微创埋线药物复合麻醉替代传统针麻用于肺切除手术的临床研究

Clinical research of lung resection surgery with microinjection acupuncture and drug anesthesia instead of traditional acupuncture anesthesia

目的:探讨微创埋线合并静脉麻醉替代传统针药复合麻醉用于肺切除手术的可行性和安全性。方法:将90例拟行肺切除术患者随机分为全麻组、埋线组与针药组,每组30例。全麻组术前肌内注射阿托品0.5mg,术中静脉注射枸橼酸芬太尼、丙泊酚、罗库溴铵麻醉诱导,并按需追加,术后予镇痛泵;埋线组在全麻组药物麻醉基础上,麻醉诱导前穴位埋线,穴取患侧T4、T6、T8夹脊穴,患侧肺俞、心俞、膈俞,双侧曲池、足三里,术后予镇痛泵;针药组在全麻组药物麻醉基础上,麻醉诱导前取合谷、内关、后溪、支沟穴予电针治疗30min,术中电针联合静脉用药,取穴同术前,术后予灸疗合并镇痛泵镇痛。各组均在术中监测T0(麻醉诱导前)、T1(全麻诱导插管)、T2(切皮)、T3(切肌暴露肋骨)、T4(开胸)、T5(取肺)、T6(置引流管)、T7(关胸)、T8(缝肌)、T9(缝皮)、T10(拔管)11个时间点的生理指标;计量术中麻醉药物实际使用量及术后镇痛泵中枸橼酸芬太尼用量。结果:1埋线组、针药组术中枸橼酸芬太尼追加量均少于全麻组[(1.23±0.28)μg·kg-1·h-1 vs(2.40±0.54)μg·kg-1·h-1,(1.18±0.38)μg·kg-1·h-1 vs(2.40±0.54)μg·kg-1·h-1,均P<0.05];各组术中丙泊酚及罗库溴铵追加量差异无统计学意义(均P>0.05]。2埋线组、针药组术后镇痛泵中枸橼酸芬太尼用量均少于全麻组[(11.04±1.04)μg/kg vs(15.40±1.52)μg/kg,(11.55±1.38)μg/kg vs(15.40±1.52)μg/kg,均P<0.05],并较之用药量减少25%。33组患者术中11个时间点心率、血压变化差异均无统计学意义(均P>0.05)。结论:微创埋线合并静脉麻醉与传统针药复合麻醉均能显著减少肺切除术中和术后的静脉麻药使用量,镇痛效果和单纯静脉用药相仿,且安全性好。并且微创埋线合并静脉麻醉较传统针麻更易操作,更具推广性。

Objective To explore the feasibility and safety on lung resection surgery with the combined method of microinjection acupuncture（MIA）and intravenous anesthesia instead of compound traditional acupuncture and drug anesthesia（ADA）.Methods Ninety cases of lung resection surgery were randomized into a general anesthesia group,a MIA group and a ADA group,30 cases in each one.In the general anesthesia group,before surgery,the intramuscular injection of atropine 0.5 mg was used;during surgery,the anesthesia induction was followed with intravenous injection of fentanyl citrate,propofol and rocuronium bromide and the dosage was increased accordingly;after surgery,the analgesia pump was applied.In the MIA group,on the basis of general anesthesia,before anesthesia induction,the acupoint catgut embedding was applied to Jiaji（EX-B 2）of T4,T6 and T8,Feishu（BL 13）,Xinshu（BL 15）and Geshu（BL 17）on the affected side and bilateral Quchi（LI 11）and Zusanli（ST36）;after surgery,the analgesia pump was applied.In the ADA group,on the basis of general anesthesia,before anesthesia induction,electroacupuncture（EA）was applied to Hegu（LI 4）,Neiguan（PC 6）,Houxi（SI 3）and Zhigou（TE 6）for 30min;during surgery,EA and intravenous medication were combined at the same acupoints as those before surgery;after surgery,moxibustion and the analgesia pump were applied in combination for analgesia.In each group,the biological indices were monitored during surgery at 11 time points named T0（before anesthesia induction）,T1（intubation in general anesthesia induction）,T2（skin incision）,T3（rib exposure in muscular incision）,T4（chest open）,T5（lung removal）,T6（drainage tube implantation）,T7（chest closure）,T8（muscular stitching）,T9（skin stitching）and T10（extubation）.The actual dosage of anesthetics during surgery and the dosage of fentanyl citrate in analgesia pump were quantified after surgery.Results（1）In the MIA group and ADA group,the increased dosage of fentanyl citrate was less than that in the general anesthesia group[（1.23±0.28）μg·kg-1·h-1 vs（2.40±0.54）μg·kg-1·h-1,（1.18±0.38）μg·kg-1·h-1 vs（2.40±0.54）μg·kg-1·h-1,both P〈0.05].The increased dosage of propofol and rocuronium bromide was not different during surgery among the groups（all P〉0.05）.（2）In the MIA group and ADA group,after surgery,the increased dosage of fentanyl citrate was less than that in the general anesthesia group[（11.04±1.04）μg/kg vs（15.40±1.52）μg/kg,（11.55±1.38）μg/kg vs（15.40±1.52）μg/kg,both P〈0.05],reducing by 25%in comparison.（3）The differences in heart rate and blood pressure at 11 time points during surgery were not significant among the three groups（all P〉0.05）.Conclusion The combined method of MIA and intravenous anesthesia significantly reduces the dosage of intravenous anesthetics during and after lung resection surgery as compared with ADA,presenting the similar analgesic effect as simple intravenous medication and the good safety.The combined method of MIA and intravenous anesthesia is much more convenient in operation and generalized as compared with traditional acupuncture anesthesia.