甲状腺结节消融术应用针药复合麻醉的效果及其对患者血清β-内啡肽的影响

Effect of combined acupuncture-medicine anesthesia in thyroid nodule ablation and its effect on serum β-endorphin

目的:观察针药复合麻醉用于甲状腺良性结节微波消融术的麻醉效果及其对患者血清β-内啡肽(β-EP)含量的影响。方法:将符合纳入标准并行甲状腺良性结节射频消融术的60例患者随机分为针药复合麻醉(治疗)组和静脉麻醉(对照)组,每组30例。观察两组麻醉镇静镇痛效果、麻醉药的用量、术中打鼾和呼吸抑制发生率以及麻醉前、手术前、手术完毕时血清β-EP含量的变化。结果:两组均取得了良好的镇痛效果;治疗组Ramsay镇静评分、芬太尼及丙泊酚用量、术中打鼾和呼吸抑制发生率均明显低于对照组(P<0.05,P<0.01)。治疗组血清β-EP含量在手术前和手术完毕时均升高(P<0.05),且高于同时点对照组(P<0.05);对照组血清β-EP含量各时点差异无统计学意义(P>0.05)。结论:针药复合麻醉用于甲状腺良性结节微波消融术镇痛镇静效果良好,能减少静脉麻药用量;减少术中打鼾和呼吸抑制发生率。针刺麻醉的镇痛作用可能与β-EP分泌增加有关。

Objective To investigate the anesthetic effect of combined acupuncture-medicine anesthesia in microwave ablation of benign thyroid nodules and its effect on serumβ-endorphin.Methods A total of 60 patients who met the inclusion criteria and received microwave ablation of benign thyroid nodules were randomly divided into the treatment group and the control group,with 30 patients in each.The patients in the treatment group were given combined acupuncture-medicine anesthesia,and those in the control group were given intravenous anesthesia.The two groups were compared in terms of the sedative and analgesic effects of anesthesia,amount of anesthetics used,incidence rate of intraoperative snore and respiratory depression,and change in serumβ-endorphin level before anesthesia,before surgery,and after the surgery.Results Both groups obtained satisfactory anesthetic effects.Compared with the control group,the sedation score,the amounts of fentanyl and propofol used,the incidence rates of intraoperative snore and respiratory depression in the treatment group were obviously lower(P<0.05,P<0.01).The treatment group had an increase in serumβ-endorphin level before surgery and at the end of surgery(P<0.05),while the control group showed no significant change in serumβ-endorphin level at each time point.Conclusion In microwave ablation of benign thyroid nodules,combined acupuncture-medicine anesthesia has good sedative and analgesic effects and can reduce the amounts of anesthetics used as well as the incidence rates of intraoperative snore and respiratory depression.The analgesic effect of acupuncture anesthesia is associated with increasedβ-endorphin secretion.