腹腔镜胆囊切除术患者针药复合麻醉效果

评价腹腔镜胆囊切除术患者针药复合麻醉的效果。方法:选取择期行腹腔镜胆囊切除术患者90例,ASAI～Ⅱ级,(年龄29～80岁),随机分成3组:全麻组、针刺复合全麻经穴组、针刺复合全麻非经非穴组,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,术中以静脉输注异丙酚,间断静脉注射芬太尼、维库溴铵维持麻醉。经穴组选取双侧合谷、内关、足三里、阳陵泉,非经非穴组选用经穴组每个经穴所在经脉与外侧相邻经脉连线的中点,与经穴相平处持续电针刺激。分别于麻醉诱导前(基础值)、开始CO2充气即刻、CO2充气后5min、胆囊切除、术毕时记录平均动脉压(MAP)、心率(HR)、心脏指数(CI)、心排量(CO)、体血管阻力指数(SVRI)和加速度指数(ACI),比较3组患者术中麻醉药用量,记录停药至自主呼吸恢复、呼之睁眼、拔除气管导管时间。结果:①3组患者气腹后CI、CO、ACI明显降低,全麻组和非经非穴组HR、MAP、SVRI均明显增加,经穴组则变化较小;②经穴组麻醉药用量明显少于全麻组,芬太尼、维库溴铵、异丙酚分别比全麻组节约14%、13%、25%;③经穴组患者从停药到呼之睁眼、拔除气管导管时间显著快于非经非穴组及全麻组。结论:腹腔镜胆囊切除术病人采用针刺经穴复合全麻能维持血液动力学的稳定,恢复迅速。

Effects of Combined Acupuncture and Medicine Anesthesia in Patients of Iaparoscopic Cholecystectomy

Objective：To evaluate the effects of patients of laparoscopic cholecystectomy undergoing acupuncture anesthesia combined with medicine anesthesia.Methods：A total 90 cases of cholecystitis plus cholelithiasis patients（age from 29 to 80,ASA Ⅰ~Ⅱ）were randomly divided into medicine anesthesia group,acupuncture combined with medicine asesthesia（acupoints） group,acupuncture combined with medicine anesthesia（nonpoints）group,30 cases in each group.The dosage of anesthesia induction of each patient was Fentany（Fen）l 3μg/kg,Propofol（Pro） 2mg/kg,Vecuronium（Vcr） 0.1mg/kg.Maintenance of anesthesia was Propofol intravenous injection and interruption intravenous injection with Fentanyl and Vecuronium.The patients in the acupuncture combined with medicine asesthesia（acupoints） group received electrical point stimulation at Hegu（LI4）,Neiguan（PC6）,Zusanli（ST36）,Yanglinquan（GB34）.The patients of acupuncture combined with medicine anesthesia（nonpoints） group received electrical point stimulation at the point beside acupucture point.Records were mean arterial pressure（MAP）,heart rate（HR）,cardiac index（CI）,cardiac output（CO）,systemic vascular res.index（SVRI） and acceleration index（ACI） at the time of before anesthesia induction,beginning of pneumoperitoneum,5 minutes after pneumoperitoneum,excision of gallbladder and the end of operation.Compare with the dosage of anesthetic among the three groups,record the time consuming from discontinuation to spontaneously breathing recovery,analepsia and extubation.Results：①CI,CO,ACI of all patients decreased significantly after pneumoperitoneum,the cases in medicine anesthesia group and acupuncture combined with medicine anesthesia（nonpoints）group had significant increasing in HR,MAP,SVRI,the cases in acupuncture combined with medicine asesthesia（acupoints） group had less change.②Compared with medicine asesthesia group,the dosage reduction of acupuncture combined with medicine asesthesia（acupoints） group was 14%（Fen）、13%（Vcr）、25%（Pro）,which was significantly less than that of medicine asesthesia group ③The time consuming from discontinuation to sanalepsia and extubation of acupuncture combined with medicine asesthesia（acupoints） group was shorter than that of medicine anesthesia group and acupuncture combined with medicine anesthesia（nonpoints）group.Conclusion：Patients of laparoscopic cholecystectomy undergoing acupuncture anesthesia combined with medicine anesthesia had such advantages as stabilization of haemodynamics and sooner recorvery.