针刺复合全麻对胆囊切除术患者围手术期血流动力学的影响

目的观察针刺复合全身麻醉对腹腔镜胆囊切除术患者围术期血流动力学的影响,方法选择择期腹腔镜胆囊切除手术ASAⅠ-Ⅱ级患者60例,随机分成两组,分别用全麻(对照组)和针刺复合全麻(针麻组)。两组均以咪达唑仑、芬太尼、丙泊酚、维库溴铵诱导,针麻组在全麻诱导前应用针麻仪刺激器(取双侧内关、合谷、曲池穴)进行电针刺激,针麻诱导15 min后与全麻组一样开始全麻诱导和维持。并运用胸电生物阻抗法无创连续血流动力监测仪监测麻醉诱导前基础值、麻醉诱导后意识消失时、气管插管即刻、手术开始时、术毕、拔管时、拔管后10 min的心功能和血流动力学变化。结果两组患者手术持续时间和麻醉维持时间均无统计学意义。单位时间维库溴铵用药量针麻组比对照组明显减少(P<0.05)。对照组平均动脉压(MAP)、心率(HR)、心率收缩压乘积(RPP)、心排血量(CO)、外周血管阻力(SVR)及血流加速度指数(ACI)在麻醉诱导期均显著低于麻醉诱导前(P<0.05或P<0.01),在插管即刻和拔管时均显著高于麻醉诱导前(P<0.05或P<0.01),而针麻组无明显变化;插管即刻和拔管时,MAP、RPP、SVR和ACI对照组明显高于针麻组(P<0.05或P<0.01)。结论针刺复合麻醉具有双向调节作用,使术中血流动力学波动小,血液循环趋于稳定,并且能减少麻醉药用量,具有广泛的应用价值。

英文摘要:

Objective To observe the effect of acupuncture-general anesthesia on hemodynamics in the peri- operative period of patients undergoing laparoscopic choleeystectomy.Methods Sixty patients of ASA classⅠ-Ⅱscheduled to receive laparoscopic cholecystectomy were randomly assigned to two groups equally,Group A,the control group,and Group B,the compound anesthesia group.The general anesthesia applied on them during opera- tion was induced by combined midazolam,fentanyl,propofol and vecuronium bromide,but for those in Group B, 15 rain of electric stimulation at bilateral Neiguan（PC6）,Hegu（LI4）and Quchi（LI11）was given with an acu- puncture anesthesia apparatus before the drug induction as acupuncture anesthesia induction,then the general anes- thesia started and maintained the same as that in Group A.Changes of cardiac function and hemodynamics were monitored using thoracic electrical bio-impedance method at different time points of operation,i.e.the baseline be- fore induction（T₀）,after induction when loss of consciousness（T₁）,during intubation（T2）,beginning of opera- tion（T₃）,ending of operation（T₄）,during extubation（T₅）and 10 min after extubation（T₆）.Results No sig- nificant difference between the two groups was found in operation lasting time and anesthesia maintaining time（P>0.05）.The amount of veeuronium bromide consumed in an unit of time in Group B was significantly lower than that in Group A（P<0.05）.The mean arterial pressure（MAP）,heart rate（HR）,rate pressure product （RPP）,cardiac output（CO）,systemic vascular resistance（SVR）,and blood flow acceleration index（ACI）in Group A at T₁ were all significantly lower（P<0.05 or P<0.01）,but became significantly higher at T₂ and T₅ as compared with those of baseline（P<0.05 or P<0.01）,while no significant change of them was found in Group B.Moreover,MAP,RPP,SVR and ACI were significantly higher in Group A than those in Group B at T2 and T₅ （P<0.05 or P<0.01）.Conclusion The acupuncture-general anesthesia shows a hi-directional effect for dimin- ishing the fluctuation of hemodynamics and stabilizing the blood circulation,and also can reduce the consumption of narcotics during operation,so it has an extensive value in clinical practice.

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