电针复合不同麻醉方式对脑血管支架置入术患者术中及术后恢复的影响(1)
摘要 目的：本研究擬观察电针复合局部监测麻醉或者全身麻醉，应用于脑血管内支架置入术的患者，观察对其术中维持和术后恢复的影响。方法：连续纳入2015年12月至2016年10月内，行脑血管内支架置入术的患者185例，分为局麻电针组(LA组，n=41)和局麻对照组(LC组，n=44)，全麻电针组(GA组，n=38)和全麻对照组(GC组，n=42)。穴位的选择为术侧，水沟连百会，合谷连外关。对电针组患者进行针刺，对照组患者采用假电针做对照。记录术中的循环变化，记录血管活性药及麻醉药物的使用情况，记录患者的术后恢复情况。结果：基本情况表示，采用局部监测麻醉的患者均为前循环堵塞的脑卒中患者；而必须采用全身麻醉的患者大部分为后循环堵塞(GC=28例，GA=29例)的脑卒中患者。LA组术中尼莫地平使用总量明显小于LC组(P<0.05)。而全麻2组中术中多巴胺平均使用量GA组小于GC组(P<0.05)。全身麻醉的患者，GA组术中瑞芬太尼使用量少于GC组(P<0.05)。术后拔管期的呼吸恢复时间、苏醒时间、拔管时间，GA组小于GC组(P<0.01)。4组患者术后出现中等疼痛以上(VAS评分≥4分)的例数，在术后第1天9 am、术后第1天4 pm，LA组少于LC组(P<0.05)；GA组少于GC组(P<0.05)。结论：脑血管内支架置入术患者的麻醉方式的选择与血管堵塞部位密切相关。针刺辅助局部监测麻醉或全身麻醉应用于CAS术中，可稳定术中血流动力学变化，减少术中血管活性药物用量及麻醉药物用量，具有辅助镇痛、促进麻醉恢复的功效，均具有一定的推广价值。
关键词 电针；麻醉方式；脑血管支架置入术；循环稳定；术后恢复
Abstract Objective：To investigate the effects of electro-acupuncture(EA) combined with local anesthesia or general anesthesia on intraoperative anesthesia maintenance and post-operative recovery in cerebral artery stenting patients.Methods：A total of 165 cases from December 2015 to October 2016 were assigned into local anesthesia and electro-acupuncture group (group LA，n=41)，local anesthesia control group (group LC，n=44)，general anesthesia and electro-acupuncture group (group GA，n=38)，general anesthesia control group (group GC，n=42).The patients in Group LA and GA received EA at acupoints of Shuigou (GV 26) and Baihui (GV 20)，Hegu (LI 4) and Waiguan (TE 5) at the same side of the stenting.The patients in group LA and group GA were received EA，while patients in group LC and group GC were received shame EA.The change of MAP，the use of vasoactive drugs and anesthetics during the four groups，post-operative pain scores (visual analogue scale，VAS) and the recovery condition after operation were recorded and analyzed.Results：Basic conditions showed that patients who use general anesthesia presented with vertebrobasilar occlusion stroke，whereas local anesthesia usually used in patients presenting with anterior circulation stroke (GC=28 cases，GA=29 cases).The average use of nimodipine in group LA was significantly less than group LC (P<0.05).The average use of dopamine in group GA was significantly less than group GC (P<0.05).The use of remifentanil in group GA was less than group GC (P<0.05).The time of postoperative respiratory recovery，wake-up and extraction in group GA were much less than the GC group (P<0.01).At 9 am and 4 pm 1 day after operation，the number of patient with pain (VAS≥4) in group LA was smaller than group LC (P<0.05)，and group GA was smaller than group GC (P<0.05).Conclusion：The selection of anesthesia methods was closely related with location of vascular occlusion.EA combined with local anesthesia or general anesthesia in CAS could stabilize hemodynamics，decrease the use of vasoactive agent and anesthetics，with effects of supplementary analgesic and improving anesthesia recovery，which is worthy of clinical promotion., http://www.100md.com(赵春美 谢思宁 张晴 贾春蓉 安立新)
关键词 电针；麻醉方式；脑血管支架置入术；循环稳定；术后恢复
Abstract Objective：To investigate the effects of electro-acupuncture(EA) combined with local anesthesia or general anesthesia on intraoperative anesthesia maintenance and post-operative recovery in cerebral artery stenting patients.Methods：A total of 165 cases from December 2015 to October 2016 were assigned into local anesthesia and electro-acupuncture group (group LA，n=41)，local anesthesia control group (group LC，n=44)，general anesthesia and electro-acupuncture group (group GA，n=38)，general anesthesia control group (group GC，n=42).The patients in Group LA and GA received EA at acupoints of Shuigou (GV 26) and Baihui (GV 20)，Hegu (LI 4) and Waiguan (TE 5) at the same side of the stenting.The patients in group LA and group GA were received EA，while patients in group LC and group GC were received shame EA.The change of MAP，the use of vasoactive drugs and anesthetics during the four groups，post-operative pain scores (visual analogue scale，VAS) and the recovery condition after operation were recorded and analyzed.Results：Basic conditions showed that patients who use general anesthesia presented with vertebrobasilar occlusion stroke，whereas local anesthesia usually used in patients presenting with anterior circulation stroke (GC=28 cases，GA=29 cases).The average use of nimodipine in group LA was significantly less than group LC (P<0.05).The average use of dopamine in group GA was significantly less than group GC (P<0.05).The use of remifentanil in group GA was less than group GC (P<0.05).The time of postoperative respiratory recovery，wake-up and extraction in group GA were much less than the GC group (P<0.01).At 9 am and 4 pm 1 day after operation，the number of patient with pain (VAS≥4) in group LA was smaller than group LC (P<0.05)，and group GA was smaller than group GC (P<0.05).Conclusion：The selection of anesthesia methods was closely related with location of vascular occlusion.EA combined with local anesthesia or general anesthesia in CAS could stabilize hemodynamics，decrease the use of vasoactive agent and anesthetics，with effects of supplementary analgesic and improving anesthesia recovery，which is worthy of clinical promotion., http://www.100md.com(赵春美 谢思宁 张晴 贾春蓉 安立新)