针麻复合靶控输注对腹腔镜宫外孕手术病人术中心脏泵功能的影响

目的采用无创方法对患者血流动力学进行监测,探讨腹腔镜宫外孕手术中针麻复合靶控输注(target-controlled infusion,TCI)对心脏泵功能的影响。方法选择20例行腹腔镜宫外孕手术的患者作为研究对象,随机分为两组,每组10例。对照组行单纯TCI;观察组行TCI联合针刺合谷、内关。在维持相同麻醉深度的条件下,通过无创血流动力学监测患者麻醉前、诱导后插管前、插管时、气腹时、气腹毕以及苏醒时、拔管时的血流动力学指标,包括心率(HR)、平均动脉压(MAP)、每搏输出量(SV)、心输出量(CO)、体循环血管阻力(SVR)、胸腔液体量(TFC)。记录患者术中所用异丙酚和瑞芬太尼的用量。结果 1组内比较:对照组与基础值相比,插管前的HR、MAP、CO、SVR明显降低;插管时的MAP明显升高;气腹时HR、MAP、SVR明显升高;气腹毕的HR、CO明显降低;苏醒时HR、MAP、CO明显升高;拔管时的HR、MAP、CO明显升高。观察组与基础值相比,插管前的HR、MAP明显降低;气腹毕的HR明显降低。2组间比较:观察组在插管前的HR、SVR高于对照组,气腹时的HR、MAP低于对照组,苏醒及拔管时的HR、MAP、CO低于对照组。3观察组异丙酚和瑞芬太尼的用量小于对照组。结论在控制麻醉深度相同的条件下,针麻复合TCI能明显减轻术中血流动力学的波动,使血流动力学趋于稳定,并且能减少麻醉药物的用量。

Effect of Combined Acupuncture and Target-controlled Infusion Anesthesia on Hemodynamics During Laparoscopy of Ectopic Pregnancy

Objective To evaluate the influences of combined acupuncture and target-controlled infusion anesthesia on hemodynamic parameter variations during laparoscopy of ectopic pregnancy through non-invasive methods. Methods Twenty female patients scheduled for laparoscopy of ectopic pregnancy were selected in this study , and divided into the control group and the observation group, 10 patients for each. The control group used target-controlled infusion only, and the observation group used combined target-controlled infusion and ac- upuncture at bilateral Neiguan and Hegu. Changes of hemodynamics were monitored using thoracic bio-imped- ance method at different time points of operation, i.e. the baseline, after induction and before intubation, dur- ing intubation, estabhshing pneumoperitoneum, ending of pneumoperitoneum, regaining consciousness and dur- ing extubation. Changes of hemodynamics inclused heart rate （ HR）, mean arterial pressure （MAP）, stroke vol- ume （ SV）, cardiac output （ CO）, systemic vascular resistance （SVR） and thoracic fluid content （ TFC ）. The dosages of anesthetic among groups were compared. Results ①Comparing to the baseline in the control group, HR, MAP, CO, SVR after induction and before intubation decreased significantly; MAP increased sig- nificantly during intubation; HR, MAP, SVR at establishing pneumoperitoneum increased significantly; HR,CO at ending of pneumoperitoneum decreased significantly; HR, MAP, CO at regaining consciousness and dur- ing extubation increased significantly. Comparing to the baseline in the observation group, HR, MAP after in- duction and before intubation decreased significantly; HR at ending of pneumoperitoneum decreased significant- iy. ②Comparing to the control group, HR, SVR of the observation group after induction and before intubation increased significantly; HR, MAP of the observation group at establishing pneumoperitoneum decreased signifi- cantly; HR, MAP, CO of the observation group at regaining consciousness and during extuba