摘要
目的探讨加速康复外科结合针刺内关穴对颅脑手术患者麻醉期应激指标和苏醒质量的影响。方法将符合入选标准的2018年1月-2020年12月本院120例颅脑外伤患者采用区组随机化法分为3组,每组40例。对照组予以常规促醒法干预,干预1组予以常规促醒+针刺内关干预,干预2组予以常规促醒+针刺内关+加速康复外科干预。分别于入室稳定后10 min、气管插管即刻、拔管即刻采用电化学发光仪检测血清皮质醇(cortisol,COR)水平,ELISA法检测血清多巴胺水平,记录患者血压、心率;比较患者麻醉期苏醒质量,包括苏醒时间、自主呼吸恢复时间、拔管时间及定向力恢复时间;采用神经行为认知状态测验(Neurobehavioral Cognitive Status Examination,NCSE)评估患者认知功能;观察并记录治疗期间肠麻痹、恶心呕吐发生率及住院时间。结果气管插管即刻、拔管即刻,干预2组与干预1组、对照组收缩压降低(F值分别为12.03、13.96),血清COR(F值分别为91.40、53.76)、多巴胺(F值分别为29.72、69.39)水平降低(P<0.01)。干预2组麻醉期定向力恢复时间[(39.09±3.12)min比(41.57±3.54)min、(43.84±3.28)min,F=34.65]短于干预1组、对照组(P<0.01)。干预2组住院时间[(9.36±1.78)d比(10.92±1.81)d、(12.10±1.95)d,F=1.44]短于干预1组、对照组(P<0.05)。结论加速康复外科结合针刺内关穴可有效降低颅脑手术患者麻醉期应激水平,提高苏醒质量,减轻患者术后认知功能障碍。
Objective To explore the effects of fast-track surgery(FTS)combined with acupuncture at Neiguan acupoint on stress indicators and recovery quality in patients during anesthesia of craniocerebral surgery.Methods According to block randomization method,120 patients with craniocerebral trauma meeting inclusion criteria in the hospital were divided into three groups between January 2018 and December 2020,40 in each group.The control group was given routine awakening intervention,intervention 1 group was given routine awakening intervention and acupuncture at Neiguan acupoint,and intervention 2 group was given FTS and treatment of intervention 1 group.At 10 min after entering the room,immediately after tracheal intubation and immediately after extubation,level of serum cortisol(COR)was detected by electrochemical luminescence apparatus.The level of serum dopamine was detected by ELISA.The blood pressure and heart rates were recorded.The recovery quality during anesthesia was compared,including recovery time,recovery time of spontaneous breathing,extubation time and recovery time of orientation.The cognitive function of patients was evaluated by Neurobehavioral Cognitive Status Examination(NSCE).The incidence of intestinal paralysis,nausea and vomiting,and hospitalization time were observed and recorded during treatment.Results Immediately after tracheal intubation and extubation,systolic blood pressure in intervention 2 group,intervention 1 group and control group were significantly decreased(F=12.03,13.96),levels of serum COR(F=91.40,53.76),and dopamine(F=29.72,69.39)were significantly decreased(P<0.01).The recovery time of orientation during anesthesia[(39.09±3.12)min vs.(41.57±3.54)min,(43.84±3.28)min,F=34.65]in intervention 2 group was significantly shorter than that of the intervention 1 group and control group(P<0.01),and hospitalization time[(9.36±1.78)d vs.(10.92±1.81)d,(12.10±1.95)d,F=1.44]was significantly shorter than that of the intervention 1 group and control group(P<0.05).Conclusion The FTS combined with acupuncture at Neiguan acupoint can reduce stress level during anesthesia,improve recovery quality and relieve postoperative cognitive dysfunction in patients undergoing craniocerebral surgery.
作者
刘永琳
何世桂
秦书琴
Liu Yonglin;He Shigui;Qin Shuqin(Department of Anesthesiology,Fangchenggang First People's Hospital,Fangchenggang 538021,China)
出处
《国际中医中药杂志》
2022年第9期987-991,共5页
International Journal of Traditional Chinese Medicine
基金
广西壮族自治区卫生健康委员会自筹科研课题(Z20190407)。
关键词
加速康复外科
针刺疗法
穴
内关
颅脑手术
应激障碍
创伤性
麻醉后苏醒延迟
Enhanced recovery after surgery
Acupuncture therapy
Point PC6(Neiguan)
Craniocerebral surgery
Stress disorders,traumatic
Delayed emergence from anesthesia
作者简介
通信作者:刘永琳,Email:bfc3260382@163.com。
