针药复合对心脏外科手术患者镇痛及镇静效果的影响

Analgesic and Sedative Effect of Acupuncture Combined with Medicine on Patients Undergiong Cardiac Surgery

目的观察针药复合对心脏外科手术患者镇痛、镇静的临床效果。方法 50例2012年1月—2014年10月心脏外科手术患者随机分为常规镇痛组(A组)和针药复合镇痛组(B组),每组25例。A组患者予以盐酸右美托咪定注射液镇痛镇静,B组患者予以电针(神庭穴及印堂穴)联合盐酸右美托咪定镇痛镇静,效果欠佳时均加用盐酸吗啡注射液。观察两组患者在不同时间点的静态及动态视觉模拟评分(VAS)、Riker镇静躁动评分(SAS)、平均动脉压(MAP)、心率(HR)、氧饱和度(Sp O2)水平;观察记录两组患者盐酸右美托咪定、盐酸吗啡注射液用量,镇痛满意率,镇静满意率,治疗期间心动过缓、低血压等不良反应的发生率,以及机械通气时间及ICU时间、住院费用。结果两组患者在不同时间点静态及动态VAS评分、SAS评分、MAP、HR、Sp O2比较,差异均无统计学意义(P>0.05);与A组比较,B组患者右美托咪定及盐酸吗啡注射液的用量减少(P<0.05),镇痛满意率提高(P<0.05),心动过缓的发生率也明显下降(P<0.05)。两组患者的镇静满意率,低血压、谵妄、腹胀、呕吐发生率以及机械通气时间、住ICU时间、住院费用比较,差异均无统计学意义(P>0.05)。结论针药复合的镇痛方式能减少传统镇痛药物的用量,减少部分不良反应的发生。

Objective To observe analgesic and sedative effect of acupuncture combined with medicine（ ACM） on patients undergiong cardiac surgery. Methods A total of 50 patients with cardiac surgery from January 2012 to October2014 were randomly assigned to the conventional analgesia group（ group A） and the ACM analgesia group（ group B）,25 in each group. Patients in group A were subjected to analgesia and sedation by injecting dexmedetomidine,while patients in group B were subjected to analgesia and sedation by electro-acupuncture [EA,Shenting（ GV24）; Yintang（ EX-HN3） ]combined with injection of dexmedetomidine. Morphine hydrochloride injection was performed when analgesia and sedation effect was ineffective in the two groups. The indicators of patients at different time points in the two groups were observed,such as static and dynamic VAS scores,SAS scores,mean arterial pressure（ MAP）,heart rate（ HR）,oxygen saturation（ Sp O2）. The injection dosage of dexmedetomidine and morphine hydrochloride,analgesia satisfaction rate,sedation satisfaction rate,the incidences of adverse reactions during treatment such as bradycardia and low blood pressure,mechanical ventilation time,ICU time,and hospitalization expense were observed and recorded in the two groups. Results There was no statistical difference in static and dynamic VAS scores,SAS score,MAP,HR and Sp O2 between the two groups at different time points（P 〉0. 05）. The injection dosage of dexmedetomidine and morphine hydrochloride was significantly reduced in group B than in group A（P 〈0. 05）. The analgesia satisfaction rate of patients in group B was much higher than that in group A（P 〈0. 05）. The incidence of bradycardia also obviously decreased more in group B than in group A（P 〈0. 05）. There wasno statistical difference in patients＇ sedation satisfaction rate,incidences of low blood pressure,delirium,vomiting; mechanical ventilation time,ICU time,or hospitalization expense between the two groups（P〈 0. 05）. Conclusion The analgesia method of ACM could reduce the dosage of traditional analgesic drugs and the occurrence of partial adverse reactions.