耳穴埋针对行腹外疝手术老年人靶控输注诱导时丙泊酚-瑞芬太尼血浆及效应室浓度的影响

发布时间：2018-01-17 13:38

本文关键词：耳穴埋针对行腹外疝手术老年人靶控输注诱导时丙泊酚-瑞芬太尼血浆及效应室浓度的影响　出处：《中国针灸》2017年08期 　论文类型：期刊论文

【摘要】：目的:应用靶控输注(target-controlled infusion,TCI)和脑电双频指数(bispectral index,BIS)技术观察耳穴埋针对行腹外疝手术老年人意识及疼痛消失时丙泊酚和瑞芬太尼血浆及效应室浓度的影响。方法:将择期行腹外疝手术的老年患者50例,随机分为观察组和对照组,每组25例。观察组在麻醉诱导前30 min于术侧腹股沟、肝、皮质下、神门穴行耳穴埋针并用对压法按压,每穴按压10次,埋针持续至术毕。对照组在麻醉诱导前30 min于上述耳穴区贴同样规格及数量的医用胶布,不予任何刺激,术毕去除。两组均予静脉全麻,采用BIS麻醉深度监护仪监测BIS值。麻醉诱导TCI丙泊酚血浆浓度1.5μg/L,每30 s递增0.3μg/L,直至患者意识消失。后TCI瑞芬太尼血浆浓度2.0μg/L,每30 s递增0.3μg/L,直至患者对疼痛刺激(压眶反射)无体动反应。记录两组患者T_0(入手术室后)、T_1(意识消失)及T_2(疼痛消失)时平均动脉压(mean arterial pressure,MAP)、心率(heart rate,HR)及BIS值,T_1时的丙泊酚血浆及效应室浓度,T_2时瑞芬太尼血浆及效应室浓度;术毕记录两组丙泊酚和瑞芬太尼的用药总量及手术时间与麻醉时间。结果:T_1及T_2时,观察组MAP、HR均高于对照组(P0.05,P0.01);T_1时,观察组丙泊酚血浆及效应室浓度均明显低于对照组(P0.05,P0.01)。T_2时,观察组瑞芬太尼血浆及效应室浓度均明显低于对照组(P0.05,P0.01)。T_1及T_2时,两组BIS值比较差异均无统计学意义(均P0.05)。两组患者手术时间和麻醉时间差异均无统计学意义(均P0.05)。观察组瑞芬太尼用药总量明显低于对照组(P0.01),丙泊酚用药总量两组差异无统计学意义(P0.05)。结论:耳穴埋针复合丙泊酚-瑞芬太尼TCI能降低老年腹外疝手术患者诱导时丙泊酚、瑞芬太尼的血浆及效应室浓度,降低瑞芬太尼用量,具有辅助镇静、镇痛作用。
[Abstract]:Objective: to use target-controlled infusion (TCI) and bispectral index (bispectral index). BIS). To observe the effects of auricular acupoint embedding on the consciousness of the elderly patients undergoing external abdominal hernia surgery and the effects of propofol and remifentanil on the plasma and effect ventricular concentration when the pain disappeared. Methods: 50 elderly patients undergoing selective external abdominal hernia surgery were selected. The observation group was randomly divided into observation group and control group with 25 cases in each group. 30 min before anesthesia induction, the observation group was treated with auricular acupuncture at the operative side of groin, liver, subcortical and Shenmen acupoints, and was pressed 10 times per point. The needle burying lasted until the end of the operation. The control group applied the same size and quantity of medical adhesive cloth to the above-mentioned auricular area 30 min before anesthesia induction without any stimulation and was removed at the end of the operation. Both groups were given intravenous general anesthesia. The plasma concentration of propofol in anesthetized TCI was 1.5 渭 g / L and increased 0.3 渭 g / L every 30 s. After TCI remifentanil plasma concentration was 2.0 渭 g / L, increased 0.3 渭 g / L every 30 s. Until the patients did not respond to pain stimulation (pressure-orbital reflex). The two groups of patients were recorded T _ 0 (after entering the operating room). Mean arterial pressure (mean arterial pressure MAPP), heart rate (heart rate) and heart rate (heart rate) in patients with T _ 1 and T _ 2 (pain disappeared). The concentration of propofol in plasma and effect chamber at T _ 1 and remifentanil concentration in T _ (2) and T _ (2); The total dosage of propofol and remifentanil, the time of operation and the time of anesthesia were recorded at the end of the operation. Results the mitogen HR of observation group was higher than that of control group (P0.05) at the time of W / T _ 1 and T _ 2. P0.01; The plasma and effect chamber concentrations of propofol in the observation group were significantly lower than those in the control group at T _ 1, P _ (0.05) and P _ (0.01) 路T _ (2). The concentrations of remifentanil in plasma and effector chamber in the observation group were significantly lower than those in the control group at the time of P0.05, P0.01U. There was no significant difference in BIS between the two groups (all P 0.05), but there was no significant difference in operation time and anesthesia time between the two groups (all P 0.05). The total amount of remifentanil in the observation group was significantly lower than that in the control group (P 0.01). There was no significant difference in the total dosage of propofol between the two groups (P 0.05). Conclusion: Auricular acupoint embedding combined with propofol / remifentanil TCI can reduce propofol induction in elderly patients with external abdominal hernia. The concentration of remifentanil in plasma and effector chamber decreased the dosage of remifentanil and had auxiliary sedative and analgesic effects.
【作者单位】：福建医科大学省立临床学院;福建省立医院麻醉科;福建省中医药大学研究生院;
【基金】：福建省中医药科研项目:wzsy201302
【分类号】：R246.2
【正文快照】： 耳穴埋针是针灸学的一个重要组成部分,它指的静脉全麻诱导时血流动力学稳定的新方法。是采用皮内针刺激耳郭上的穴位,以防治疾病的一种1临床资料方法。耳针可在较长时间内对患者进行有效刺激,具1.1一般资料有辅助麻醉镇痛和调节各种生理功能,具有增强麻醉本研究选择50例行单侧

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