针麻复合靶控输注对腹腔镜宫外孕手术病人麻醉恢复的影响

EFFECT OF COMBINED ACUPUNCTURE WITH TARGET-CONTROLLED INFUSION ANESTHESIA ON ANESTHESIA RECOVERY IN PATIENTS UNDERGOING LAPAROSCOPIC SURGERY FOR ECTOPIC PREGNANCY

目的探讨腹腔镜宫外孕手术中针刺麻醉（针麻）复合靶控输注（TCI）与单纯TCI对病人恢复期的影响。方法选择20例行腹腔镜宫外孕手术的病人,随机分为对照组与观察组两组,每组10例。两组病人均采用咪唑安定、瑞芬太尼、丙泊酚、维库溴铵全身麻醉诱导;术中TCI丙泊酚和瑞芬太尼维持相同麻醉深度。观察组于全身麻醉诱导前20min选取双侧合谷穴和内关穴进针得气后,分别通电刺激至拔除气管插管后30 min。监测两组病人麻醉前、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）及胸腔液体量（TFC）;记录术中所用异丙酚和瑞芬太尼的用量;记录意识恢复时间、清醒拔管时间、有无恶心呕吐与寒战、躁动等的反应程度。结果与基础值相比,对照组苏醒及拔管时的HR、MAP、CO明显升高（F=10.870~43.408,P〈0.05）。与基础值相比,观察组在苏醒及拔管时的各项血流动力学指标的变化差异无显著性（P〉0.05）。观察组在苏醒及拔管时的HR、MAP、CO低于对照组（t=3.368~8.188,P〈0.05）。观察组异丙酚和瑞芬太尼的用量少于对照组（t=2.144、2.411,P〈0.05）。观察组的苏醒时间和拔管时间明显短于对照组（t=2.762、3.320,P〈0.05）;躁动评分低于对照组（t=4.830,P〈0.05）。两组的呕吐评分和寒战评分差异无显著性（P〉0.05）。结论针麻复合TCI能明显减轻麻醉恢复期病人血流动力学指标的波动,使血流动力学指标趋于稳定;并且能减少麻醉药物的用量,缩短苏醒和拔管时间,减轻麻醉恢复期的躁动反应。

Objective To evaluate the impact of combined acupuncture with target-controlled infusion（TCI）anesthesia versus simple TCI on anesthetic stage of recovery period in patients undergoing laparoscopic surgery for ectopic pregnancy. Methods Twenty patients scheduled for laparoscopic surgery for ectopic pregnancy were enrolled in this study and equally randomized to control group and observation group.The patients in both group received midazolam,remifentanil,propofol and vecuronium for general anesthesia induction,and TCI with propofol and remifentanil were used to keep the same depth of anesthesia at surgery.Acupuncture of bilateral Neiguan and Hegu was performed 20 min before general anesthesia induction,and electro-acupuncture continued until 30 min after the tracheal cannula was removed.Hemodynamic markers—heart rate（HR）,mean arterial pressure（MAP）,stroke volume（SV）,cardiac output（CO）,systemic vascular resistance（SVR）and thoracic fluid content（TFC）-were monitored before anesthesia,at recovery of anesthesia,and removing tracheal cannula.The dosage of remifentanil and propofol used at surgery was recorded.The time of return to conciousness,extubation time,nausea and vomiting,shiver and restlessness were recorded. Results Compared with the baseline：the changes in HR,MAP and CO at regaining consciousness and removing tracheal cannula were not significant differences in the observation group（P〉0.05）,but HR,MAP and CO were lower than that in the control group（t=3.368-8.188,P〈0.05）.The dosages of propofol and remifentanil used in the observation group were less than that used in the control group（t=2.144,2.411;P〈0.05）.The time of analepsia and extubation in the observation group was shorter（t=2.762,3.320;P〈0.05）,and the restlessness score was lower than that in the control group（t=4.830,P〈0.05）.The differences in vomiting and shiver score between the two groups were not significant（P〉0.05）. Conclusion Combined acupuncture and target-controlled infusion anesthesia can obviously lessen hemodynamic fluctuation and make it stable during anesthesia recovery period,decrease the dosage of anesthetics,shorten analepsia and extubation time and relieve restlessness reaction at recovery stage of anesthesia.