电针结合七氟烷麻醉在脑外科手术中的应用

作者	单位
王莉莉	首都医科大学附属北京天坛医院麻醉科
王保国	首都医科大学第十一临床医学院北京三博脑科医院
任秀君	北京中医药大学
刘蕴宁	首都医科大学流行病与卫生统计学系
吉勇	首都医科大学附属北京天坛医院麻醉科
安立新	首都医科大学附属北京天坛医院麻醉科

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中文摘要:

目的观察电针结合七氟烷麻醉在脑外科手术中的应用及其对麻醉恢复期的影响。方法择期进行幕上肿瘤切除术的患者80例,随机分为七氟烷吸入全麻组(A组)、电针加七氟烷全麻组(B组)。在药物麻醉诱导开始前,对B组患者进行电针,取开颅侧切口近端穴位,即:风池透天柱及攒竹透鱼腰,频率2/100Hz,刺激强度以患者最大耐受程度为宜。电刺激时间为麻醉诱导开始前直至手术结束。A组患者在上述相应穴位上贴上导线,不进行针刺和电刺激。两组患者在异丙酚2mg/kg、舒芬太尼0.3μg/kg、维库溴铵0.1mg/kg诱导下行气管插管,吸入2%七氟烷维持麻醉,维持脑电双频指数(BIS)在40～50之间,术毕停止吸入七氟烷。记录各时间点七氟烷呼气末浓度、最低肺泡有效浓度(MAC)、BIS以及麻醉恢复期情况。结果两组患者平均动脉压和心率均差异无统计学意义。B组的七氟烷呼气末浓度和MAC,在开颅期、颅内期各时间点均显著低于A组(P<0.05);B组七氟烷用量比A组节省(8.34±1.24)%。两组都能够维持BIS值在40～50之间,保证术中的麻醉深度。B组自主呼吸恢复时间、拔管时间、睁眼时间、随意运动恢复时间、定向力恢复时间、离开手术室时间,均明显小于A组(P<0.05,P<0.01)。麻醉恢复期B组躁动和恶心、呕吐的发生率低于A组。结论电针结合七氟烷麻醉应用于脑外科手术,能够节省七氟烷用量,显著缩短麻醉恢复时间,提高麻醉恢复质量,是一种良好的麻醉方法。

英文摘要:

Objective To observe the effects of electro-acupuncture combined with sevoflurane anesthesia used in neurosurgery patients and the speed of recovery following surgery.Methods Eighty patients with supratentorial tumor resection were anesthetized with sevoflurane and randomly allocated into the complete anesthesia group(Group A) and the electro-acupuncture combined with sevoflurane group(Group B).Han’s acupoint nerve stimulator with 2/100 Hz frequency was used to stimulate the points.Patients in Group B received electro-acupuncture at Fengchi(GB20) toward Tianzhu(BL10) and Cuanzhu(BL2) toward Yuyao(EX-HN4) at the same side of the craniotomy before anesthesia induction.The stimulation was lasted from anesthesia induction until the end of operation.Patients in Group A were pasted with the conducting wire at the aforesaid points,but with no acupuncture or electric stimulation.All patients were induced with propofol 2 mg/kg,sufentanyl 0.3 μg/kg,and vecuronium 0.1 mg/kg,and maintained anesthesia with 2% sevoflurane.The bispectral index(BIS) was maintained ranging 40-50.The sevoflurane was stopped inhaling at the end of the operation.The end-tidal sevoflurane concentration,minimum alveolar concentration(MAC),BIS,and the anesthesia recovery at each time point were recorded in the two groups.Results There was no statistical difference in the mean arterial pressure or the heart rate.The end-tidal concentration and MAC of sevoflurane were significantly lower in Group B than in Group A at each time point(P<0.05).The dose of sevoflurane was reduced by 8.34%±1.24% in Group B when compared with that of Group A.The BIS value could be maintained ranging 40-50 in both groups,thus guaranteeing the anesthesia depth.The time for the spontaneous respiration recovery,the extubation time,the time for opening eyes,the time for the voluntary movement recovery,and the time for orientation recovery,and the time for leaving the operation room were significantly shorter in Group B than in Group A(P<0.01).The occurrence of dysphoria,nausea and vomiting was less in Group B than in Group A.Conclusions Electro-acupuncture combined with sevoflurane used in neurosurgery could save the dose of sevoflurane,significantly shorten the anesthesia recovery time,and improve the quality of the anesthesia recovery.It was a favorable anesthesia method.

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