针刺复合静脉麻醉用于甲状腺良性结节消融术的临床观察

摘要

目的:评价针刺复合静脉麻醉用于甲状腺良性结节微波消融手术的临床效果.方法:选取2016年10月至2018年2月在上海中医药大学附属市中医医院接受甲状腺良性结节微波消融手术的患者66例,随机分为观察组和对照组,每组33例,观察组采用针刺复合静脉麻醉,对照组采用常规静脉麻醉的方法,观察2组镇痛镇静效果、静脉麻醉药的用量、术中打鼾和呼吸抑制发生率以及麻醉前、术毕、术后第1天血清皮质醇(Cor)含量的变化.结果:2组均取得了良好的镇痛和镇静效果;在观察组不用异丙酚的情况下,右美托咪定和芬太尼的用量与对照组比较,差异无统计学意义(P＞0.05);观察组术中打鼾和呼吸抑制发生率明显低于对照组;血清Cor含量的变化组间比较,差异无统计学意义(P＞0.05),组内比较,2组麻醉前和术毕血清Cor含量差异均无统计学意义(P＞0.05),术后第1天早上血清Cor含量较麻醉前和术毕均明显下降,差异有统计学意义(P＜0.05).结论:针刺复合静脉麻醉用于甲状腺良性结节微波消融手术镇痛镇静效果良好,能够减少静脉麻醉药用量;降低术中打鼾和呼吸抑制的发生率,并可以降低术后应激反应.%Objective:To investigate the effect of acupuncture combined intravenous anesthesia in microwave ablation of benign thyroid nodules.Methods:A total of 66 patients in our hospital from October 2016 to February 2018 who conformed to the inclu－sion criteria and received microwave ablation were divided into two groups randomly .Acupuncture combined intravenous anesthesia (Treatment group, 33 cases) and conventional intravenous anesthesia alone (Control group, 33 cases) were performed.The anal－gesic effect, sedative effect, anesthetic dosage, incidence rate of snoring and respiratory depression , and serum cortisol level be－fore and after operation were examined in two groups.Results:Both two groups obtained satisfactory anesthetic effect.There were no significant difference in the doses of dexmedetomidine and fentanyl between two groups , but the treatment group did not use propofol.Compared with control group , patients in treatment group had lower incidence rate of snoring and respiratory depression . In terms of cortisol level, there were no significant differences between two groups.Cortisol level in the first day after surgery was lower than that before and after operation.Conclusion:Acupuncture combined with intravenous anesthesia has satisfactory anesthe－sia effect in microwave ablation of benign thyroid nodules.It can obviously decrease the dosage of narcotic , adverse effects rate, and postoperative stress response.