针刺辅助全身麻醉对冠心病患者行非心脏手术时应激反应的影响

Effects of acupuncture assisted general anesthesia on stress response in patients with coronary artery disease undergoing non-cardiac surgery

目的观察针刺辅助全身麻醉用于冠心病患者行非心脏手术时应激反应的影响。方法择期行腹部手术的冠心病患者80例,ASAⅡ或Ⅲ级,随机均分为单纯全麻组(A组)和针刺辅助全麻组(B组)。A组采用咪达唑仑、依托咪酯、芬太尼以及阿曲库铵麻醉诱导,麻醉维持采用丙泊酚、芬太尼及阿曲库铵,B组麻醉诱导前取"内关"、"足三里"穴持续刺激20min后行全身麻醉诱导,麻醉诱导及维持同A组,针刺辅助全身麻醉持续至手术结束。记录麻醉前(T1)、麻醉后30min(T2)、60min(T3)、180min(T4)及术毕30min(T5)血流动力学、Narcotrend指数及T1、T2、T5时心电图ST段变化。检测T1和T5血清皮质醇(Cor)、去甲肾上腺素(NE)、肾上腺素(E)、心肌肌钙蛋白I(cTnI)和糖原磷酸化酶BB(GP-BB)含量。结果与T1时比较,T2、T3时A组患者HR明显增快、MAP明显升高(P<0.05或P<0.01);T2时A组患者HR与SBP乘积(RPP)大于12000(P<0.05)。T5时A组患者ST段明显低于B组(P<0.05)。A组患者术中需用硝酸甘油14例(35%)、艾司洛尔10例(25%),明显多于B组6例(15%)和3例(7.5%)(P<0.05)。与术前比较,A组术毕30minCor、NE、E、cTnI及GP-BB含量均明显升高,且高于B组(P<0.05)。结论针刺辅助全身麻醉应用于冠心病患者行非心脏手术时可降低患者围术期应激反应,对心肌有良好的保护作用。

Objective To observe acupuncture assisted general anesthesia on stress response in coronary artery disease patients receiving non-cardiac surgeries. Methods Eighty patients with CAD undergoing elective abdominal surgery were randomly divided into general anesthesia group （group A, n= 40） and acupuncture assisted anesthesia group （group B, n = 40）. Midazolam, etomidate, fentanyl and atracurim were used for induction and propofol, fentanyl and atracurium for maintenance in group A. In group B, the points ＂Nei-kuan＂ and ＂Tsu-San-I.i＂ were punctured electrically for 20 minutes prior to general anesthesia. Acupuncture assisted general anesthesia did not terminate until the end of surgery. Recorded before anesthesia （T1）, 30 min （Tz） after anesthesia, 60 min （T3）, 180 min （T4） and operation, 30 rain after finishing operation （T5） hemodynamic Narcotrend index and T1, T2, T3 ECG ST-segment changes detected Tj and T5 serum cortisol （Gar）, norepinephrine （NE）, epinephrine （E）, changes in cardiac troponin I （cTnI） and glycogen phosphorylase BB （GP BB）. Results Compared with T1 ,T2 ,T3 goroup A patients HR faster, MAP significantly increased（P〈0. 05 or P〈0.01）. The RPP in group A 30 min after induction was greater than 12 000（P〈0. 05）. The ST segment at the end of operation in group A was depressed significantly than that in group B （P --Q.0. 05）. The number of patients that received vasoactive drugs such as nitroglycerin and esmolol in group A was dramatically greater than that in group B （P〈 0. 05）. The serum levels of （;or, NE, E,cTnI and （;P-BB were increased at the end of the surgery in group A and also higher than those in group B （P〈0. 05）. Conclusion Acupuncture assisted general anesthesia can suppress stress response in patients with coronary artery disease undergoing non-cardiac surgery, which is beneficial for myocardial protection.