【摘要】 目的:观察甲状腺次全切除术中电针刺激双侧“合谷”、“内关”穴对儿茶酚胺的干预效果。方法:①选取2005-05/2006-03暨南大学附属第一医院拟行择期甲状腺次全切除术的住院患者60例,按随机对照Doll’s法分为电针刺激+颈丛阻滞组、单纯颈丛阻滞组,各30例。两组患者性别、年龄、身高、体重、手术时间、病种等差异均无显著性意义(P>0.05)。②电针刺激+颈丛阻滞组患者分别于双侧“内关”、“合谷”穴皮肤消毒后刺入银针,直到有明显“得气”感觉,接上电刺激仪连续高频密波刺激(60Hz,1～2mA,20V),以能耐受无特殊不适为度,观察约10min后行双侧颈深丛阻滞。单纯颈丛阻滞组不给予电针刺激,只以同法行颈丛阻滞。③分别于麻醉前(t1)、双侧颈丛阻滞后5min(t2)、切开皮肤(t3)、剥离甲状腺(t4)、缝皮前(t5)、缝皮后5min(t6)各时间点记录两组平均动脉血压、心率、手指血氧饱和度、肾上腺素、去甲肾上腺素的变化。同时对患者术中疼痛程度(0分=无痛,10分=剧痛)及镇静与紧张程度(0分=轻松舒适,10分=紧张不适)进行评分。观察围术期并发症和毒副反应。结果:按实际处理分析,实验选取拟行择期甲状腺次全切除术的住院患者60例,电针刺激+颈丛阻滞组有1例患者因冰冻切片为甲状腺癌需行扩大根治术改全身麻醉而剔除。①围术期神经内分泌应激反应指标-儿茶酚胺检测结果:单纯颈丛阻滞组肾上腺素浓度在剥离甲状腺、缝皮前、缝皮后5min明显高于电针刺激+颈丛阻滞组(P<0.01),去甲肾上腺素浓度于缝皮前、缝皮后5min明显高于电针刺激+颈丛阻滞组(P<0.05)。②围术期各项循环指标检测结果:术中平均动脉血压电针刺激+颈丛阻滞组比较稳定,而单纯颈丛阻滞组波动明显,于切开皮肤、剥离甲状腺、缝皮前明显升高(P<0.01);单纯颈丛阻滞组心率于切开皮肤、剥离甲状腺时间点明显高于电针刺激+颈丛阻滞组(P<0.01);两组手指血氧饱和度基本相似(P>0.05)。③术中疼痛程度评分、镇静与紧张程度评分结果:电针刺激+颈丛阻滞组患者术中疼痛程度评分、镇静与紧张程度评分均明显低于单纯颈丛阻滞组(P<0.01)。④围术期并发症和毒副作用:术后恶心呕吐发生率电针刺激+颈丛阻滞组明显低于单纯颈丛阻滞组(P<0.05)。结论:电针刺激“合谷”、“内关”穴联合颈丛阻滞应用于甲状腺切除手术较单纯颈丛阻滞效果更好,明显减轻心血管系统和神经内分泌系统应激反应。更多还原

【Abstract】 AIM: To investigate the interventional effects of electro-acupuncture (EA) on catecholamine (CA) in patients undergoing subtotal thyroidectomy. METHODS: ①Sixty inpatients undergoing elective subtotal thyroidectomy at the First Affiliated Hospital of Jinan University between May 2005 and March 2006 were randomized to receive an EA combined with deep cervical plexus block (group EA,n=30) or a deep cervical plexus block (group CPB,n=30). There were no significant differences in age, sex, weight, height, operation time and disease kind between the two groups (P > 0.05).②In group EA, the patients after skin disinfections were pricked with silver needle on bilateral Hegu (LI 4) and Neiguan (P 6) acupoints until the patients felt needling sensation, and continuous high-frequency dense wave (1-2 mA, 20 V, 60 Hz) was administered by using the electric stimulation device unless the patients were not tolerant. Ten minutes later, deep CPB was performed bilaterally. In group CPB, no EA stimulation was administered besides the same deep CPB was conducted.③Pain intensity and stress scores were assessed by means of visual analogue scale (VAS, 0=no pain, 10=worst imaginable pain) and visual stress score (VSS, 0=no stress, 10=the maximum stress) respectively during operation. Meanwhile, the venous blood samples were taken at 6 time points (t1=baseline, t2=5 minutes after bilateral CPB, t3=skin incision, t4=maximum operative trauma, t5=end of surgery, t6=5 minutes after surgery) for measurements of main aortic pressure (MAP), heart rate (HR), epinephrine and norepinephrine (NE) and pulse oxygen saturation (SpO2). Complications and toxic side effects were documented during perioperation period. RESULTS: According to on-treatment analysis, 60 inpatients undergoing elective subtotal thyroidectomy were enrolled in the study. One patient in group EA was excluded because of thyroid cancer.①Detection of CA as a neuroendocrine stress index in perioperation period: Epinephrine concentration was significantly lower in group EA than in group CPB at t4-t6 (P < 0.01), and NE concentration was significantly lower in group EA than in group CPB at t5-t6 (P < 0.05).②Detections of various circulation index: MAP and HR showed significant higher levels in group CPB at t3-t5 versus group EA (P < 0.01); SpO2 showed no significant difference between the two groups (P > 0.05).③Pain scores and stress scores were decreased obviously in group EA during operation compared with group CPB (P < 0.01).④Complications and toxic side effects: Significantly less side effects (postoperative nausea and vomiting) were noted in group EA versus group CPB at perioperation period (P < 0.05). CONCLUSION: The combination of EA on Hegu (LI 4) and Neiguan (P 6) with CPB has better effects subtotal thyroidectomy compared with simple CPB, and can obviously relieve the cardiovascular system and neuroendocrine system stress.更多还原