摘要
目的探讨不同频率针刺辅助麻醉用于甲状腺手术是否具有不同的麻醉效果，为针刺辅助麻醉的实施提供一种最佳的刺激频率。方法60例ASAⅠ～Ⅱ级的择期甲状腺手术患者随机分为3组，每组20例，分别在不同频率疏密波针刺辅助麻醉结合颈丛神经阻滞下行甲状腺手术，其中A，B两组分别选用2／100Hz，2／15Hz疏密波刺激，C组为对照组，刺激穴位为双侧合谷、内关穴。针刺诱导15min后行颈丛神经阻滞，术中镇痛效果不全者分次追加芬太尼，剂量每次为1μg／kg，镇痛效果采用世界卫生组织疼痛程度评级标准进行评定。比较3组患者在基础状态下（t0）、入室诱导前（t1）、阻滞后15min（t2）、切皮前消毒时（t3）、切皮时（t4）、阻滞后30min（t5）、牵拉甲状腺时（t6）、阻滞后1h（t7）、阻滞后2h（t8）、术毕（t9）这9个时间点心率、血压、呼吸的变化以及术中辅助用药的情况和镇痛效果；并观察围术期并发症及毒副反应。结果3组患者术中镇痛效果均在2级以上，无一例术中更改麻醉方式。镇痛效果显著率以B组为最高，C组最低，组间比较差异有显著性（P〈0.05）；C组患者t2时的心率、血压，t3时心率，t7，t8时的血压以及术中辅助用药量均明显高于A，B两组（P〈0.05），同时C组患者在t6—t7时间段呼吸频率明显慢于A，B两组（P〈0.05）；B组患者t3，t4，t6时的血压明显低于A，C两组（P〈0.05），t9时的血压明显低于C组（P〈0．05）；A组患者t7，t8，t9时的心率明显低于B，C两组（P〈0．05）。3组患者各有两例出现声音嘶哑。所有患者中除C组有2例患者因SpO2降至91％需要进行吸氧治疗外，其余患者均未吸氧，且SpO2均维持在94％以上。C组有2例患者因术中血压过高需要进行降压治疗，其余患者均未应用降压药治疗。结论在针刺辅助麻醉中2／15Hz的疏密波刺激频率比2／100Hz的麻醉效果更佳。
Objective To investigate the analgesic effects of acupuncture - assisted anesthesia（ Transcutaneous electrical nerve stimulation TENS with different frequencies）combined with cervical plexus block （CPB）in patients undergoing thyroidectomy, so as to find a more effective frequency in acupuncture - assisted anesthesia. Methods Sixty patients undergoing elective thyroidectomy, ASA Ⅰ-Ⅱ, were randomly divided into three groups. In Group A, 20 patients received CPB plus a low -high mixed -frequency（2/100 Hz）TENS; In group B, 20 patients received CPB plus low - middle mixed- frequency（2/15 Hz）TENS; In group C, 20 patients receive CPB plus sham TENS（ as a controlled group）. Bilateral Hegu and Neiguan were selected as the acupoints. CPB was performed 15 minutes after TENS. Fentanyl was administered as the additional drug if the analgesic effect was not satisfactory, and the analgesic effect was assessed through the standard for degree of pain by world health organization（WHO）. Blood pressure（ SBP/DBP）, heart rate（HR） , respiratory rate（ RR）, pulse oxygen saturation（ SpO2 ）and the additional drugs were recorded at 9 time points（ baseline t1, before the anesthesia t2, 15 minutes after CPB t3 , skin incision t4,30 minutes after CPB t5 , maximum operative trauma t6 , 1 h after CPB t7, 2 hrs after CPB t8, end of surgery t9 ）. Complications and toxic side effects were recorded during perioperation period. Statistical analysis was performed with SPSS12. 0 software. P 〈 0.05 presented significance difference in statistics. Results Among patients undergoing thyroidectomy, analgesic effect was better than level 2, and no one changed anesthesia. Group B is the best in the analgesic effect and group C was the worst. There was a significance difference among these groups （ P 〈 0.05）. In the group C, the BP and HR at t2 , the HR at t3 , the BP at t7 and ts as well as the dose of the additional fentanyl was significant higher than that group A and B （ P 〈 0.05 ）, while the RR is slower than in group A and B between t6 - t7 （ P 〈 0. 05）. In group B, the BP was lower at the time of t3 t4 t6 （ P 〈 0.05）, and lower than that of group C at t9 （P 〈 0. 05）. In group A, the HR was slower than that in group B and group C at the time of t7 t8 t9. There were 2 patients appearing hoarse voice in each group, and in Group C 2 patients needed oxygen. At the same time, 2 patients required treatment because of hypertension. Conclusion Acupuncture - assisted anesthesia by 2/15 Hz thin - dense waves stimulation has better analgesic effects than 2/100 Hz on thyroid surgery.
出处
《广东医学》
CAS
CSCD
北大核心
2008年第8期1257-1260,共4页
Guangdong Medical Journal
基金
广东省科学技术社会发展计划项目(编号:2006B35602004)
关键词
甲状腺手术
针刺辅助麻醉
频率
Thyroid surgery Acupuncture -assisted anesthesia Frequency
