针麻复合靶控输注对腹腔镜宫外孕手术病人术中心脏泵功能的影响

Effect of Combined Acupuncture and Target-controlled Infusion Anesthesia on Hemodynamics During Laparoscopy of Ectopic Pregnancy

目的采用无创方法对患者血流动力学进行监测,探讨腹腔镜宫外孕手术中针麻复合靶控输注(target-controlled infusion,TCI)对心脏泵功能的影响。方法选择20例行腹腔镜宫外孕手术的患者作为研究对象,随机分为两组,每组10例。对照组行单纯TCI;观察组行TCI联合针刺合谷、内关。在维持相同麻醉深度的条件下,通过无创血流动力学监测患者麻醉前、诱导后插管前、插管时、气腹时、气腹毕以及苏醒时、拔管时的血流动力学指标,包括心率(HR)、平均动脉压(MAP)、每搏输出量(SV)、心输出量(CO)、体循环血管阻力(SVR)、胸腔液体量(TFC)。记录患者术中所用异丙酚和瑞芬太尼的用量。结果 1组内比较:对照组与基础值相比,插管前的HR、MAP、CO、SVR明显降低;插管时的MAP明显升高;气腹时HR、MAP、SVR明显升高;气腹毕的HR、CO明显降低;苏醒时HR、MAP、CO明显升高;拔管时的HR、MAP、CO明显升高。观察组与基础值相比,插管前的HR、MAP明显降低;气腹毕的HR明显降低。2组间比较:观察组在插管前的HR、SVR高于对照组,气腹时的HR、MAP低于对照组,苏醒及拔管时的HR、MAP、CO低于对照组。3观察组异丙酚和瑞芬太尼的用量小于对照组。结论在控制麻醉深度相同的条件下,针麻复合TCI能明显减轻术中血流动力学的波动,使血流动力学趋于稳定,并且能减少麻醉药物的用量。

Objective To evaluate the influences of combined acupuncture and target-controlled infusion anesthesia on hemodynamic parameter variations during laparoscopy of ectopic pregnancy through non-invasive methods. Methods Twenty female patients scheduled for laparoscopy of ectopic pregnancy were selected in this study , and divided into the control group and the observation group, 10 patients for each. The control group used target-controlled infusion only, and the observation group used combined target-controlled infusion and ac- upuncture at bilateral Neiguan and Hegu. Changes of hemodynamics were monitored using thoracic bio-imped- ance method at different time points of operation, i.e. the baseline, after induction and before intubation, dur- ing intubation, estabhshing pneumoperitoneum, ending of pneumoperitoneum, regaining consciousness and dur- ing extubation. Changes of hemodynamics inclused heart rate （ HR）, mean arterial pressure （MAP）, stroke vol- ume （ SV）, cardiac output （ CO）, systemic vascular resistance （SVR） and thoracic fluid content （ TFC ）. The dosages of anesthetic among groups were compared. Results ①Comparing to the baseline in the control group, HR, MAP, CO, SVR after induction and before intubation decreased significantly; MAP increased sig- nificantly during intubation; HR, MAP, SVR at establishing pneumoperitoneum increased significantly; HR,CO at ending of pneumoperitoneum decreased significantly; HR, MAP, CO at regaining consciousness and dur- ing extubation increased significantly. Comparing to the baseline in the observation group, HR, MAP after in- duction and before intubation decreased significantly; HR at ending of pneumoperitoneum decreased significant- iy. ②Comparing to the control group, HR, SVR of the observation group after induction and before intubation increased significantly; HR, MAP of the observation group at establishing pneumoperitoneum decreased signifi- cantly; HR, MAP, CO of the observation group at regaining consciousness and during extubation decreased sig- nificantly. ③The consumption of propofol and remifentanil in the observation group were both less than that of the control group. Conclusion In the control of anesthesia under the same conditions, comparing with the target-controlled infusion only, combined acupuncture and target-controlled infusion anesthesia can achieve bet- ter circulation and less consumption of anaesthetic.