇痛效应的影响。方法选择腹腔镜胆囊切除术患者90例，ASA分级I或Ⅱ级，年龄29～80岁，体重50～80k，采用随机数字表法，将患者随机分为3组（n=30）：针刺经穴复合全身麻醉组（A组）、针刺非经非穴复合全身麻醉组（B组）、全身麻醉组（C组）。A组选取双侧合谷穴、内关穴、足三里穴、阳陵泉穴和曲池穴，B组选用A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，两组均于全麻诱导前15～30min持续电针刺激至术毕。静脉注射芬太尼、异丙酚和维库溴铵行麻醉诱导，TCI异丙酚，间断静脉注射芬太尼和维库溴铵维持麻醉。术后均行PCIA。记录维库溴铵的显效时间、起效时间、维持时间和恢复指数及术中麻醉药用量、术后镇痛泵芬太尼用量及术后不良反应的发生情况。结果与C组比较，A组维持时间延长、维库溴铵、异丙酚、术中芬太尼及术后镇痛泵芬太尼用量减少，恶心发生率降低（P〈0．05），显效时间、起效时间和恢复指数比较差异无统计学意义（P〉0．05）。与B组比较，A组术中芬太尼及术后镇痛泵芬太尼用量减少（P〈O．05）。结论针刺经穴可延长全身麻醉患者维库溴铵的维持时间，增强术中和术后镇痛效应。

Objective To investigate the effects of acupuncture on neuromuscular block of vecuronium and analgesia under general anesthesia.Methods Ninety ASA I or II patients, aged 29-80 yr, weighing 50-80 kg, scheduled for laparoscopic cholecystectomy, were randomly divided into 3 groups （ n = 30 each） ： acupuncture at acupoints combined with geueral anesthesia group （group lk）, acupuncture at uon-acupoints comhiued with gen- eral anesthesia group （group B） and general anesthesia group （group C）. Bilateral Hegu （LI4）, Neiguan （PC6）, Zusanli （ST36）, Yanglingquan （GB34）, and Quchi （LI11 ） acupoints were selected in group A. In group B, the points adopted were the midpoints between the meridians in which the acupoints were selected in group A and the adjacent meridians on the lateral side, at the level of selected meridian points correspondingly. Electric stimulation was started from 15-30 min before anesthesia induction and continued until the end of operation. Anesthesia was in- duced with iv injection of fentanyl, propofol and vecuronium and maintained with intermittent iv boluses of fentanyl and vecuronium. All the patients received patient-controlled intravenous analgesia after operation. The effect time, onset time, clinical duration and recovery index of vecuronium, consumption of anesthetics during operation, and consumption of fentanyl for postoperative analgesia and postoperative adverse reactions were recorded. Results Compared with group C, the clinical duration was significantly prolonged, the consumption of anesthetics during operation and consumption of fentanyl for postoperative analgesia were significantly reduced, and the incidence of nausea was significantly decreased （P 〈 0.05）, while no significant changed was found in the effect time, onset time, and recovery index in group A （P 〉 0.05）. Compared with group B, the amount of fentanyl consumed during and after operation was significantly reduced in group A （ P 〈 0.05 ）. Conclusion Acupuncture can prolong the clinical duration of vecuronium, and enhance the analgesic efficacy during and after operation under general anesthesia.