针刺辅助全身麻醉在老年腹腔镜胆囊切除术中的应用

Application Research of Acupuncture Assisting General Anesthesia in Elderly Patients Undergoing Laparoscopic Cholecystectomy

目的:观察针刺辅助全身麻醉在老年腹腔镜胆囊切除术中的应用。方法:选择本院2012年1月至2015年12月行腹腔镜胆囊切除术的老年患者146例,随机分成对照组和治疗组各73例,两组全身麻醉方法同,静脉注射咪达唑仑、丙泊酚、芬太尼和顺式阿曲库胺等后行气管插管机械通气。治疗组麻醉诱导前20～30 min采用一次性无菌针灸针,取双侧合谷穴和太冲穴,直刺捻转进针,间断给予手法捻转刺激,观察临床疗效及相关指标变化情况。结果:治疗组丙泊酚用量,苏醒时间,除管时间均少于对照组(P <0. 05);治疗组使用阿托品、多巴胺、硝酸甘油比例小于对照组(P <0. 05);治疗组老年腹腔镜胆囊切除术患者平均动脉压(mean arterial blood pressure,AMP)、心率(heart rate,HR)在T_2(气腹前)、T_3(气腹后5 min)、T_4(气腹后30 min)、T_5(气腹结束后5 min)、T_6(拔除气管导管后5 min)时与对照组比较差异有统计学意义(P <0. 05);治疗组术后反应低于对照组(P <0. 05)。结论:针麻辅助全身麻醉既能明显减少异丙酚麻醉药量和毒副作用,又能缩短老年手术患者苏醒和拔管时间。

Objective: To observe the application of acupuncture assisting general anesthesia in elderly patients undergoing laparoscopic cholecystectomy. Methods: One hundred and forty-six elderly patients undergoing laparoscopic cholecystectomy in our hospital from January 2012 to December 2015 were randomly divided into the control group and the treatment group,with with 73 cases in each group. Both groups were given general anesthesia with midazolam,propofol,fentanyl and cis-atracuridine by intravenous injection,and then mechanical ventilation was performed through tracheal intubation. In the treatment group,20-30 minutes before induction of anesthesia,disposable sterile acupuncture needles were used,bilateral Hegu ( LI 4) and Taichong ( LR 3) acupoints were taken,direct needling and twirling needling were performed,and manual twirling stimulation was given intermittently, then the clinical efficacy and changes of relevant indicators were observed. Results: The dosage of propofol,recovery time and tube-removal time in the treatment group were less than those in the control group ( P < 0. 05) . The proportion of atropine, dopamine and nitroglycerin in the treatment group was smaller than that in the control group ( P < 0. 05) . AMP and HR in T1 ( 5 minutes after tracheal intubation) and T2 ( 5 minutes before pneumoperitoneum) were lower than those in T0 ( before anesthesia) ,but T3 ( 5 minutes after pneumoperitoneum) ,T4 ( 30 minutes after pneumoperitoneum) and T5 ( 5 minutes after pneumoperitoneum) were significantly different between the two groups ( P < 0. 05) . In the control group,AMP and HR were significantly affected by pneumoperitoneum,T3 ( 5 minutes after pneumoperitoneum) ,T4 ( 30 minutes after pneumoperitoneum) and T5 ( 5 minutes after pneumoperitoneum) were significantly increased ( P < 0. 05) ,while in the treatment group,AMP and HR were relatively stable in T3 ,T4 and T5 ( P > 0. 05) . The two groups were affected by sputum suction and other operations while removing the tube,so the AMP and HR of T6 ( 5 minutes after the removal of tracheal tube) in the two groups were higher than that of T5 , but there was a significant difference between the control group and the treatment group ( P < 0. 05) ,and the post-operative response of the treatment group was lower than that of the control group ( P < 0. 05) . Conclusion: Acupuncture assisting general anesthesia can not only significantly reduce the amount of propofol anesthetics and toxic side effects,but also shorten the recovery and extubation time of elderly patients undergoing surgery.