针刺复合麻醉对甲状腺良性结节消融术镇痛和应激的影响
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摘要
目的观察针刺复合局部麻醉在甲状腺良性结节消融术中的镇痛效果和对应激反应的影响。方法将60例择期进行甲状腺良性结节微波消融术的患者随机分为治疗组和对照组,每组30例。对照组采用单纯局部麻醉,治疗组在对照组基础上采用针刺麻醉。比较两组各时间点[麻醉前(T_0)、麻醉后(T_1)、消融术中(T_2)、手术结束(T_3)]患者的平均动脉压(MAP)、心率(HR)、术毕VAS评分和T_0、T_2、T_3时点血清皮质醇(Cor)、肾上腺素(E)、葡萄糖(Glu)水平的变化情况。结果治疗组T_2 MAP和HR与同组T_0比较,差异均具有统计学意义(P<0.05);对照组T_2、T_3 MAP和HR与同组T_0比较,差异均具有统计学意义(P<0.05)。两组T_2、T_3 MAP和HR比较,差异均具有统计学意义(P<0.05)。治疗组术后VAS评分为(1.69±1.43)分,对照组为(3.54±1.27)分,两组比较差异具有统计学意义(P<0.01)。治疗组T_2、T_3 E和Glu水平与同组T_0比较,差异均具有统计学意义(P<0.05)。对照组T_2、T_3各项应激指标与同组T_0比较,差异均具有统计学意义(P<0.05)。两组T_2、T_3各项应激指标比较,差异均具有统计学意义(P<0.05)。结论针刺复合局部麻醉在甲状腺良性结节消融术中可有效镇痛,并能维持较稳定的血压和心率。
Objective To observe the effect of acupuncture-combined anesthesia on analgesia and stress reactions in benign thyroid nodule ablation. Method Sixty patients who were going to receive microwave ablation for benign thyroid nodules were randomized into a treatment group and a control group, with 30 cases in each group. The control group was intervened by local anesthesia, and the treatment group was additionally given acupuncture anesthesia. For the two groups, the mean arterial pressure(MAP) and heart rate(HR) at each time point [before anesthesia(T_0), after anesthesia(T_1), during ablation(T_2) and at the end of the operation(T_3)] were compared, as well as the Visual Analogue Scale(VAS) at T_3, the serum levels of cortisol(Cor), adrenaline(E) and glucose(Glu) at T_0, T_2 and T_3. Result In the treatment group, the MAP and HR at T_2 were significantly different from those at T_0(P<0.05); in the control group, the MAP and HR at T_2 and T_3 were significantly different from those at T_0(P<0.05). There were significant differences in the MAP and HR between the two groups at T_2 and T_3(P<0.05). After the operation, the VAS score was(1.69±1.43)in the treatment group versus(3.54±1.27) in the control group, and the between-group difference was statistically significant(P<0.01). In the treatment group, the levels of E and Glu at T_2 and T_3 were significantly different from those at T_0(P<0.05). In the control group, the stress indicators at T_2 and T_3 were significantly different from those at T_0(P<0.05). There were significant differences in the stress indicators between the two groups at T_2 and T_3(P<0.05).Conclusion Acupuncture-combined anesthesia can produce effective analgesic effect in benign thyroid nodule ablation, and it basically can maintain the stability of blood pressure and HT.
Objective To observe the effect of acupuncture-combined anesthesia on analgesia and stress reactions in benign thyroid nodule ablation. Method Sixty patients who were going to receive microwave ablation for benign thyroid nodules were randomized into a treatment group and a control group, with 30 cases in each group. The control group was intervened by local anesthesia, and the treatment group was additionally given acupuncture anesthesia. For the two groups, the mean arterial pressure(MAP) and heart rate(HR) at each time point [before anesthesia(T_0), after anesthesia(T_1), during ablation(T_2) and at the end of the operation(T_3)] were compared, as well as the Visual Analogue Scale(VAS) at T_3, the serum levels of cortisol(Cor), adrenaline(E) and glucose(Glu) at T_0, T_2 and T_3. Result In the treatment group, the MAP and HR at T_2 were significantly different from those at T_0(P<0.05); in the control group, the MAP and HR at T_2 and T_3 were significantly different from those at T_0(P<0.05). There were significant differences in the MAP and HR between the two groups at T_2 and T_3(P<0.05). After the operation, the VAS score was(1.69±1.43)in the treatment group versus(3.54±1.27) in the control group, and the between-group difference was statistically significant(P<0.01). In the treatment group, the levels of E and Glu at T_2 and T_3 were significantly different from those at T_0(P<0.05). In the control group, the stress indicators at T_2 and T_3 were significantly different from those at T_0(P<0.05). There were significant differences in the stress indicators between the two groups at T_2 and T_3(P<0.05).Conclusion Acupuncture-combined anesthesia can produce effective analgesic effect in benign thyroid nodule ablation, and it basically can maintain the stability of blood pressure and HT.
引文
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[12]王婧,田素领,吴娇娟,等.合谷穴穴性剖析[J].中国针灸,2017,37(5):565-566.
[13]马越英.颈丛阻滞麻醉结合针麻用于甲状腺手术的临床观察[J].中医药导报,2005,11(7):50-51.
[14]任平.针刺内关穴对心律失常治疗的Meta分析[C].中国中西医结合学会循证医学专业委员会暨第九届中医/中西医结合循证医学方法研讨会会议论文,2015:4.
[15]Cassu RN,Luna SP,Clark RM,et al.Electroacupuncture analgesia in dogs:is there a difference between uni-and bi-lateral stimulation?[J].Vet Anaesth Analg,2008,35(1):52-61.
[2]Pacella CM,Mauri G,Cesareo R,et al.A comparison of laser with radiofrequency ablation for the treatment of benign thyroid nodules:a propensity score matching analysis[J].Int J Hyperthermia,2017,33(8):911-919.
[3]Gambelunghe G,Bini V,Monacelli M,et al.The administration of anesthetic in the thyroid pericapsular region increases the possibility of side effects during percutaneous laser photocoagulation of thyroid nodules[J].Lasers Surg Med,2013,45(1):34-37.
[4]朋立超,蒋克泉,吴贵龙,等.针刺麻醉对甲状腺手术区域镇痛的机制[J].中国针灸,2008,28(12):910-912.
[5]刘渊泉.针刺麻醉复合靶控输注丙泊酚瑞芬太尼用于甲状腺手术疗效探讨[J].现代中西医结合杂志,2014,23(5):544-546.
[6]杨进华,刘海波,伍世绩,等.B超引导微波消融与传统手术治疗结节性甲状腺肿临床分析[J].中国综合临床,2016,32(5):417-420.
[7]王宝洪.针刺麻醉用于颈部中小手术286例临床观察[J].中国针灸,2003,23(12):735-736.
[8]邓硕曾.应激与无应激麻醉[J].临床麻醉学杂志,2003,19(9):574.
[9]Alehagen S,Wijma B,Lundberg U,et al.Fear,pain and stress hormones during childbirth[J].J Psychosom Obstet Gynaecol,2005,26(3):153-165.
[10]梁本初,彭国庆,吴在荣,等.PCEA对急性疼痛患者糖代谢的影响[J].江苏医药,2009,35(10):1140-1141.
[12]王婧,田素领,吴娇娟,等.合谷穴穴性剖析[J].中国针灸,2017,37(5):565-566.
[13]马越英.颈丛阻滞麻醉结合针麻用于甲状腺手术的临床观察[J].中医药导报,2005,11(7):50-51.
[14]任平.针刺内关穴对心律失常治疗的Meta分析[C].中国中西医结合学会循证医学专业委员会暨第九届中医/中西医结合循证医学方法研讨会会议论文,2015:4.
[15]Cassu RN,Luna SP,Clark RM,et al.Electroacupuncture analgesia in dogs:is there a difference between uni-and bi-lateral stimulation?[J].Vet Anaesth Analg,2008,35(1):52-61.