针刺复合小剂量硬膜外麻醉胆囊切除术临床研究

本文共观察行择期胆囊切除术患者 46例 ,分为A组 (针刺复合小剂量硬膜外麻醉 ) 1 6例、B组 (穴位电极刺激复合小剂量硬膜外麻醉 ) 1 4例、C组 (单纯小剂量硬膜外麻醉 ) 1 6例三组。结果A、B两组麻醉优良率 (Ⅰ +Ⅱ级 )分别为 1 0 0 %和 92 90 % ,C组优良率 (Ⅰ +Ⅱ级 )为1 2 5 0 % ,A、B两组麻醉效果优于C组 (P <0 0 1 )。三组硬膜外腔每小时平均用药量 (1 5 %利多卡因 ,mL)A、B两组比C组分别减少 33 5 0 %和 34 0 0 % (P <0 0 1 ) ;第一小时容量及总容量A、B两组比C组减少均接近 30 % (P <0 0 1 )。说明针刺 (包括穴位电极刺激 )应用于胆囊切除术 ,既明显减少了硬膜外麻醉用药量 ,提高了麻醉效果 ,又弥补了针麻镇痛和肌松不全的不足 ,可作为胆囊切除术的麻醉方法之一

Clinical Study on the Effect of Acupuncture Combined with Epidural Injection of Small Dose of Anesthetic for Cholecystectomy

Objective: To observe the effect of acupuncture combined with extradural administration of small dose of anesthetic for cholecystectomy. Methods: 46 cases of cholecystectomy were divided into acupuncture + epidural administration of anesthetic (A+EAA) group (n=16), electrical stimulation + EAA (ES+EAA) group (n=14) and EAA group (n=16). Bilateral Neiguan (PC 6) and Zusanli (ST 36) were used for acupuncture (2～3 mA, 2/15 Hz, sparse dense waves) and electrical stimulation (13 mA, 2/15 Hz, sparse dense waves) in A+EAA and ES+EAA groups. Before anesthesia, all the patients were given with intramuscular injection of atropine (0.5 mg/50 kg body weight) and luminal sodium (0.1 g/50 kg), and during operation, they were given with intravenous drip of meperidine (1 mg/kg). Epidural anesthetic used was lidocaine (1.5%, 5 mL) with epinephrine (E) for patients without contraindications or with E. Results: In A+EAA, ES+EAA and EAA groups, the excellent and good rates of anesthetic effect were 100.0% (16 cases), 92.9% (13 cases) and 12.5% (2 cases) respectively. The anesthetic effect of the former 2 groups was obviously superior to that of EAA group (P<0.05). The doses of lidocaine used every hour in A+EAA and ES+EAA decreased by 33.5.% and 34.0% respectively in comparison with EAA group, being significantly lower than that of EAA group (P<0.01). The volume in the first hour and the total volume of lidocaine in A+EAA and ES+EAA groups reduced by 30% compared with that of EAA group. During operation, blood pressure kept stable in A+EAA and ES+EAA groups while lowered in EAA group. Conclusion: Acupuncture and acupoint electrical stimulation combined with extradural injection of small dose of anesthetics can raise the anesthetic effect and meet the demands of cholecystectomy.