针刺复合硬膜外麻醉胆囊切除术胆心反射发生率探讨

目的 :探讨针刺复合硬膜外麻醉胆囊切除术胆心反射发生率。方法 :共观察择期胆囊切除术患者 45例 ,按麻醉方法不同 ,随机分为A、B、C三组 ,A组 (即针硬组 )、B组 (即电极组 )、C组(即对照组 )均要求硬膜外麻醉阻滞平面达到T4～ 1 1 以上 ,麻醉效果镇痛完全 ,肌肉松弛 ,牵拉反应轻 ,术中安静 ,根据术中探查、提胆囊、分离胆囊、切胆囊、缝胆囊床等主要手术步骤中HR、MAP、ECG的变化判断胆心反射是否发生。结果 :三组 (各 1 5例 )发生胆心反射共 1 5例 (31 1 1 % ) ,以提胆囊、分离胆囊及探查刺激胆囊发生胆心反射最多 (85 71 % ) ,按统一判断胆心反射标准评定三组胆心反射发生率无显著差异 (P >0 0 5 ) ,术前心电异常病例在术中胆心反射发生率较高 (5 7 1 4% ,P <0 0 5 )。结论 :本项研究三种麻醉方法还不足以抑制或阻断胆心反射发生 ,降低胆囊手术胆心反射发生率的有效方法尚需进一步探讨

Incidence Rate of Gallbladder-cardiac Reflex during Cholecystectomy under Acupuncture Combined with Epidural Administration of Small Dose of Anesthetic

Objective: To observe the incidence rate of gallbladder cardiac reflex during cholecystectomy under acupuncture anesthesia combined with epidural administration of small dose of anesthetic. Methods: 45 cases of cholecystectomy were randomly and evenly divided into acupuncture + epidural administration of anesthetic (A+EAA), electrical stimulation (ES) + EAA and EAA groups. In A+EAA and ES+EAA groups, bilateral Neiguan (PC 6) and Zusanli (ST 36) were stimulated with electroacupuncture (2～3 mA, 2/15 Hz, sparse dense waves) and electrical stimulation (11～12 mA, 2/15 Hz, sparse dense waves), and the patients were also given with lidocaine (1.5%, 5 mL, till the blocked nerve segments being above T 4～11 ) with epinephrine (E) for patients without contraindications or with E. The anesthetic effect was asked to be painless, muscular relaxation, slight traction reaction, and the patient being quiet during operation. In the process of operation including exploring, lifting, separating and incising the gallbladder and suturing the gallbladder bed, the incidence of gallbladder cardiac reflex was assessed according to changes of heart rate (HR), mean artery blood pressure (MBP) and electrocardiogram (ECG). Results: In A+EAA, ES+EAA and EAA groups, the gallbladder cardiac reflex occurred in 4(26.67%), 5 (33.33%) and 5 (33.33%) cases respectively, mainly when the gallbladder was lifting, separating and exploring (85.71%). There was no significant difference among the 3 groups in the incidence of gallbladder cardiac reflex (P>0.05). In addition, in patients who had abnormal ECG before operation, the incidence of this reflex was higher during operation (57.14%). Conclusion: These three anesthetic methods are not capable of suppressing or blocking the occurrence of gallbladder cardiac reflex. The effective method for lowering this reflex needs to be researched further in the future.