1. 上海中医药大学附属曙光医院胸外科,上海,201203
2. 上海中医药大学特色诊疗技术研究所,上海,201203
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XU Jian-jun, CHEN Tong-yu, ZHOU Jia, et al. Lung-protecting effect of acupuncture anesthesia on thoracic surgery patients during one-lung ventilation. [J]. Shanghai Journal of Traditional Chinese Medicine 50(4):11-14(2016)
目的:观察针刺复合麻醉对胸腔镜下肺切除手术患者单肺通气期间肺氧合及肺内分流的影响。 方法:将60例择期行胸腔镜下肺切除手术的患者随机分为针刺复合麻醉组及全身麻醉组,每组30例。全身麻醉组予常规全身麻醉方法;针刺复合麻醉组在常规全身麻醉的基础上,取双侧后溪、支沟、内关、合谷穴,手术前30 min予2~100 Hz的疏密波进行电针刺激,直至手术结束。分别于麻醉后双肺通气30 min(T,0,)、单肺通气15 min(T,1,)、单肺通气30 min(T,2,)、单肺通气 60 min(T,3,),抽取混合静脉血(本研究采用右心房血作为混合静脉血样)进行血气分析,计算肺内分流量(Q,s,/Q,t,)。 结果:①双肺通气(T,0,)与单肺通气(T,1,、T,2,、T,3,)期间比较,两组患者的MAP、HR、CVP、Paw 以及pH、PaCO,2,、PvO,2,、SaO,2,、SvO,2,、Hb无显著性变化(P,>,0.05);组间相同时点比较,上述各指标差异均无统计学意义(P,>,0.05)。②与双肺通气时(T,0,)比较,两组单肺通气各时点(T,1,、T,2,、T,3,)PaO,2,明显下降(P,<,0.05)。其中全身麻醉组在单肺通气30 min时(T,2,)达到最低值,之后开始回升,而针刺复合麻醉组直到60 min时(T,3,)才达到最低值;针刺复合麻醉组PaO,2,值在T,1,、T,2,、T,3,时点明显高于全身麻醉组(P,<,0.05)。两组单肺通气各时点(T,1,、T,2,、T,3,)SaO,2,值差异无统计学意义(P,>,0.05)。③两组患者术前Q,s,/Q,t,差异无统计学意义(P,>,0.05),且均在正常范围内;单肺通气后,Q,s,/Q,t,值明显增加(P,<,0.05)。针刺复合麻醉组Q,s,/Q,t,峰值发生在单肺通气15 min(T,1,),而全身麻醉组肺内分流峰值发生在单肺通气30 min(T,2,);针刺复合麻醉组在T,1,、T,2,、T,3,时点的Q,s,/Q,t,值均明显低于全身麻醉组,差异有统计学意义(P,<,0.05)。 结论:针刺复合麻醉可以降低肺切除术患者单肺通气期间的肺内分流,改善肺的氧合作用,对围手术期的肺保护具有积极意义。
Objective:To investigate effects of Electroacupuncture(EA)combined with general anesthesia(GA)strategy on oxygenation and pulmonary shunt during one-lung ventilation in patients with thoracic surgery. MethodsSixty patients with thoracic surgery were randomly divided into EA group and GA group,with 30 cases in each group.Patients of the GA group received simple general anesthesia.EA(2/100 Hz)was applied to bilateral Houxi(SI03),Zhigou(SJ6),Neiguan(PC6),and Hegu(LI4)beginning about 30 min before the surgery in the EA group.Blood samples were obtained at four time points:two lung ventilation 0 min(T,0,),one-lung ventilation 15 min(T,1,),one-lung ventilation 30 min(T,2,),one-lung ventilation 60 min(T,3,)via internal jugular vein and radial artery to perform blood gas analysis.Intrapulmonary shunt(Q,s,/Q,t,)was calculated and detected. Results:①Compared to the two lung ventilation(T,0,), there was no significant difference in the MAP, HR, CVP, Paw, pH, PaCO,2, PvO,2, SvO,2, and Hb in both group during the one-lung ventilation(T,1,-T,3,)(P,>,0.05); There was also no significant difference between the two groups at the same time points(P,>,0.05). ②Compared to the T,0, the partial pressure of oxygen(PaO,2,)was significantly reduced at T,1, T,2, and T,3, in each group(P,<,0.05); In GA group, the PaO,2, was reached the lowest value at T,2, and then began to increase; However, in EA group, the PaO,2, was reached the lowest value at T,3,; Meanwhile, compared to the GA group,the PaO,2, was significantly higher at the time points T,1,T,2,and T,3, in EA group(P,<,0.05); During the one-lung ventilation, there was no significant difference in SaO,2, between the two groups at T,1, T,2, and T,3,(P,>,0.05). ③There was no significant difference in Q,s,/Q,t, between the two groups before surgery(P,>,0.05), and both were in the normal range. After one lung ventilation, Q,s,/Q,t, value increased significantly(P,<,0.05). The peak value of Q,s,/Q,t, in EA group was at 15 min(T,1,)after one lung ventilation, while the peak of pulmonary shunt occurred at 30 min(T,2,)in GA group. The Q,s,/Q,t, value in EA group was significantly lower than that in GA group at T,1, T,2, T,3, with a significant difference between two groups(P,<,0.05). Conclusion:EA combined with general anesthesia can increase the PaO,2, and reduce intrapulmonary shunt during one-lung ventilation in patients undergoing thoracic surgery.It has positive effects on lung protection in clinical practice.
针刺复合麻醉单肺通气血氧分压肺内分流肺保护
electroacupuncture combined with general anesthesiaone-lung ventilationpartial pressure of oxygenpulmonary shunt fractionlung protection
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