本文關(guān)鍵詞：耳穴埋針對行腹外疝手術(shù)老年人靶控輸注誘導(dǎo)時丙泊酚-瑞芬太尼血漿及效應(yīng)室濃度的影響　出處：《中國針灸》2017年08期 　論文類型：期刊論文

  更多相關(guān)文章： 耳穴埋針 丙泊酚 瑞芬太尼 靶控輸注 腦電雙頻指數(shù) 血漿效應(yīng)室濃度 鎮(zhèn)痛 鎮(zhèn)靜

【摘要】：目的:應(yīng)用靶控輸注(target-controlled infusion,TCI)和腦電雙頻指數(shù)(bispectral index,BIS)技術(shù)觀察耳穴埋針對行腹外疝手術(shù)老年人意識及疼痛消失時丙泊酚和瑞芬太尼血漿及效應(yīng)室濃度的影響。方法:將擇期行腹外疝手術(shù)的老年患者50例,隨機(jī)分為觀察組和對照組,每組25例。觀察組在麻醉誘導(dǎo)前30 min于術(shù)側(cè)腹股溝、肝、皮質(zhì)下、神門穴行耳穴埋針并用對壓法按壓,每穴按壓10次,埋針持續(xù)至術(shù)畢。對照組在麻醉誘導(dǎo)前30 min于上述耳穴區(qū)貼同樣規(guī)格及數(shù)量的醫(yī)用膠布,不予任何刺激,術(shù)畢去除。兩組均予靜脈全麻,采用BIS麻醉深度監(jiān)護(hù)儀監(jiān)測BIS值。麻醉誘導(dǎo)TCI丙泊酚血漿濃度1.5μg/L,每30 s遞增0.3μg/L,直至患者意識消失。后TCI瑞芬太尼血漿濃度2.0μg/L,每30 s遞增0.3μg/L,直至患者對疼痛刺激(壓眶反射)無體動反應(yīng)。記錄兩組患者T_0(入手術(shù)室后)、T_1(意識消失)及T_2(疼痛消失)時平均動脈壓(mean arterial pressure,MAP)、心率(heart rate,HR)及BIS值,T_1時的丙泊酚血漿及效應(yīng)室濃度,T_2時瑞芬太尼血漿及效應(yīng)室濃度;術(shù)畢記錄兩組丙泊酚和瑞芬太尼的用藥總量及手術(shù)時間與麻醉時間。結(jié)果:T_1及T_2時,觀察組MAP、HR均高于對照組(P0.05,P0.01);T_1時,觀察組丙泊酚血漿及效應(yīng)室濃度均明顯低于對照組(P0.05,P0.01)。T_2時,觀察組瑞芬太尼血漿及效應(yīng)室濃度均明顯低于對照組(P0.05,P0.01)。T_1及T_2時,兩組BIS值比較差異均無統(tǒng)計(jì)學(xué)意義(均P0.05)。兩組患者手術(shù)時間和麻醉時間差異均無統(tǒng)計(jì)學(xué)意義(均P0.05)。觀察組瑞芬太尼用藥總量明顯低于對照組(P0.01),丙泊酚用藥總量兩組差異無統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:耳穴埋針復(fù)合丙泊酚-瑞芬太尼TCI能降低老年腹外疝手術(shù)患者誘導(dǎo)時丙泊酚、瑞芬太尼的血漿及效應(yīng)室濃度,降低瑞芬太尼用量,具有輔助鎮(zhèn)靜、鎮(zhèn)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.
【作者單位】： 福建醫(yī)科大學(xué)省立臨床學(xué)院;福建省立醫(yī)院麻醉科;福建省中醫(yī)藥大學(xué)研究生院;
【基金】：福建省中醫(yī)藥科研項(xiàng)目:wzsy201302
【分類號】：R246.2
【正文快照】： 耳穴埋針是針灸學(xué)的一個重要組成部分,它指的靜脈全麻誘導(dǎo)時血流動力學(xué)穩(wěn)定的新方法。是采用皮內(nèi)針刺激耳郭上的穴位,以防治疾病的一種1臨床資料方法。耳針可在較長時間內(nèi)對患者進(jìn)行有效刺激,具1.1一般資料有輔助麻醉鎮(zhèn)痛和調(diào)節(jié)各種生理功能,具有增強(qiáng)麻醉本研究選擇50例行單側(cè)

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