【摘要】：目的低頻脈沖電針輔助全麻反饋調(diào)控丙泊酚靶控輸注,評(píng)價(jià)低頻脈沖電針對(duì)全身麻醉患者心率變異性(HRV)的影響。方法擇期行腹腔鏡膽囊切除手術(shù)患者80例,隨機(jī)分為低頻脈沖電針?lè)答佌{(diào)控丙泊酚靶控組(觀(guān)察組)和靶控丙泊酚輸注組(對(duì)照組),每組40例。觀(guān)察組術(shù)前30 min預(yù)先給予經(jīng)皮電針刺激,穴位選取雙側(cè)合谷、內(nèi)關(guān)穴,頻率選擇2 Hz,波形選擇連續(xù)波,電針強(qiáng)度選擇3,時(shí)間設(shè)定30 min。兩組患者均采用相同全身麻醉方式,麻醉誘導(dǎo)采用咪達(dá)唑侖0.05 mg/kg、芬太尼2.0μg/kg,丙泊酚2.0 mg/kg,阿曲庫(kù)銨0.5 mg/kg,行氣管插管。麻醉維持用阿曲庫(kù)銨0.25 mg/kg/h,2%七氟醚吸入。觀(guān)察組丙泊酚靶控輸注,血漿靶濃度為2.0 mg/mL,設(shè)定丙泊酚反饋值為腦電雙頻指數(shù)(BIS)=50,BIS≥50時(shí)輸注持續(xù)進(jìn)行,BIS50時(shí)反饋程式啟動(dòng),輸注將被終止,對(duì)照組丙泊酚靶控輸注,血漿靶濃度為2.0 mg/mL。分別記錄觀(guān)察組實(shí)施電針前(T0)、觀(guān)察組實(shí)施電針后(T1)、插管后(T2)、切皮(T3)、分離膽囊(T4)、膽囊切除(T5)、縫皮(T6)7個(gè)時(shí)間點(diǎn)的血壓(BP)、心率(HR)、HRV、BIS的變化和丙泊酚的用量。結(jié)果觀(guān)察組丙泊酚用量為(241.3±21.4)mL,對(duì)照組為(315.2±13.2)mL,觀(guān)察組丙泊酚用量明顯少于對(duì)照組(P0.05)。對(duì)照組在T2、T4時(shí)間點(diǎn)SBP下降較觀(guān)察組明顯,觀(guān)察組中有4例需用多巴胺升高血壓,對(duì)照組中有10例需用多巴胺升高血壓。兩組患者的HR在麻醉后均有下降,對(duì)照組在T4時(shí)間點(diǎn)HR下降較觀(guān)察組明顯。兩組患者的高頻(HF)、低頻(LF)、低頻高頻比(LF/HF)在T0、T1、T2、T3各個(gè)時(shí)間點(diǎn)均有下降,對(duì)照組的下降幅度大于觀(guān)察組,在T4、T5時(shí)間點(diǎn)牽拉膽囊時(shí)LF、HF均升高,其中HF顯著升高,LF/HF降低,對(duì)照組的降低幅度大于觀(guān)察組。結(jié)論低頻脈沖電針輔助全身麻醉,可以降低患者BP、HR的波動(dòng),對(duì)HRV有正性調(diào)節(jié)作用,BIS作為反饋控制變量調(diào)控丙泊酚靶控輸注,可以達(dá)到較精確地控制麻醉深度,減少術(shù)中血流動(dòng)力學(xué)波動(dòng),并減少丙泊酚用量。
[Abstract]:Objective to evaluate the effect of low frequency pulse electroacupuncture on heart rate variability (HRV) in patients with general anesthesia. Methods 80 patients undergoing laparoscopic cholecystectomy were randomly divided into low frequency pulse electroacupuncture controlled propofol target control group (observation group) and target controlled propofol infusion group (control group) with 40 cases in each group. The observation group was given transcutaneous electroacupuncture stimulation 30 min before operation. The acupoints were selected as bilateral Hegu, Neiguan acupoint, frequency selection 2 Hz, waveform, electroacupuncture intensity 3, time 30 min.. Both groups were given the same general anesthesia. Midazolam 0.05 mg/kg, fentanyl 2.0 渭 g / kg and propofol 2.0 mg/kg, atracurium 0.5 mg/kg, were used for intubation. Anesthesia was maintained by inhalation of atracurium 0.25 mg/kg/h,2% sevoflurane. In the observation group, the target controlled infusion of propofol and the plasma target concentration of 2.0 mg/mL, set the feedback value of propofol as the EEG bispectral index (BIS) 50 BIS 鈮，

本文編號(hào)：2252031