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本研究是探索以针刺镇痛与小剂量硬膜外阻滞复合作肾移植手术的麻醉方法并与同期肾移植手术用硬膜外阻滞的病员进行临床资料比较。100例终末肾衰作肾移植手术患者随机分成针刺复合小剂量硬膜外阻滞(针药复合组)与硬膜外阻滞(对照组)各50例,男女之比前者36:14,后者44:6。年龄范围分别为19～54岁和18～55岁。两者患者的肾移植方法、局麻药种类、术前药、辅助药、注药途径和注药时间基本相同。在保持患者无痛的前提下,比较两组局麻药的初量和总量。术中血流动力学的改变、升压药和抗胆碱药的应用、移植肾开始泌尿时间以及麻醉前后免疫功能的变化。针刺选穴采用循经取穴和循神经取穴两者相结合原则。主穴:次髎、三阴交、太溪(均双侧);配穴:肾俞和切口旁针或足三里(双)。刺激方法:刺激波形,G6805电麻仪,连续波。刺激频率:次髎,肾俞,切口旁针用80～100Hz,三阴交、太溪、足三里用2～4Hz,刺激强度调节至患者能耐受的最高刺激强度,诱导时间30分钟,硬膜外阻滞穿刺点T_(12)-L_1脊椎间隙,导管向头端留置3.5cm,局麻药为2％利多卡因和1％利多卡因与0.15％地卡因合液,术前药安定10mg,盐酸东茛菪碱0.3mg术前一小时肌注。麻醉辅助用药:切皮前30分钟肌注哌替啶1mg/kg,切皮前10分钟静脉滴注氟哌啶0.05mg/kg,芬太尼0.05mg。术中常规鼻导管供氧,以及监测心电图,S_pO_2。针药复合麻醉效果评定,以术中保持病人安静,无痛和手术顺利进行为前提。麻醉效果评定,根据硬膜外注药的初量分为优、良、可三级,以切皮前10分钟之前所注药量的总和为初量。初量≤5ml为优,6～8ml为良,>8ml为可。手术在3小时内追加次数不超过3次者,保持原评级,超过三次者,依次降级。结果针药复合组麻醉效果,优31例(62％),良13例(26％),可6例(12％),总优良率达88％。两组局麻药初量和总量比较:针药复合组为(5.6±0.3)ml和(13.5±1.0)ml。而对照组为(14.5±0.4)ml和(25.4±1.2)ml,两组间有非常显著性差异(P<0.001)。术中对照组的血流动力学改变较大,两组需用升压药和抗胆碱药的病例数和次数分别为1和2与9和5次。移植肾首次泌尿时间针药复合组较对照组快,分别为(209±25)秒和(410±47)秒(P<0.001)。麻醉前后的免疫功能变化两组间无明显差异。
This study was to explore the anesthetic method of acupuncture analgesia combined with low-dose epidural anesthesia for renal transplantation and compared with the clinical data of patients with epidural block for renal transplantation. 100 patients with end-stage renal failure for renal transplant patients were randomly divided into acupuncture combined with small-dose epidural block (acupuncture combined with epidural block) and epidural block (control group) 50 cases, the ratio of male to female 36:14 , The latter 44: 6. The age range is 19 ~ 54 and 18 ~ 55 respectively. Both patients with kidney transplantation, local anesthetic types, preoperative drugs, adjuvant drugs, injection routes and injection time is basically the same. Under the premise of maintaining the patient’s painlessness, the initial and total amount of local anesthetic in two groups were compared. Intraoperative hemodynamic changes, vasopressors and anticholinergic drugs, renal transplant urinary tract time and changes in immune function before and after anesthesia. Acupuncture acupoints by acupoints and acupoints follow the principle of combining the two. The main points: second 髎, Sanyinjiao, too Creek (both sides); with points: Shenshu and incision needle or Zusanli (double). Stimulation method: stimulate the waveform, G6805 electric meter, continuous wave. Stimulation frequency: second 髎, Shenshu, incision needle with 80 ~ 100Hz, Sanyinjiao, too Creek, Zusanli with 2 ~ 4Hz, the intensity of stimulation to the patient can withstand the highest stimulus intensity, induction time 30 minutes, epidural Blocking puncture point T_ (12) -L_1 intervertebral space, the catheter to the head end retention 3.5cm, 2% local anesthetic lidocaine and lidocaine 1% and 0.15% combined liquid, preoperative analgesic 10mg, Scopolamine hydrochloride 0.3mg intramuscularly one hour before surgery. Anesthesia Assisted medication: intramuscular injection of meperidine 1mg / kg intramuscularly 30 minutes before skin incision, intravenous infusion of droperidol 0.05mg / kg, fentanyl 0.05mg 10 minutes before skin incision. Intraoperative routine nasal catheter oxygen supply, and monitoring of ECG, S_pO_2. Acupuncture drug anesthesia assessment, to keep patients quiet during surgery, painless and smooth operation as a precondition. Evaluation of anesthesia, according to the initial amount of epidural injection is divided into excellent, good, can be three, to the first 10 minutes before the injection of the amount of the initial dose. Initial amount ≤ 5ml is excellent, 6 ~ 8ml is good,> 8ml is acceptable. Surgery in 3 hours to append no more than 3 times, keep the original rating, more than three times, followed by downgrade. Results Anesthesia effect of acupuncture combination group was excellent in 31 cases (62%), good in 13 cases (26%) and fair in 6 cases (12%). The total excellent and good rate was 88%. The two groups of local anesthesia initial volume and total volume comparison: acupuncture combined group was (5.6 ± 0.3) ml and (13.5 ± 1.0) ml. While the control group was (14.5 ± 0.4) ml and (25.4 ± 1.2) ml, with significant difference between the two groups (P <0.001). Intraoperative hemodynamic changes in the control group larger, two groups need to use antihypertensive drugs and anticholinergic cases and the number of times were 1 and 2 and 9 and 5 times. The first time of urinary bladder needle in the transplantation group was (209 ± 25) seconds and (410 ± 47) seconds (P <0.001), respectively, faster than the control group. There was no significant difference between the two groups in the changes of immune function before and after anesthesia.