电针刺激对全麻患者术中麻醉药用量及术后恶心、呕吐的辅助作用
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摘要
目的探讨穴位电针刺激对全身麻醉下行后路腰椎椎间融合术(posterior lumbar interbody fusion,PLIF)患者术中麻醉药用量及术后恶心、呕吐的辅助作用。方法选择择期行PLIF术的患者78例,年龄18～59岁,随机分为3组,每组26例。3组均行全凭静脉麻醉。A组(全凭静脉麻醉组)、B组(在A组基础上复合百会、四神聪、双侧内关电针刺激)、C组(在B组基础上复合双侧合谷、足三里电针刺激)。B组、C组患者均于手术前1天、麻醉诱导前30min给予相应穴位电针刺激。记录3组患者术中丙泊酚、瑞芬太尼、舒芬太尼、苯磺顺阿曲库铵用药量,患者入室、切皮、上内固定、拔管、离室时的平均动脉压(MAP)、心率(HR)、指脉氧饱和度(SpO2),术后第1天视觉模拟量表(visual analogue scale,VAS)评分以及恶心、呕吐发生情况。结果 3组各剔除1例。B组、C组瑞芬太尼用量少于A组(P<0.05),B组与C组间比较差异无统计学意义(P>0.05);3组患者丙泊酚、舒芬太尼、苯磺顺阿曲库胺用量以及术后第1天VAS评分差异均无统计学意义(P均>0.05)。3组患者入室、切皮、上内固定、拔管、离室时的MAP、HR和SpO2组间和组内比较差异均无统计学意义(P均>0.05)。B组、C组恶心、呕吐发生比例均少于A组(P<0.05)。结论全凭静脉麻醉复合百会、四神聪、双侧内关电针刺激可以减少全麻患者术中瑞芬太尼用药量及术后恶心、呕吐的发生。
Objective To explore the auxiliary role of acupoint electroacupuncture(EA) stimulation on intraoperative anesthetic dosage and postoperative nausea and vomiting in patients with posterior lumbar interbody fusion under general anesthesia. Methods Total 78 patients were selected,aged from 18 to 59,randomly divided into 3 groups,with 26 cases in each group. All three groups were given total intravenous anesthesia. Group A(total intravenous anesthesia),group B(on the basis of group A,compound baihui,sishencong,bilateral neiguan electroacupuncture stimulation),group C(on the basis of group B,compound bilateral hegu and zusanli electroacupuncture stimulation).In group B and C,EA stimulation was administered one day before the operative and 30 minutes before induction of anesthesia. The intraoperative dosage of propofol,remifentanil,sufentanil and cisatracurium besylate,mean arterial pressure(MAP),heart rate(HR),finger oxygen saturation(SpO2)at admission,skin incision,internal fixation,extubation and departure were recorded. The visual analogue scale(VAS)score and the incidence of nausea and vomiting on the first day after operation were recorded. Results One case was eliminated in each group. The dosage of remifentanil in group B and group C was less than that in group A(P<0.05),and there was no statistically significant difference between group B and group C(P>0.05). There was no statistically significant difference in the doses of propofol,sufentanil and benzalsudosutrascumide between the three groups as well as the VAS(visual analogue scale)score on the first day after surgery(P all >0.05). There was no statistically significant differences in mean arterial pressure,heart rate and digital pulse oxygen saturation at admission,skin incision,internal fixation,extubation and departure between the three groups(P all >0.05). The incidence of post-operative nausea and vomiting in group B and C was less than that in group A(P<0.05),and there was no statistically significant difference between group B and C(P>0.05). Conclusion Total intravenous anesthesia combined with baihui,sishenchong and bilateral neiguan electroacupuncture stimulation can reduce the amount of remifentanil used during general anesthesia and occurrence of postoperative nausea and vomiting.
Objective To explore the auxiliary role of acupoint electroacupuncture(EA) stimulation on intraoperative anesthetic dosage and postoperative nausea and vomiting in patients with posterior lumbar interbody fusion under general anesthesia. Methods Total 78 patients were selected,aged from 18 to 59,randomly divided into 3 groups,with 26 cases in each group. All three groups were given total intravenous anesthesia. Group A(total intravenous anesthesia),group B(on the basis of group A,compound baihui,sishencong,bilateral neiguan electroacupuncture stimulation),group C(on the basis of group B,compound bilateral hegu and zusanli electroacupuncture stimulation).In group B and C,EA stimulation was administered one day before the operative and 30 minutes before induction of anesthesia. The intraoperative dosage of propofol,remifentanil,sufentanil and cisatracurium besylate,mean arterial pressure(MAP),heart rate(HR),finger oxygen saturation(SpO2)at admission,skin incision,internal fixation,extubation and departure were recorded. The visual analogue scale(VAS)score and the incidence of nausea and vomiting on the first day after operation were recorded. Results One case was eliminated in each group. The dosage of remifentanil in group B and group C was less than that in group A(P<0.05),and there was no statistically significant difference between group B and group C(P>0.05). There was no statistically significant difference in the doses of propofol,sufentanil and benzalsudosutrascumide between the three groups as well as the VAS(visual analogue scale)score on the first day after surgery(P all >0.05). There was no statistically significant differences in mean arterial pressure,heart rate and digital pulse oxygen saturation at admission,skin incision,internal fixation,extubation and departure between the three groups(P all >0.05). The incidence of post-operative nausea and vomiting in group B and C was less than that in group A(P<0.05),and there was no statistically significant difference between group B and C(P>0.05). Conclusion Total intravenous anesthesia combined with baihui,sishenchong and bilateral neiguan electroacupuncture stimulation can reduce the amount of remifentanil used during general anesthesia and occurrence of postoperative nausea and vomiting.
引文
[1] Goldman N,Chen M,Fujita T,et al. Adenosine A1receptors mediate local anti-nociceptive effects of acupuncture[J]. Nature Neuroscience,2010,13(7):883-888.
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[6]林舜艳,尹正录,高巨,等.针药复合麻醉对老年患者术后早期认知功能障碍及炎性细胞因子TNF-α、IL-1β、IL-6的影响[J].中国中西医结合杂志,2014,34(7):795-799.
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[11] Tedesco D,Gori D,Desai KR,et al. Drug-free interventions to reduce pain or opioid consumption after total knee arthroplasty:a systematic review and meta-analysis[J]. JAMA Surgery,2017,152(10):172872.
[12]欧阳晖,樊蓥,巩昌镇,等.美国阿片类药物危机与针灸发展的契机[J].中医药导报,2018,24(05):1-9.
[13]方剑乔,房军帆,梁宜,等.电针即刻镇痛效应及其对脊髓p-ERK1/2的调控[J].中国针灸,2012,32(11):1007-1011.
[14]于冰,王聪,张永臣.《针灸大成》合谷穴临床应用浅析[J].针灸临床杂志,2016,32(6):61-64.
[15] Patil S,Sen S,Bral M,et al. The role of acupuncture in pain management[J]. Curr Pain Headache Rep,2016,20:22.
[16]郭文平,高辉.经皮穴位电刺激足三里及合穴临床应用研究进展[J].世界最新医学信息文摘,2017,17(2):88-89.
[17]赵喜波,邢群智,韩学昌.电针内麻点和内关穴对胸科手术后镇痛的观察[J].中国针灸,2013,33(9):829-832.
[18]顾陈怿,沈利荣,丁依红,等.针刺经穴与非经穴对胆囊切除术患者围术期影响的对照观察[J].中国针灸,2010,30(8):675-678.
[19] Majholm B.Acupressure at acupoint P6 for prevention of postoperative nausea and vomiting:a randomised clinical trial[J]. European Journal of Anaesthesiology,2011,28(6):412-419.
[2] Mendelson G. Effectiveness of acupuncture[J]. Jama,1981,246(17):1900.
[3]韩济生.针麻镇痛研究[J].针刺研究,2016,41(5):377-387.
[4] Abbate D,Santamaria A,Brambilla A,et al. beta-Endorphin and electroacupuncture[J]. Lancet,1980,2(8207):1309.
[5] Mayer DJ. Endorphin release as mechanism of acupuncture analgesia[J].Pain,1981,11(2):273-280.
[6]林舜艳,尹正录,高巨,等.针药复合麻醉对老年患者术后早期认知功能障碍及炎性细胞因子TNF-α、IL-1β、IL-6的影响[J].中国中西医结合杂志,2014,34(7):795-799.
[7]黄文起,佘守章.让疼痛治疗朝着精准医疗的方向发展[J].广东医学,2018,39(1):1-5.
[8] Voepel-Lewis T,Zikmund-Fisher B,Smith EL,et al.Opioid-related adverse drug events:do parents recognize the signals[J]. The Clinical Journal of Pain,2015,31(3):198-205.
[9] Mitra S,Carlyle D,Kodumudi G,et al. New advances in acute postoperative pain management[J]. Current Pain and Headache Reports,2018,22(5):35.
[10]张吉,张宁.针刺镇痛机制的探讨[J].中国针灸,2007,27(1):72-75.
[11] Tedesco D,Gori D,Desai KR,et al. Drug-free interventions to reduce pain or opioid consumption after total knee arthroplasty:a systematic review and meta-analysis[J]. JAMA Surgery,2017,152(10):172872.
[12]欧阳晖,樊蓥,巩昌镇,等.美国阿片类药物危机与针灸发展的契机[J].中医药导报,2018,24(05):1-9.
[13]方剑乔,房军帆,梁宜,等.电针即刻镇痛效应及其对脊髓p-ERK1/2的调控[J].中国针灸,2012,32(11):1007-1011.
[14]于冰,王聪,张永臣.《针灸大成》合谷穴临床应用浅析[J].针灸临床杂志,2016,32(6):61-64.
[15] Patil S,Sen S,Bral M,et al. The role of acupuncture in pain management[J]. Curr Pain Headache Rep,2016,20:22.
[16]郭文平,高辉.经皮穴位电刺激足三里及合穴临床应用研究进展[J].世界最新医学信息文摘,2017,17(2):88-89.
[17]赵喜波,邢群智,韩学昌.电针内麻点和内关穴对胸科手术后镇痛的观察[J].中国针灸,2013,33(9):829-832.
[18]顾陈怿,沈利荣,丁依红,等.针刺经穴与非经穴对胆囊切除术患者围术期影响的对照观察[J].中国针灸,2010,30(8):675-678.
[19] Majholm B.Acupressure at acupoint P6 for prevention of postoperative nausea and vomiting:a randomised clinical trial[J]. European Journal of Anaesthesiology,2011,28(6):412-419.