穴位配伍因素对腹腔镜胆囊切除术患者针药平衡麻醉效果的影响

Effects of acupoint compatibility factors on efficacy of acupuncture-drug balanced anesthesia in patients undergoing laparoscopic cholecystectomy

目的:比较不同穴位配伍用于腹腔镜胆囊切除术患者针药平衡麻醉的效果。方法:择期腹腔镜胆囊切除术患者140例,性别不限,年龄18~64岁,BMI 18.5~24.0 kg/m^2,ASA分级Ⅰ-Ⅲ级,采用随机数字表法分为4组(n=35):单纯全麻组(A组)、合谷穴+内关穴组(B组)、合谷穴+内关穴+足三里穴组(C组)和合谷穴+内关穴+足三里穴+三阴交穴组(D组)。B组、C组和D组于麻醉诱导前30 min开始至术毕经皮电刺激相应穴位,频率2/100 Hz,疏密波,刺激强度以患者所能耐受的最大电流为宜。记录术中丙泊酚、瑞芬太尼用量及补救镇痛情况;于术前24 h、术后24、48和72 h时记录匹兹堡睡眠质量指数(PSQI);记录气管拔管时间、术后住院时间;记录术中高血压、低血压、心动过缓、心动过速等不良事件的发生情况。结果:与A组比较,B组、C组和D组术中丙泊酚、瑞芬太尼用量、术后补救镇痛率降低,气管拔管时间以及术后住院时间缩短,术后24和48 h时PSQI降低(P<0.05);与B组和C组比较,D组术后24和48 h PSQI降低,术后住院时间缩短(P<0.05);4组术前24 h和术后72 h时PSQI、术中高血压、低血压、心动过缓、心动过速的发生率比较差异无统计学意义(P>0.05)。结论:合谷穴+内关穴+足三里穴+三阴交穴配伍用于腹腔镜胆囊切除术患者针药平衡麻醉的效果较好。

Objective To compare the effects of different acupoint compatibility on the efficacy of acupuncture-drug balanced anesthesia in the patients undergoing laparoscopic cholecystectomy.Methods A total of 140 patients of both sexes,aged 18-64 yr,with body mass index of 18.5-24.0 kg/m^2,of American Society of Anesthesiologists physical statusⅠ-Ⅲ,undergoing elective laparoscopic cholecystectomy under general anesthesia,were divided into 4 groups(n=35 each)by a random number table method:general anesthesia group(group A),Hegu plus Neiguan group(group B),Hegu plus Neiguan plus Zusanli group(group C),and Hegu plus Neiguan plus Zusanli plus Sanyinjiao group(group D).Group B,group C and group D underwent percutaneous electrical stimulation of the corresponding acupoints from 30 min before induction of anesthesia to the end of operation,with a frequency of 2/100 Hz and disperse-dense waves.The intensity of stimulation was the maximum current that patients could tolerate.The intraoperative consumption of propofol and remifentanil and requirement for rescue analgesia were recorded.Sleep quality was assessed using the Pittsburgh Sleep Quality Index(PSQI)at 24 h before surgery and 24,48 and 72 h after surgery.The extubation time and postoperative length of hospital stay were recorded.Adverse events such as intraoperative hypertension,hypotension,bradycardia and tachycardia were recorded.Results Compared with group A,the intraoperative consumption of propofol and remifentanil and postoperative requirement for rescue analgesia were significantly reduced,the extubation time and postoperative length of hospital stay were shortened,and PSQI was decreased at 24 and 48 h after surgery in B,C and D groups(P<0.05).Compared with group B and group C,PSQI was significantly decreased at 24 and 48 h after surgery,and postoperative hospitalization time was shortened in group D(P<0.05).There was no significant difference in the PSQI and incidence of intraoperative hypertension,hypotension,bradycardia and tachycardia among the four groups(P>0.05).Conclusion Combination of Hegu,Neiguan,Zusanli and Sanyinjiao has a better effect on the efficacy of acupuncture-drug balanced anesthesia in the patients undergoing laparoscopic cholecystectomy.