针药复合麻醉用于老年冠心病腹腔镜胆囊手术效果

Effectiveness of acupuncture combined with intravenous anesthesia in laparoscopic gallbladder surgery in elderly patients with coronary artery disease

背景冠心病合并胆石症患者由于心血管功能下降,在腹腔镜胆囊切除术过程中易出现应激反应,而针药复合麻醉可减少麻醉药物用量、稳定血流动力学,有利于患者术后恢复.目的基于术后胃肠功能、循环稳定性、炎症-氧化应激探究针药复合麻醉用于老年冠心病腹腔镜胆囊手术效果.方法选取2021-09/2023-06我院收治伴老年冠心病拟行腹腔镜胆囊切除术的104例患者,以随机数字表法分为常规组、针药复合组,各52例.常规组予以全凭静脉复合全麻,针药复合组予以针药复合麻醉,比较两组循环稳定性[心率、平均动脉压(mean arterial pressure,MAP)]、炎症应激指标[白介素-6(interleukin-6,IL-6)、C反应蛋白(C-reactive protein,CRP)、细胞间黏附分子-1(intercellular adhesion molecule-1,ICAM-1)、肿瘤坏死因子-α(tumor necrosis factor alpha,TNF-α)]、氧化应激指标[超氧化物歧化酶(superoxide dismutase,SOD)、过氧化氢酶(catalase,CAT)、总抗氧化能力(total antioxidant capacity,T-AOC)、丙二醛(malondialdehyde,MDA)]、麻醉镇痛用药情况、麻醉恢复与术后胃肠功能及血管活性药物应用、术中快速补液情况.结果针药复合组气管插管后、建立气腹时、术毕心率、MAP低于常规组(P<0.05);针药复合组术后1 d和3 d的CRP、IL-6、ICAM-1、TNF-α低于常规组(P<0.05);针药复合组术后1 d和3 d的SOD、CAT、T-AOC高于常规组,MDA低于常规组(P<0.05);针药复合组丙泊酚、维库溴铵、芬太尼术后24 h镇痛泵点按次数低于常规组(P<0.05);针药复合组意识恢复时间、拔管时间、术后进食时间早于常规组,恶心呕吐发生率低于常规组,24 h内肛门排气患者占比高于常规组(P<0.05);针药复合组应用硝酸甘油、艾司洛尔、术中快速补液患者占比低于常规组(P<0.05).结论针药复合麻醉对于老年冠心病腹腔镜胆囊术具有良好麻醉效果,可促进循环稳定性、炎症-氧化应激及胃肠功能改善,减少麻醉药物用量,有利于术后恢复.

BACKGROUND Patients with coronary artery disease combined with cholelithiasis are susceptible to stress during laparoscopic cholecystectomy due to the decline in cardiovascular function,and acupuncture combined with intravenous anesthesia can reduce the amount of anaesthesia drugs used and stabilise haemodynamics,which is conducive to the patient’s post-operative recovery.AIM To explore the effectivenss of acupuncture combined with intravenous anesthesia in laparoscopic gallbladder surgery in elderly patients with coronary heart disease with regard to postoperative gastrointestinal function,circulatory stability,inflammation,and oxidative stress.METHODS A total of 104 patients with coronary heart disease who would undergo laparoscopic cholecystectomy at our hospital from September 2021 to June 2023 were selected and divided into either a routine intravenous anesthesia group or an acupuncture plus intravenous anesthesia group using the random number table method,with 52 cases in each group.Both groups were given routine intravenous general anesthesia,and the combination group additionally underwent acupuncture.Circulatory stability[heart rate and mean arterial pressure(MAP)],inflammatory stress indexes[interleukin-6(IL-6),C-reactive protein(CRP),intercellular adhesion molecule-1(ICAM-1),and tumor necrosis factor-α(TNF-α)],oxidative stress indexes[superoxide dismutase(SOD),catalase(CAT),total antioxidant capacity(T-AOC),and malondialdehyde(MDA)],anesthesia and analgesia medication,anesthesia recovery,postoperative gastrointestinal function,vasoactive drug application,and rapid intraoperative fluid rehydration were compared between the two groups.RESULTS The heart rate and MAP at intubation,at pneumoperitoneum establishment,and after operation were lower in the combination group than in the routine anesthesia group(P<0.05).The levels of CRP,IL-6,ICAM-1,and TNF-αin the combination group were lower than those in the routine anesthesia group 1 and 3 d after surgery(P<0.05).SOD,CAT,and T-AOC in the combination group were higher than those of the routine anesthesia group,while MDA was lower than that of the routine anesthesia group(P<0.05).The number of times of analgesic pump pressing for administering propofol,vicuronium,and fentanyl at 24 h after operation in the combination group was lower than that of the routine anesthesia group(P<0.05).The time to consciousness recovery,time to extubation,and time to postoperative intake in the combination group were earlier than those of the routine anesthesia group,the incidence of nausea and vomiting was lower than that of the routine anesthesia group,and the proportion of patients with anal exhaust within 24 h was higher than that of the routine anesthesia group(P<0.05).The proportion of patients receiving nitroglycerin,esmolol,and rapid fluid rehydration in the combination group was lower than that of the routine anesthesia group(P<0.05).CONCLUSION Acupuncture combined with intravenous anesthesia has a good anesthetic effect in laparoscopic cholecystectomy for elderly patients with coronary heart disease,which can promote circulation stability,improve inflammatory-oxidative stress and gastrointestinal function,reduce the amount of anesthetic drugs used,and is conducive to postoperative recovery.