2021 年第 1 期 第 16 卷

耳穴揿针干预在全身麻醉下胆囊切除术中的应用价值

Application value of auricular acupoints pressing needle intervention in cholecystectomy under general anesthesia 

作者：何涛杨丽徐哲

英文作者：He Tao Yang Li Xu Zhe

单位：河北省中医院麻醉科,石家庄050011

英文单位：Department of Anesthesiology Hebei Hospital of Traditional Chinese Medicine Shijiazhuang 050011 China

关键词：耳穴揿针；胆囊切除术；疼痛视觉模拟量表评分；β-内啡肽；C反应蛋白；自主神经功能

英文关键词：Auricularacupointspressingneedle;Cholecystectomy;Visualanaloguescalescore;β-endorphin;C-reactiveprotein;Autonomicnervousfunction

• 摘要：

• 目的 探讨耳穴揿针干预在全身麻醉下胆囊切除术中的应用价值。方法 选取河北省中医院2018年6月至2019年6月收治的全身麻醉下行胆囊切除术患者182例，采用随机数字表法将其分为观察组与对照组，各91例。对照组于术前1 h在神门、交感、皮质下等穴位贴敷无色胶布；观察组于术前1 h在相应穴位进行耳穴揿针，比较2组术后苏醒时间，围术期疼痛视觉模拟量表（VAS）评分，血清β-内啡肽及C反应蛋白水平，以及心率变异性频阈指标水平。结果 观察组术后自主呼吸恢复时间、拔管时间和定向力恢复时间均显著短于对照组［(12.0±2.2)min比（15.0±3.3）min，(18±3)min比（22±3）min，(22±4)min比（28±4）min］（均P<0.05）。与术前比较，2组术后3、6、12 h的VAS评分均显著升高，但观察组术后各时点VAS评分均显著低于对照组［(3.66±1.45)分比（4.46±1.73）分，(3.13±1.14)分比（4.25±1.25）分，(2.89±0.54)分比（4.13±0.63）分］（均P<0.05）。与术前比较，2组术中做切口后和手术结束时血清β-内啡肽及C反应蛋白水平均显著升高，但观察组均显著低于对照组（均P<0.05）。麻醉后，2组总功率均低于术前，但观察组高于对照组（均P＜0.05）；术后清醒时，2组总功率、低频标化功率和低频功率/高频功率均低于术前、但观察组均高于对照组，2组高频标化功率均高于术前、但观察组低于对照组（均P＜0.05）。结论 麻醉前行耳穴揿针干预能有效减轻全身麻醉胆囊切除术患者围术期疼痛及炎性反应强度，缩短术后自主呼吸恢复、拔管及定向力恢复时间，且能减少手术及麻醉对患者自主神经功能的干扰。

• Objective To investigate the application value of auricular acupoints pressing needle intervention in cholecystectomy under general anesthesia. Methods From June 2018 to June 2019， 182 patients with cholecystectomy under general anesthesia admitted to Hebei Hospital of Traditional Chinese Medicine were selected， they were randomly divided into observation group and control group, with 91 cases in each group. In the control group, colorless adhesive tape was applied at shenmen, sympathetic and subcortical acupoints 1 h before operation. In the observation group, auricular acupuncture needles were applied at corresponding acupoints 1 h before the operation The postoperative recovery time, visual analogue scale（VAS） score, serum β-endorphin and C-reactive protein and heart rate variability frequency threshold index levels were compared between the two groups. Results The recovery time of spontaneous breathing, extubation and orientation in the observation group were significantly shorter than those in the control group ［(12.0±2.2)min vs (15.0±3.3)min, (18±3)min vs (22±3)min, (22±4)min vs (28±4)min］ (all P<0.05). Compared with preoperation, VAS scores at 3, 6 and 12 h after operation in both groups were significantly increased, but VAS scores at 3, 6 and 12 h after operation in observation group were significantly lower than those in control group ［(3.66±1.45) vs (4.46±1.73), (3.13±1.14) vs (4.25±1.25), (2.89±0.54) vs (4.13±0.63)］ (all P<0.05). Compared with preoperation, the levels of serum β-endorphin and C-reactive protein in the two groups were significantly increased after incision and at the end of operation, but the observation group was significantly lower than the control group (all P<0.05). After anesthesia, the total power of the two groups was lower than preoperation, but that in the observation group was higher than that in the control group (all P<0.05). After awakening, the total power, low frequency standardized power and low/high frequency power of the two groups were lower than those before operation, but those in the observation group were higher than those in the control group, and the high frequency standardized power in both groups were higher than that before operation, but that in the observation group was lower than that in the control group (all P<0.05). Conclusion Auricular acupoints pressing needle intervention for patients underwent cholecystectomy under general anesthesia can effectively alleviate the pain and inflammatory response degree, shorten the time of postoperative spontaneous respiration recovery, extubation and directional force recovery, and reduce the interferences of surgery and anesthesia on the patients′ autonomic nervous function.