针灸辅助全凭静脉麻醉对冠心病行腹部手术患者围手术期应激反应的影响

目的：探讨针灸辅助全凭静脉麻醉对冠心病行腹部手术患者围手术期应激反应的影响。方法：选取本院近年来收治冠心病行腹部手术患者160例,采用随机数字表法分为对照组（80例）和针灸组（80例）;其中对照组患者行常规全凭静脉麻醉;针灸组患者则在行常规全凭静脉麻醉前给予针刺穴位30 min,并持续辅助全身麻醉至手术结束;比较两组患者不同时间点血流动力学、心电图ST段改变、血清皮质醇（Cor）、去甲肾上腺素（NE）、肾上腺素（E）及心肌肌钙蛋白I（cTnI）水平等。结果：针灸组患者不同时间点HR和MAP水平比较差异无统计学意义（P〉0.05）;对照组患者麻醉后30 min、60 minHR和MAP水平均显著高于对照组和麻醉前,差异有统计学意义（P〈0.05）;两组患者麻醉后60 min和手术完成后30 minST段均显著低于麻醉前（P〈0.05）;但针灸组患者手术完成后30 minST段较对照组显著提高,差异有统计学意义（P〈0.05）;对照组患者手术完成后Cor、NE、E及cTnI水平均显著高于麻醉前（P〈0.05）;针灸组患者麻醉前和手术完成后Cor、NE及E水平比较差异无统计学意义（P〉0.05）;针灸组患者手术完成后cTnI较麻醉前显著提高,但低于对照组,差异有统计学意义（P〈0.05）。结论：针灸辅助全凭静脉麻醉可有效降低冠心病行腹部手术患者围手术期应激反应,改善心肌缺血症状。

Effects of Acupuncture Assisted with Total Intravenous Anesthesia on Stress Response in Peri-operation Period of Patients with Coronary Heart Disease and Abdominal Operation

Objective：To investigate effects of acupuncture assisted with total intravenous anesthesia on stress response in peri- operation period of patients with coronary heart disease and abdominal operation. Methods：160 patients with coronary heart disease and abdominal operation were chosen in recent years in our hospital and randomly divided into two groups including control group（80 patients） with conventional total intravenous anesthesia and acupuncture group（80patients） with acupuncture points for 30 min before conventional total intravenous anesthesia and continued to the end of operation; and the hemodynamics,ST segment changes of ECG,the levels of Cor,NE,E and cTnI in different time points of both groups were compared. Results：There was no significant difference in levels of HR and MAP in different time points of acupuncture group（ P〈0. 05）. The levels of HR and MAP in 30 min and 60 min after anesthesia of control group were statistically significant higher than acupuncture group and before anesthesia（P〈0. 05）. The levels of ST segment in 60 min after anesthesia and 30 min after operation of both groups were significantly lower than before anesthesia（P〈0.05）. But the levels of ST segment in 30 min after operation of acupuncture group were significantly higher than control group（P〈0. 05）. The levels of Cor,NE,E and cTnI after operation of control groups were significantly lower than before anesthesia（P〈0. 05）. There was no significant difference in levels of Cor,NE,E before anesthesia and after operation of acupuncture group（P〈0. 05）. The levels of cTnI after operation of acupuncture group were significantly higher than before anesthesia and lower than control group（P〈0. 05）. Conclusion：Acupuncture assisted total intravenous anesthesia on patients with coronary heart disease and abdominal operation can effectively reduce the stress response in peri-operation period and improve symptoms of myocardial ischemia.