电针对全麻胃肠道手术老年患者术后苏醒质量的影响

Effects of electroacupuncture on general anesthesia recovery of elderly patients undergoing gastrointestinal surgery

目的观察电针对全麻胃肠道手术老年患者术后麻醉苏醒质量的影响。方法选择2015年9月-2016年12月于北京中医药大学东直门医院就诊的因胃癌、结肠癌、直肠癌行择期全麻下胃肠道肿瘤手术老年患者60例(年龄≥65岁),随机分为电针辅助全麻组(A组)和单纯全麻组(B组),每组30例;A组于全麻诱导前30 min选择双侧足三里、三阴交穴进行电针刺激直至手术结束,B组仅接受常规麻醉。观察对比两组患者术中全麻药用量、全麻苏醒拔管情况、镇静和伤口疼痛程度评分、胃肠道不良反应反应情况、躁动和寒战发生率。结果术后患者苏醒拔管时A组患者睁眼时间、指令恢复时间分别为(8.0±1.7)min及(10.3±4.1)min,明显短于B组的(9.7±1.2)min及(12.9±3.5)min(P均<0.05);A组患者在拔管后1 h的视觉模拟评分为(2.2±0.1),低于B组(3.6±0.4)(P<0.05);A组患者在拔管后30 min、1 h发生严重恶心呕吐达WHO标准Ⅳ级的人数均为0,低于B组(分别为2例和3例)(P均<0.05)。结论电针能改善全麻胃肠道手术老龄患者麻醉苏醒质量,主要表现为缩短患者拔管期苏醒时间、改善术后早期镇痛效果、降低胃肠道反应的发生率。

Objective To observe the effects of electroacupunctrue on the general anesthesia recovery of elderly patients undergoing gastrointestinal surgery. Methods Sixty elderly patients（age≥65） who underwent gastrointestinal surgery with general anesthesia were enrolled and divided into electroacupunctrue group（group A, n=30） and routine anesthesia group（group B, n=30）. Electroacupuncture was administered to patients at Zusanli（ST36） and Sanyinjiao（SP6） in group A from 30 minutes before anesthesia to the end of operation. The dose of sedative and analgesic during the surgery, the time of awaking and extubation, the Ramsay score, VAS score, the incidence of gastrointestinal side effects, agitation and chills were compared between the two groups. Results It took significantly less time for patients in group A than patients in group B to respond to verbal command [（8.0±1.7） min vs（9.7±1.2） min] and follow the instructions [（10.3±4.1） min vs（12.9±3.5） min] after surgery（P〈0.05, respectively）. One hour after extubation, the VAS scores of patients in group A was significantly lower than that in group B [（2.2±0.1） vs（3.6±0.4）, P〈0.05]. The number of patients with severe nausea and vomiting reached the level Ⅳadverse reaction in group A was less than that in group B at 30 min（0 vs 2） and 1 h（0 vs 3） after extubation（P〈0.05, respectively）. Conclusion Electroacupuncture can improve the general anesthesia recovery of elderly patients undergoing gastrointestinal surgery, which can shorten the time of extubation, strengthen postoperative analgesia effect and reduce the incidence of gastrointestinal side effects.