CAJ | 학술논문

目的：探讨针刺复合全身麻醉在妇科腹腔镜手术中的应用价值。方法将60例ASAⅠ～Ⅱ级择期妇科腹腔镜手术患者采用简单随机方法分为针麻组和对照组。针麻组选择穴位为双侧合谷、内关；针刺穴位后，电针刺激20～30 min后再复合静脉全身麻醉，电针刺激直到术毕。对照组为单纯静脉全身麻醉。两组麻醉过程中调节麻醉药用量，维持患者术中麻醉深度脑电双频指数（ BIS）在40～60之间。观察记录两组患者相同时间点血压、心率和BIS变化；记录麻醉药用量；记录苏醒时间和拔管时间，记录苏醒后患者警觉镇静分级评分，疼痛评分；记录术后镇痛药使用情况；有无术中知晓；评价针刺麻醉临床作用。结果针麻组丙泊酚用量（7．44±1．30）μg· kg -1· h-1，较对照组的（8．66±1．24）μg· kg-1· h-1减少（t＝3．720，P＝0.001）；瑞芬太尼用量（10．59±2．58）μg· kg-1· h-1，也少于对照组的（11．93±2．27）μg· kg-1· h-1（ t＝2.168，P＝0．034）。与基础值相比，对照组血压在手术中、苏醒时、拔管时、拔管后10 min增高（均P＜0．05），针麻组较平稳。对照组拔管时、拔管后10 min，心率较针麻组快。针麻组苏醒时间和拔管时间分别为（9．05±2．36）min和（11．61±2.40）min，短于对照组的（12．50±3．20）min和（15．90±3．37）min（均P＜0．05）。苏醒后疼痛评分针麻组低于对照组，针麻组警觉镇静评分较高，躁动、寒战发生较少。结论针刺复合全身麻醉用于妇科腹腔镜手术，能减少全身麻醉药用量，缩短苏醒时间和拔管时间。患者警觉镇静评分高，清醒程度较高，疼痛减轻，苏醒质量更高。
목적：탐토침자복합전신마취재부과복강경수술중적응용개치。방법장60례ASAⅠ～Ⅱ급택기부과복강경수술환자채용간단수궤방법분위침마조화대조조。침마조선택혈위위쌍측합곡、내관；침자혈위후，전침자격20～30 min후재복합정맥전신마취，전침자격직도술필。대조조위단순정맥전신마취。량조마취과정중조절마취약용량，유지환자술중마취심도뇌전쌍빈지수（ BIS）재40～60지간。관찰기록량조환자상동시간점혈압、심솔화BIS변화；기록마취약용량；기록소성시간화발관시간，기록소성후환자경각진정분급평분，동통평분；기록술후진통약사용정황；유무술중지효；평개침자마취림상작용。결과침마조병박분용량（7．44±1．30）μg· kg -1· h-1，교대조조적（8．66±1．24）μg· kg-1· h-1감소（t＝3．720，P＝0.001）；서분태니용량（10．59±2．58）μg· kg-1· h-1，야소우대조조적（11．93±2．27）μg· kg-1· h-1（ t＝2.168，P＝0．034）。여기출치상비，대조조혈압재수술중、소성시、발관시、발관후10 min증고（균P＜0．05），침마조교평은。대조조발관시、발관후10 min，심솔교침마조쾌。침마조소성시간화발관시간분별위（9．05±2．36）min화（11．61±2.40）min，단우대조조적（12．50±3．20）min화（15．90±3．37）min（균P＜0．05）。소성후동통평분침마조저우대조조，침마조경각진정평분교고，조동、한전발생교소。결론침자복합전신마취용우부과복강경수술，능감소전신마취약용량，축단소성시간화발관시간。환자경각진정평분고，청성정도교고，동통감경，소성질량경고。
Objective To investigate the clinical application of acupuncture combined with general anesthe -sia in gynecologic laparoscopic surgery .Methods 60 ASA( the American society of anesthesiologists )Ⅰ-Ⅱpatients undergoing elective gynecologic laparoscopic surgery were randomly divided into the acupuncture group and control group.Patients in the acupuncture group were chosen Hegu (LI 4),Neiguan(PC 6) on both sides.After acupuncture, the two acupoints,electroacupuncture stimulated 20-30min,then administered general anesthesia ,electroacupuncture until surgery finished ,the control group received general anesthesia only .The drug dosages of the two groups was regu-lated,maintained anesthesia depth bispectral index ( BIS) between 40 and 60.The changes of the blood pressure ( BP) ,heart rate and BIS of the two groups at the same time points were observed;the propofol and remifentanil dos-age after the surgery ,the awaken time and extubation time ,OAA/S score and pain score after wake ,the happening of restlessness,chills,nausea and vomiting ,the usage of narcotic analgesics postoperation ,and the intraoperative aware-ness were recorded .The effect of acupuncture combined with general anesthesia was evaluated .Results Anesthetic dosage propofol of the acupuncture group [(7.44 ±1.30)μg· kg-1· h-1] was less than [(8.66 ±1.24)μg· kg-1· h-1] of the control group (t=3.720,P=0.001),remifentanil dosage was also less than the control group [acupunc-ture group (10.59 ±2.58)μg· kg-1· h-1,control group (11.93 ±2.27)μg· kg-1· h-1,t=2.168,P=0.034]. Compared with the basic value ,the BP values were higher at the time of intraoperation ,waking,extubation and 10 min after extubation (all P<0.05),the acupuncture group had more stable BP .Compared with the acupuncture group , heart rates in the control group were faster at extubation and 10min after extubation .Recovery time and extubation time of the acupuncture group were (9.05 ±2.36)min and (1.61 ±2.40)min,which were shorter than (12.50 ± 3.20)min and (15.90 ±3.37)min of the control group (P<0.05).Pain score(VAS) in the acupuncture group was lower than that of the control group .Consciousness score was higher in the acupuncture group ,the incidence rates of restlessness,chills were less.Conclusion The use of acupuncture combined with general anesthesia in gynecologic laparoscopic surgery can reduce the dosage of general anesthetics ,shorten the awaken time and extubation time ,increase the OAA/S score of the patients ,relieve pain ,and the recovery quality is higher .