电针复合药物全麻对围术期腹腔镜胆囊切除术患者血流动力学及内啡肽的影响

目的观察不同麻醉方法对腹腔镜胆囊切除术围术期患者血流动力学及内啡肽的影响。方法选择90例腹腔镜胆囊切除术患者,按美国麻醉医师协会(American Society of Anesthesiologists,ASA)病情分级Ⅰ～Ⅱ级,年龄29～80岁,随机分为3组:A组(电针经穴复合全麻组)、B组(电针非经非穴复合全麻组)、C组(全麻组),每组30例。3组患者均采用芬太尼3μg/kg、异丙酚2mg/kg、维库溴铵0.1mg/kg进行全麻诱导,脑电双频指数(bispectral index,BIS)(40～65)处于全麻状态下,术中以静脉血浆靶控输注异丙酚,间断静脉注射芬太尼、维库溴铵维持麻醉。术后患者均静脉自控镇痛(patient controlled intravenous analgesia,PCIA)。在此基础上,A组选取双侧合谷、内关、曲池、足三里、阳陵泉,B组选用A组每个经穴所在经脉与外侧相邻经脉与经穴相平处连线的中点取穴,两组均于全麻诱导前15～30min持续电针刺激至术毕。分别于麻醉诱导前、腹腔开始CO2充气即刻、CO2充气后5min、胆囊切除、术毕时连续监测心率(heart rate,HR)、平均动脉压(mean arterial pressure,MAP)、心脏指数(cardiac index,CI)、心排量(cardiac output,CO)、体血管阻力指数(systemic vascular resistance index,SVRI)、加速度指数(acceleration index,ACI)。记录停药至自主呼吸恢复、呼之睁眼、拔除气管导管时间,并分别于麻醉诱导前、术毕2h、术后第1天及术后第3天采集患者静脉血3mL,送检β-内啡肽(β-endorphin,β-EP)。观察并记录3组患者术后4、6、8、24及44h疼痛视觉模拟评分(visu alanalogue scale,VAS)。结果 (1)与本组麻醉诱导前比较,各组的CI、CO、ACI在CO2充气后5min及胆囊切除时均显著降低(P<0.01,P<0.05),B组和C组HR、MAP、SVRI在各时段均有明显上升(P<0.05,P<0.01),A组则变化较小;与C组比较,A组的MAP在充气后5min上升幅度较小,差异有统计学意义(P<0.05)。(2)A组患者从停药到呼之睁眼、拔除气管导管时间显著短于B、C两组(P<0.05,P<0.01)。(3)A组术后第1天β-EP水平明显低于B组(P<0.05)和C组(P<0.01)。(4)A组术后44hVAS评分明显低于B、C两组(P<0.05)。结论电针经穴复合全麻能维持血流动力学的稳定,减轻CO2气腹后及术后应激反应,并可延长至术后早期,增强术后镇痛效果,术后恢复迅速,安全可靠。

电针复合不同麻醉方式对脑血管支架置入术患者术中及术后恢复的影响

目的探讨电针复合不同麻醉方式对脑血管支架置入术患者术中及术后恢复的影响.方法将2014年12月至2017年12月在我院进行脑血管支架植入术的50例患者分为全麻电针组、全麻对照组、局麻电针组和局麻对照组.观察对比四组患者术后恢复的情况.结果全麻电针组的多巴胺及瑞芬太尼的平均用量均少于全麻对照组(P<0.05).术后全麻电针组拔管期呼吸恢复时间、拔管时间、苏醒时间均短于全麻对照组(P<0.05).全麻电针组中在术后第1天的9 am、4 pm出现中等以上疼痛的患者少于全麻对照组,局麻电针组少于局麻对照组(P<0.05).结论脑血管支架置入术患者需要根据血管堵塞部位选择麻醉方式.术中全麻或局麻采用针刺辅助可以减少麻醉药物和血管活性药物的使用量,促进麻醉恢复和辅助镇痛.

电针复合乌拉坦麻醉对家兔的生理影响

试验通过电针复合乌拉坦对家兔麻醉的麻醉效果和生理影响。选用21只家兔按体重随机分为电针组(A组)、乌拉坦组(分为B1组3 mL/kg、B2组4 mL/kg、B3组5 mL/kg)和电针复合乌拉坦组(C1组3 mL/kg、C2组4 mL/kg、C3组5 mL/kg)监测麻醉状态下的0、15、30、45、60、75 min的生理指标和麻醉指标。结果显示,在麻醉指标上,A组与B3组和C2组差异显著(P<0.05),同时B3组和C2组麻醉效果相似。在生理指标上,B3组和C2组体温差异显著(P<0.05);C2组和B3组在15min后呼吸频率较平稳;心率差异显著(P<0.05),B组随乌拉坦剂量增加,心率增加,C组则相反。结论:电针复合乌拉坦在麻醉效果方面,可以减少麻醉药品的使用量,在生理上,可以维持生理指标的平稳,提高镇静作用,广泛应用于试验过程中。

电针治疗膝骨关节炎临床研究进展

近10年来,有关电针治疗膝骨关节炎的临床研究发展迅速,研究方向可分为单一电针疗法和电针复合疗法两方面。这些研究均表明,电针在膝骨关节炎的治疗中具有良好疗效,可明显缓解关节疼痛、僵硬症状,提高患者日常生活能力。但当前临床研究存在设计不够严谨、远期疗效不明确、横向对比欠缺等问题,今后研究需针对这些问题加以改进。参考文献57篇。

Observation on effect of electroacupuncture of different frequencies on patients after thyroid surgery:a randomized controlled trial

Objective To observe postoperative effect of electroacupuncture（EA） of different frequencies in acupuncture anesthesia combined with drugs on patients undergoing thyroid surgery.Methods One hundred and twenty patients undergoing thyroid surgery were randomly divided into a 2Hz electroacupuncture anesthesia group（group A）,a 100 Hz electroacupuncture anesthesia group（group B）,a 2Hz/100 Hz electroacupuncture anesthesia group（group C） and a cervical plexus block group（group D） in accordance with the random number table method,with 30 patients in each group.In group A,group B and group C,electroacupuncture was applied at bilateral Futu（扶突 LI 18）,Hegu（合谷 LI 4） and Neiguan（内关 PC 6） at frequencies of 2 Hz,100 Hz and 2 Hz/100 Hz respectively for 30 min.The needles were retained till the end of the surgery.Dolantin and atropine were intramuscularly injected In group D,bilateral cervical plexus block was produced with a mixture of1%lidocaine and 0.375%bupivicaine.Before surgery,pain threshold and threshold of pain tolerance were determined;during surgery,the duration of surgery was recorded;and after surgery,QOLS（Quality Of Life Score） and PHS（Prince-Henry Score） were assessed.Results PHS in group A,group B and group C were lower than that in group D,respectively（0.20±0.41,0.17±0.38,0.10±0.31 vs 0.40±0.50,P〈0.01）,and PHS in group C was lower than those in group A and group B,respectively（both P〈0.01）.QOLS in group A,group B and group C were higher than that in group D,respectively（9.97±1.07,9.97±2.27,10.40±1.45 vs 9.73±1.41,P〈0.05,P〈0.01）,and QOLS in group C was higher than those in group A and group B,respectively（both P〈0.05）.Conclusion Acupuncture anesthesia combined with drugs has better postoperative effect than drug anesthesia.Electroacupuncture of different frequencies can significantly improve general quality of life of patients,so patients recover well after thyroid surgery.As patients in group C suffered from the slightest pain with the highest quality of life,they recovered best within the shortest time.Electroacupuncture at frequency of 2 Hz/100 Hz can better play postoperative analgesic effect.