术前耳穴贴压治疗对无痛胃镜检查中呼吸循环抑制的影响

Effect of preoperative ear acupoint pressure therapy on respiratory and circulatory inhibition during painless gastroscopy

目的探讨术前耳穴贴压治疗对瑞芬太尼联合丙泊酚麻醉下胃镜检查中呼吸循环抑制的影响。方法选择美国麻醉医师协会(ASA)麻醉风险分级Ⅰ~Ⅱ级,拟无痛胃镜检查的门诊患者100例,分为耳穴贴压组(A组)和对照组(B组),各50例。A组患者于胃镜检查前1 d,取双耳神门、交感、心、肺、脾、肾、气管等穴位以王不留行籽行耳穴贴压,并于次日检查前取下。B组患者不予耳穴贴压。两组患者采用相同的麻醉方法,并于麻醉前(T_0)、检查开始后1 min(T_1)、术毕前(T_2)及术毕后5 min(T_3)记录两组患者的HR、MAP,同时记录术中脉搏氧饱和度(SpO_2)最低值,秒表记录术中SpO_2低于95%的持续时间;术毕记录两组患者的丙泊酚用量和检查所用时间。结果 A组患者术中SpO_2平均最低值为(94.3±4.5)%,显著高于B组[(90.6±6.6)%],差异有统计学意义(P<0.05);A组术中Sp O2<95%的持续时间为(23±31)s,显著低于B组[(49±37)s,P<0.05]。两组患者麻醉后MAP均有下降,与T_0点比较,A组的MAP在T_1和T_2时间点,B组的MAP在T_1、T_2和T_3时间点均低于T0(P<0.05);而两组患者HR在各时间点组间及组内比较,差异均无统计学意义(P>0.05)。结论术前采用耳穴贴压治疗能改善无痛胃镜检查中麻醉药物引起的呼吸抑制,但对循环抑制影响不明显。

Objective To observe the Effect of ear acupoint pressure therapy on respiratory and circulatory inhibition during gastroscopy undergoing propofol combined with remifentanil anesthesia. Methods A total of 100 cases of painless gastroscopy patients, ASA I-II, were randomly divided into the ear acupoint pressure group（group A,n=50） and the control group（group B,n=50）. Patients of group A were treated by ear acupoint pressure therapy one day before gastroscopy and completed their therapy before the start of gastroscopy, acupoint-locating： shenmen, sympathesis, heart, lung, spleen, kidney and trachea. Both groups used the same anesthesia methods. HR and MAP were recorded at the time before anesthesia（T0）, 1 min after the start of gastroscopy（T1）, the time of the completion of the procedure e（T2） and 5 min after the completion of the procedure （T3）. The minimum of SpO2 during anesthesia was also recorded for each patient. The duration of SpO2 〈 95% of each patient was measured by stopwatch. The time consuming of gastroscopy and the consumption of propofol were recorded. Results The mean value of minimum of SpO2 in group A[（94.3±4.5）%] was significantly higher than group B[（90.6±6.6）%, P〈0.05]. The mean value of duration of SpO2 〈95% in group A [（23±31） s] was significantly shorter than group B [（49±37） s, P〈0.05]. Of all patients, the MAP decreased after induction, but HR change was not obvious at various time points. Conclusion Preoperative ear acupoint pressure therapy can improve respiratory inhibition during painless gastroscopy but it is not obvious in improving circulatory inhibition.