针刺复合小剂量硬膜外麻醉胆囊切除临床研究总结

Summary of the Clinical Study on Acupuncture Combined with Epidural Injection of Small Dose of Anesthetic for Cholecystectomy

目的 :针刺 (穴位电极刺激 )复合小剂量硬膜外麻醉胆囊切除临床研究。方法 :胆囊切除术共 1 0 6例 ,其中针硬组 (A组 ) 35例 ,电硬组 (B组 ) 35例 ,单纯硬膜外麻醉组 (C组 ) 36例。A组为针麻基础上复合小剂量硬膜外麻醉 ,B组为穴位电极刺激基础上复合小剂量硬膜外麻醉 ,C组为对照组 (单纯硬膜外麻醉 )。结果 :麻醉效果Ⅰ级率A组 80 0 0 %、B组 6 8 5 7%、C组 2 5 0 0 % ;硬膜外腔 1 5 %利多卡因用量 ,首次用量C组比A组、B组多用 35 43%、30 6 2 % (P <0 0 0 5 ) ;硬膜外腔首次用药量 9mL时A、B两组比C组多阻滞 2～ 3个神经节段 (A∶C、B∶C ,P <0 0 0 1 ) ;监测指标提示术中HR、BP、MBP、RR、TV、MV、SPO2 、ECG基本平稳 ,顺利、安全渡过手术。结论 :针刺(穴位电极刺激 )复合小剂量硬膜外麻醉可作为胆囊切除术麻醉方法之一。

Objective: To observe the therapeutic effect of acupuncture combined with epidural injection of small dose of anesthetic for cholecystectomy. Methods: 106 cholecystectomy patients were randomly divided into acupuncture + epidural administration of anesthetic (A+EAA) group (n=35), electrical stimulation + EAA (ES+EAA) group (n=35) and EAA group (n=36). Bilateral Neiguan (PC 6) and Zusanli (ST 36) were used for electroacupuncture (2～3 mA, 2/15 Hz, sparse dense waves) and electrical stimulation (11～12 mA, 2/15 Hz, sparse dense waves) in A+EAA and ES+EAA groups. Before anesthesia, all the patients were given with intramuscular injection of atropine (0.5 mg/50 kg body weight) and luminal sodium (0.1 g/50 kg), and during operation they were given with intravenous drip of meperidine (1 mg/kg). Epidural anesthetic used was lidocaine (1.5%, 5 mL) with epinephrine (E) for patients without contraindications or with E. Results: In A+EAA, ES+EAA and EAA groups, the excellent rates of anesthetic effect were 80.00% (28 cases), 68.57% (24 cases) and 25% (9 cases); the good rates were 20.00% (7 cases), 28.57% (10 cases) and 61.11% (22); and the poor effect rates were 0 (0), 2.86% (1 case) and 13.89% (5 cases) respectively. The doses of lidocaine used in the first hour of operation in A+EAA and ES+EAA were significantly lower than that of EAA group (P<0.005), being EAA 35.43% and 30.62% respectively less than that of EAA group, but the blocked nerve segments were respectively 2 and 3 more than those of EAA group. During operation, the indices of HR, BP, MBP, RR, TV, MV, SPO 2 and ECG kept basically stable and the operation were conducting smoothly. Conclusion: Acupuncture and acupoint electrical stimulation combined with epidural administration of small dose of anesthetic may be used as one of the effective anesthetic methods for cholecystectomy.