不同麻醉方法对腹腔镜胆囊切除术患者术后镇痛的效果

目的:比较全麻、针刺复合全麻经穴组(简称经穴组)、针刺复合全麻非经非穴组(简称非经非穴组)对腹腔镜胆囊切除术(LC)患者术后镇痛效果的影响。方法:选取择期行腹腔镜胆囊切除术患者90例,ASAI或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,静脉注射芬太尼、维库溴铵维持。术后患者均行静脉自控镇痛(PCIA)。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,两组均于全麻诱导前15～30min持续电针刺激至术毕。观察并记录3组患者术后4h、6h、8h、24h及44h疼痛视觉模拟评分(VAS)、舒适评分(BCS评分)及镇静评分;记录PCIA的总次数、芬太尼用量和给药后不良反应的发生情况;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。结果:经穴组术后44hVAS评分明显低于全麻组和非经非穴组(P<0.05),BCS评分明显高于全麻组和非经非穴组(P<0.05),术后4、6h镇静评分明显低于全麻组(P<0.05);经穴组术后PCIA按压总次数明显少于全麻组(P<0.05),术后4、6、8h芬太尼用量明显少于全麻组(P<0.05),术后4h、6h芬太尼用量亦明显少于非经非穴组(P<0.05),术后不良反应发生率明显低于全麻组(P<0.05);经穴组术后第1天β-Ep水平明显低于全麻组及非经非穴组(P<0.05)。结论:针刺经穴复合全麻可以提高腹腔镜胆囊切除术患者术后镇痛效果,减少芬太尼的用量,降低不良反应的发生率,而全麻和针药复合麻醉非经非穴组术后早期需要更大剂量的芬太尼来缓解疼痛。

Effects of Different Anesthesia Methods on Postoperative Analgesia in Patients of Laparoscopic Cholecystectomy

Objective：To compare the influence of acupuncture anesthesia combined with medicine anesthesia（acupoints and nonpoints）and merely medicine anesthesia on postoperative analgesia in patients of laparoscopic cholecystectomy.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.Each patient was given patient controlled intravenous analgesia after operation.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 acupuncture point.Records were analgetic dosage during postoperative 4h,6h,8h,24h and 44h,VAS score,BCS score,conscious-sedation score,the total frequency of PCIA and the occurrence of untoward reaction.Blood samp1es（3mL/time）were collected from the peripheral vein before opearation,2 hours,1 day and 3 days after operation for level of β-EP.Results：VAS score at postoperative 44h of acupuncture combined with medicine asesthesia（acupoints） group was significantly lower than that of medicine anesthesia group and acupuncture combined with medicine anesthesia（nonpoints） group（P〈0.05）,BCS score at that time point was significantly higher than that of medicine anesthesia group and acupuncture combined with medicine anesthesia（nonpoints） group（P〈0.05）,conscious-sedation score at postoperative 4h and 6h of acupuncture combined with medicine asesthesia（acupoints） group was significantly lower than that of medicine anesthesia group（P〈0.05）.The total frequency of PCIA of acupuncture combined with medicine asesthesia（acupoints） group was significantly less than that of medicine anesthesia group（P〈0.05）.Acupuncture combined with medicine asesthesia（acupoints） group had less analgetic dosage during postoperativ 4h,6h and 8h than that of medicine anesthesia group（P〈0.05）and less analgetic dosage during postoperativ 4h and 6h than that of acupuncture combined with medicine anesthesia（nonpoints） group（P〈0.05）.There was lowest incidence rate of occurrence of untoward reaction in Acupuncture combined with medicine asesthesia（acupoints） group（P〈0.05）.The level of β-Ep of patients of acupuncture combined with medicine asesthesia（acupoints） group 1 days after operation was significantly lower than that of medicine anesthesia group and acupuncture combined with medicine anesthesia（nonpoints） group（P〈0.05）.Conclusion：Acupuncture anesthesia combined with medicine anesthesia（acupoints） can enhance the effect of postoperative analgesia,decrease the dosage of anesthetic and reduce incidence rate of postoperative untoward reaction,while patients in acupuncture combined with medicine anesthesia（nonpoints） group and medicine anesthesia group require much more dosage of Fentany during the early period of time after operation to relieve pain.