河北医科大学学报

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针刺复合基础麻醉与单纯基础麻醉应用于腹膜透析置管手术麻醉效果的比较

  

  1. 1.河北省沧州市中心医院麻醉科，河北 沧州 061000；2.河北省沧州市中心医院体检中心，河北 沧州 061000
  • 出版日期:2019-08-25 发布日期:2019-08-14
  • 作者简介:杨强(1979-)，男，河北沧州人，河北省沧州市中心医院副主任医师，医学硕士，从事临床麻醉学研究。

Comparison of anesthetic effects of acupuncture combined with basic anesthesia and simplebasic anesthesia for peritoneal dialysis catheterization#br#

  1. 1.Department of Anesthesiology, Cangzhou Central Hospital, Hebei Province, Cangzhou 061000, China;2.Physical Examination Center, Cangzhou Central Hospital, Hebei Province, Cangzhou 061000, China
  • Online:2019-08-25 Published:2019-08-14

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摘要： ［摘要］〓
〖HTH〗目的〖HTSS〗〖KG*2〗比较针刺复合基础麻醉与单纯基础麻醉应用于腹膜透析置管手术的有效性及安全性。
〖HTH〗方法〖HTSS〗〖KG*2〗选取首次行腹膜透析置管术的患者69例，采用随机数字表法分为针刺复合基础麻醉组（AA组）和单纯基础麻醉组（BA组）。手术开始前20 min，2组均静脉泵注0.3 μg/kg右美托咪定镇静，AA组于手术开始前连续电刺激双侧内关穴及三阴交穴至术毕。术中视觉模拟评分法（Visual Analogue Scale，VAS）评分大于5分，可给予静脉注射芬太尼1 μg/kg，如芬太尼总量达5 μg/kg后VAS评分大于5分者，则改为全身麻醉完成手术。记录2组手术切皮时、牵拉及切开腹膜时、建立皮下隧道时、缝皮时、术后2 h、术后12 h及术后24 h的VAS评分。记录术中镇痛药芬太尼的追加量，手术医生对麻醉效果的满意度，术中转全身麻醉率及麻醉手术相关不良反应。
〖HTH〗结果〖HTSS〗〖KG*2〗2组术中VAS评分在手术切皮开始逐渐增高至缝皮时降低， 2组术后VAS评分逐渐降低，2组术中、术后VAS评分在组间、时点间、组间·时点间交互作用差异均有统计学意义（P＜005）， AA组追加镇痛药芬太尼的总剂量明显少于BA组（P＜005）。与BA组比较，AA组手术医师满意度高，转全身麻醉率较低，差异均有统计学意义（P＜005）。
〖HTH〗结论〖HTSS〗〖KG*2〗腹膜透析置管手术中采用针刺复合基础麻醉较单纯基础麻醉安全、有效。

关键词: 腹膜透析, 置管术, 针刺麻醉, 基础麻醉

Abstract: ［Abstract］ Objective〖HTSS〗〓To compare the efficacy and safety of acupuncture combined with basic anesthesia and simple basic anesthesia in peritoneal dialysis catheterization.
〖HTH〗〖WTHZ〗Methods〖HTSS〗〓Sixtynine patients with firsttime peritoneal dialysis catheterization were selected. By random number table method the patients were divided into acupuncture combined basic anesthesia group(AA group) and simple basic anesthesia group(BA group).  Acupuncture at Neiguan and Sanyinjiao points with electrical stimulated at 20 minutes before start of surgery in AA group. The same position paste the electrode connect the point of electrical stimulation instrument in BA group. Both groups of patients were sedated with intravenous injection of 0.3 μg/kg dexmedetomidine 20 minutes before the start of surgery. In AA group, bilateral Neiguan and Sanyinjiao acupoints were stimulated continuously until the end of operation. If intraoperative Visual Analogue Scale(VAS) score was greater than 5 points, intravenous fentanyl 1 μg/kg could be administered. If the VAS score was greater than 5 after total fentanyl 5 μg/kg, general anesthesia was used to complete the operation.The VAS scores of the two groups were recorded during surgical incision, traction and incision of the peritoneum, establishment of subcutaneous tunnel, suture, 2 h after surgery, 12 h after surgery and 24 h after surgery. The additional amount of analgesic fentanyl, the surgeon′s satisfaction with the anesthetic effect, the general anesthesia during surgery, and the adverse reactions associated with anesthesia were recorded.
〖HTH〗〖WTHZ〗Results〖HTSS〗〓The intraoperative VAS score of the two groups decreased gradually from the beginning of surgical incision to the suture, and the postoperative VAS score of the two groups decreased gradually. The interaction differences between the two groups of intraoperative and postoperative VAS score were statistically significant(P＜005). The total dose of fentanyl was significantly lower in the AA group than in the BA group(P＜005). Compared with the BA group, the satisfaction of surgeons in the AA group was higher, and the rate of general anesthesia was lower, the difference was statistically significant(P＜0.05).
〖HTH〗〖WTHZ〗Conclusion〖HTSS〗〓Acupuncture combined with basic anesthesia in peritoneal dialysis surgery is more safe and effective than basic anesthesia.

Key words: peritoneal dialysis, catheterization, acupuncture anesthesia, basic anesthesia

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