颅脑手术穴位电刺激结合全麻行异氟醚控制性降压的效果评价

作者	单位
王均炉	WANG Junlu, XIE Wenxia, JU Xuanxing, et al Affiliated First Hospital, Wenzhou Medical College, Zhejiang (325000
谢文霞	WANG Junlu, XIE Wenxia, JU Xuanxing, et al Affiliated First Hospital, Wenzhou Medical College, Zhejiang (325000
巨宣兴	WANG Junlu, XIE Wenxia, JU Xuanxing, et al Affiliated First Hospital, Wenzhou Medical College, Zhejiang (325000
胡正扬	WANG Junlu, XIE Wenxia, JU Xuanxing, et al Affiliated First Hospital, Wenzhou Medical College, Zhejiang (325000
王恩真	WANG Junlu, XIE Wenxia, JU Xuanxing, et al Affiliated First Hospital, Wenzhou Medical College, Zhejiang (325000

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中文摘要:

目的：探讨穴位电刺激结合全麻行异氟醚控制性降压的临床应用价值。方法：选择脑瘤择期手术４２例，随机分为对照组（Ｉ组）和实验组（Ⅱ组），各２１例。术中通过加大异氟醚浓度使平均动脉压（ＭＡＰ）较麻醉前下降３０％～４０％，维持３０～４５ｍｉｎ。采用ＨＡＮＳ仪电刺激双侧颧■、鱼腰、风池及合谷等穴位对异氟醚控制性降压血流动力学动态变化及麻醉苏醒恢复状况的影响。结果：与Ｉ组比较，Ⅱ组维持麻醉和控制性降压所需异氟醚吸入浓度明显减少，血流动力学变化幅度明显少于Ⅰ组，术后呼吸恢复和麻醉苏醒时间明显缩短。结论：穴位电刺激结合全麻行异氟醚控制性降压适用神经外科手术麻醉。

英文摘要:

To evaluate the feasibility of combined acupuncture-isoflurane anesthesia with deliberated and controlled hypotension induced by isoflurane for the neurosurgical patients. Methods: Forty-two patients with brain tumor scheduled for selective surgery according to the methods of anesthesia, they were further divided into isoflurane anesthesia (group I, n = 21) and combined acupuncture-isoflurane anesthesia (group Ⅱ, n = 21 ). Anesthesia was induced with fentanyl, sodium pentothal and pavolon intravenously administered. The concentration of isoflurane was elevated to reduce mean arterial pressure (MAP) 30 % ～40 % during dissection and occlusion of the tumor. Compare with the hemodynamic parameters (CO, CI, SV, SI, SVR, LVSWI, RPP) which were measured with Swan-Ganz technique before, during and after isoflurane-induced hypotension. In group Ⅱ, during tracheal intubation the acupoint of Quanliao (SI 18), Yuyao (EX-HN4), Fengchi (GB 20) and Hegu (LI 4) were stimulated by Han’s Acupoint Nerve Stimulator. Meanwhile, the isoflurane was inhalated to maintain anesthesia. Results: As compared with group Ⅰ, concentration of isoflurane decreased significantly, and isoflurane average dosage per hour reduced by 31 %～42% in group Ⅱ. SVR, PVR, RPP were significantly decreased in the duration of hypotension (P < 0.05 ). The range change of CO, CI, SV, SI, LVSWI, RPP during controlled hypotension was significantly lower in combined acupuncture-isoflurane anesthe sia than that in isoflurane anesthesia (P < 0. 05). Conclusion: Combined acupuncture-isoflurane anesthesia with isoflurane induced hypotension was used as a selective way for deliberated and controlled hypotension to the neurosurgical patients.

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