针刺复合小剂量硬膜外麻醉胆囊切除临床研究总结

Summary of Clinical Research on Acupuncture Combined with Epidural Anesthesia for Cholecystectomy

目的 :针刺复合小剂量硬膜外麻醉胆囊切除麻醉方法、效果临床研究。方法 :择期胆囊切除术 1 94例 ,分A(针硬组 )、B(电硬组 )、C(对照组 )三组单盲法观察。硬膜外操作方法、局麻药种类、浓度 (1 .5 %利多卡因 )及给药程序三组相同 ,麻醉阻滞平面均达到T4～ 1 1 以上 ,使镇痛完全 ,肌肉松弛满意 ,牵拉反应轻 ,术中安静。结果 :针刺 (穴位电极 )复合小剂量硬膜外麻醉效果确切 ,A、B两组I级率分别为 75 .76%、60 .3 2 % ,C组仅 1 3 .85 % ,A、B组与C组比较P <0 .0 0 1。硬膜外麻醉首次用药量、每小时用药量、每例用药量C组均比A、B两组多 ,其中每小时用药量比A、B两组分别多 3 6.2 3 %、3 3 .5 7% ,P <0 .0 0 1 ,说明针刺与硬膜外麻醉两者复合可增强麻醉效果 ,减少硬膜外麻醉用药量 ;监测提示 (HR、MAP、RR、TV、MV、SPO2 、ECG)术中生命体征基本平稳 ,全组病例安全渡过手术 ;儿茶酚胺检测A、B两组麻醉后血浆NE含量减少 ,麻醉效果优良 ,并提示A、B两组有减轻或缓解手术应激反应作用 ;T淋巴细胞亚群检测显示针刺除有加强镇痛作用、减少麻醉用药量外 ,还可能加强细胞免疫功能。说明针刺 (穴位电极 )与硬膜外麻醉复合弥补了针麻镇痛不足、肌肉松弛欠佳、牵拉反应明显等不足 。

Objective: To conduct clinical research on the anesthetic approach and to observe the effect of acupuncture integrated with small dose of epidural anesthetic for cholecystectomy.Methods: 194 cases of cholecystectomy in 3 groups, Group A (acupuncture + epidural anesthesia group,AEA, n=66), Group B (electrode + epidural anesthesia, EEA,n=63), and Group C (control, n=65) were observed using single blind method. The operating approach of the epidural anesthesic, the type and concentration of local anesthetic (1.5% lidocaine) and administration procedure of the drug in the 3 groups are the same. The anesthetic blocking plane is T 4～11 . Results: In group A and B, the analgesic effect of the anesthesia is perfect, the muscular relaxation satisfactory, the retraction reaction mild, and the patients remain quiet during the operation. The rates of Grade I in Group A and Group B are respectively 75.75% and 60.32%, being significantly higher than 13.85% of Group C (P<0.001). The first dose of drug administration, the every hour dose, the dose of each case for epidural anesthesia in Group C are all higher than those of Group A and Group B. The every hour dose in Group C is higher than those of Group A and Group B by 36.23% and 33.75% respectively (P<0.001). The monitor of the heart rate (HR), mean blood pressure (MAP), respiratory rate (RR), tidal volume (TV), minute volume (MV), blood oxygen saturation level (SPO 2) and electrocardiogram (ECG) denotes that the vital signs keep stable basically during operation under AEA or EEA, patients in all the groups safely pass the operation. After AEA and EEA, the blood catecholamine concentration decreases and the anesthesia effect is fine. The measurement of T lymphocyte subgroup displays that acupuncture can also strengthen the cellular immunity. The facts suggest that AEA and EEA supplement the shortcomings of incomplete analgesia, unsatisfied muscular relaxation and obvious retraction response of acupuncture alone, not only remains the advantage of acupuncture anesthesia in keeping physiological balance, but also meets the anesthetic requirement for cholecystecotomy. Conclusion: AEA and EEA can be used as one of the anesthetic approaches for cholecystectomy.