妇科腹腔镜手术中电针足三里对胃黏膜血气指标的影响

The effect of electroacupuncture at tsusanli on gastric mucosal blood gas in gynecological laparoscopic surgery

目的 探讨电针足三里在妇科腹腔镜手术中对胃黏膜血气指标的影响.方法 择期行妇科腹腔镜手术患者54例,年龄18～65岁,按照随机数字表法分为两组：全麻组（A组）和电针干预＋全麻组（B组）,气管插管后经鼻腔或口腔置入胃张力计导管,置管成功后与多功能参数监护仪的胃黏膜监测模块相连接,术中气腹压力恒定在11～12 mm Hg.分别于插管后气腹前（T1）、气腹后30 min（T2）、60min（T3）、气腹结束后30 min（T4）测定动脉血pH值（pHa）、PaO2和PaCO2,输入计算机计算出胃黏膜pH值（pHi）、胃黏膜二氧化碳分压（PgCO2）、胃黏膜二氧化碳分压-动脉血二氧化碳分压差（Pg-aCO2）和胃黏膜二氧化碳分压-呼气末二氧化碳分压差（Pg-ET CO2）.结果 与T1时比较,两组患者在T2～T4时pHi明显下降（P＜0.01）,PgCO2、Pg-aCO2和Pg-ET CO2明显升高（P＜0.01或P＜0.05）;T2～T4时,A组患者pHi明显低于B组（P＜0.05）,PgCO2、Pg-ET CO2和Pg-aCO2明显高于B组（P＜0.01或P＜0.05）.结论 在妇科腹腔镜手术中电针足三里可调节胃黏膜血流量,防止胃黏膜酸化,从而保护胃黏膜.

Objective To study the effect of electroacupuncture at tsusanli on gastric mucosal blood gas in gynecological laparoscopic surgery.Methods Fifty-four patients,aged 18-65 years,scheduled for gynecological laparoscopic surgery were randomly divided into two groups：group A （n =27,general anesthesia group） and group B （n =27,combined electro-acupuncture anesthesia group）.The intra-abdominal pressure was kept at 11-12 mmHg.After tracheal intubation,pHa,PaO2 and PaCO2 was determined by arterial blood gas analysis which were used to derive pHi,PgCO2,Pg-aCO2 and Pg-ETCO2 by the determination technology of gastric tonometry.Data were collected at four time points：time after tracheal intubation and still before pneumoperitoneum （T1）,30 minutes after pneumoperitoneum （T2）,60 minutes after pneumoperitoneum （T3） and 30 minutes after the conclusion of pneumoperitoneum（T4）.Results After pneumoperitoneum was created,PgCO2,PgaCC2 and Pg-ETCO2 increased significantly while pHi decreased significantly in both groups at T2-T4 than those at T1 （P＜0.01 or P＜0.05）.During T2-T4,PgCO2,Pg-aCO2 and Pg-ETCC2 in group A were higher while phi was deeper than those in group B （P＜0.01 or P＜0.05）.Conclusion Electroacupuncture at tsusanli may increase gastric mucosal blood flow,discharged CO2 from gastric tissue and reduced accumulation of hydrogen ions so as to prevent gastric mucosal further acidification.