全身麻醉辅助针刺对冠心病患者行腹腔镜胆囊手术时心肌应激反应的影响

Influence of acupuncture assisted with general anesthesia on cardiac stress reaction of patients with coronary heart underwent laparoscopic cholecystectomy

目的观察全身麻醉辅助针刺对冠状动脉粥样硬化性心脏病（冠心病）患者行腹腔镜胆囊摘除术时心肌应激反应的影响。方法将2011年2月至2013年12月择期行腹腔镜胆囊摘除术并确诊为冠心病的60例患者随机均分为全身麻醉组（A组）和全身麻醉辅助针刺组（B组）,各30例。美国麻醉医师协会（ASA）分级Ⅱ级或Ⅲ级。A组采用咪唑安定、芬太尼、依托咪酯和维库溴铵麻醉诱导,麻醉维持采用丙泊酚、雷米芬太尼和维库溴铵;B组取内关、足三里穴持续刺激30 min后进行全身麻醉诱导,麻醉诱导及维持与A组相同,针刺辅助持续至手术结束。记录两组患者麻醉前（T1）,麻醉后20 min（T2）、30 min（T3）、45 min（T4）及手术结束30 min（T5）的血流动力学,T1、T3、T5时的心电图ST段变化。检测T1、T3时的血气分析,T1、T5时的肌酸激酶（CK）、乳酸脱氢酶（LDH）和心肌肌钙蛋白T（cTnT）等变化。结果 T2、T3时两组患者心率明显增快、平均动脉压（MAP）明显升高,T2∽T4时A组患者MAP明显高于B组,差异均有统计学意义（P〈0.05）。T5时A组患者CK、LDH、cTnT较T1时明显升高,差异均有统计意义（P〈0.05）;B组患者CK、LDH、cTnT较T1时虽有所上升,但差异均无统计学意义（P〉0.05）;A组与B组上述指标比较,差异均有统计学意义（P〈0.05）。A组患者术中需用硝酸甘油12例（40.0%）、艾司洛尔8例（26.7%）,明显多于B组的6例（20.0%）和2例（6.7%）。结论全身麻醉辅助针刺用于冠心病患者行腹腔镜胆囊摘除术可在一定程度上起到对心肌的保护作用。

Objective To observe the influence of acupuncture assisted with general anesthesia on cardiac stress reac-tion of patients with coronary heart underwent laparoscopic cholecystectomy. Methods Sixty ASAⅡorⅢpatients scheduled for elective laparoscopic cholecystectomy surgery from February 2011 to December 2013 were randomly divided into two groups：gen-eral aneasthesia（group A） and general aneasthesia combined with acupuncture（group B）. Both groups were induced with midazo-lam,fentanyl,etomidate and vecuronium,and maitained with propofol,remifentanil and vecuronium,but the group B acupunc-tured to ＆quot;zusanli＆quot; and ＆quot;neiguan＆quot; for 30 min before anesthesia and lasted to operation over. Hemodynamics before anesthesia （T1）,20 min（T2）,30 min（T3）,45 min（T4） after anesthesia and 30 min after operation（T5）,and the changes of ECG in T1,T3,T5 were recorded. The blood gas analysis at T1 and T3,the changes of creatine kinase（CK）,lactate dehydrogenase（LDH） and cTn-T were recorded. Results The heart rate（HR） and mean arterial pressure（MAP） of patients in both groups at T2 and T3 increased obviously,the MAP during T2 to T4 in the group A was obviously higher than that in the group B with statistically significant differ-ence（P〈0.05）;compared with T1,CK,LDH and cTn-T in the group B increased slightly,but the difference had no statisticaly sig-nificance（P〉0.05）;the difference between the two groups had statistical significance（P〈0.05）. 12 cases（40.0%） in the group A needed nitroglycerin and 8 cases（26.7%） needed esmolol,which was significantly higher than those in the group B[6（20.0%）,2 （6.7%）] respectively. Conclusion The general aneasthesia combined with acupuncture in laparoscopic cholecystectomy of coro-nary heart disease can provide protection for myocardium to a certain.