Objective To observe the supplementary analgesic effect of electroacupuncture and its influence on the maintenance of anesthesia and the speed of recovery of patients undergoing craniotomy. Methods Eighty cases of supratentorial tumor resection were randomly divided into a group A and a group S, 40 cases in each group. All the patients were anesthetized with 2% Sevoflurane. The patients in group A received eleetroacupuneture at Hegu （合谷 LI 4） and Waiguan （外关 TE 5）, Jinmen （金门 BL 63） and Taichong （太冲 LR 3）, Zusanli （足三里 ST 36） and Qiuxtu（丘墟 GB 40） from anesthesia beginning to the end of operation, and in group S without electroacupuncture. tidal Sevoflurane concentration, minimum alveolar concentration （MAC）, bispectral index （BIS） and the information during anesthesia recovery stage were recorded, respectively. Results The end-tidal concentration and MAC of Sevoflurane in group A at all times were significant lower than those in group S （P〈0.05, P〈0.01） with a Sevoflurane saving of 9.62% on average. The BIS in group A during a few phases were higher than that in group S （all P〈0.05）. During anesthesia recovery stage, the time of each phase in group A was significantly shorter than that in group S （all P〈0.01）. No dysphoria and one case with nausea and vomiting were shown in group A, but in group S, 2 patients had dysphoria and 3 patients had nausea and vomiting. Conclusion Electroacupuncture combined with Sevoflurane anesthesia can decrease the dosage of Sevoflurane, shorten the recovery time of anesthesia and improve the quality of anesthesia recovery of the patients undergoing resection of supratentorial tumor.
目的评价基于加速康复外科(ERAS)理念的围手术期麻醉管理用于颅内前循环动脉瘤夹闭术中的临床效果。方法选择择期行全麻颅内前循环动脉瘤夹闭手术的患者130例,男56例,女74例,年龄18~64岁,体重指数(BMI)18~30 kg/m2,美国麻醉医师协会(ASA)分级Ⅰ~Ⅲ级,Hunt‑Hess分级0~Ⅱ级。根据纳入时间将患者分为两组(每组65例):加速康复外科(ERAS)组(E组,2019年7月至2021年4月)和对照组(C组,2018年7月至2019年6月)。E组实施ERAS围手术期麻醉管理方案,C组采取传统麻醉管理方案。记录两组患者术后住院时间,住院费用,术中情况,术后恢复情况,术后2、4、8、12、18、24、48 h数字分级评分法(NRS)疼痛评分和镇痛情况,术后并发症发生情况,出院时患者对临床服务的满意度,出院后第4周卡氏功能状态(KPS)评分及再入院事件。结果与C组比较:E组术后住院时间较短(P<0.05),住院费用较少(P<0.05);术中晶体液输入量、舒芬太尼和瑞芬太尼用量较少(均P<0.05);术后2、4、8、12、18、24、48 h NRS疼痛评分较低(均P<0.05),患者自控镇痛(PCA)泵有效按压次数、总按压次数、补救镇痛例数较少(均P<0.05);术后拔除尿管时间、首次下地活动时间、首次进普食时间较短(均P<0.05);深静脉血栓(DVT)发生率较低(P<0.05)。两组患者其余术中指标、其他并发症发生情况、出院后第4周KPS评分差异均无统计学意义(均P>0.05)。出院时患者对临床服务的满意度均为100%,两组均无再入院事件。结论颅内前循环动脉瘤夹闭术运用ERAS理念进行多方位围手术期麻醉管理,能够缩短患者术后住院时间,降低住院费用、术后疼痛评分及术后并发症发生率,提高术后恢复质量。
