全身麻醉复合电针对甲状腺手术患者应激反应的影响

金深辉 张明晓 梁冬冬

[摘要] 目的 探讨全身麻醉复合电针用于甲状腺手术对患者应激反应的影响。 方法 选择2016年5～12月在我院行择期甲状腺手术的患者200例为研究对象，随机分为研究组与对照组各100例。对照组采用常规全身麻醉，研究组采用全身麻醉复合电针。比较两组手术前、术中、术后收缩压、心率和血浆ACTH、Cor、E以及血糖水平。 结果 两组在牵拉甲状腺时收缩压及心率均显著升高，与入室前比较差异有统计学意义（P<0.05）；牵拉甲状腺时对照组收缩压及心率均显著高于研究组，差异有统计学意义（P<0.05）。两组ACTH均在牵拉甲状腺时显著升高，至手术结束即刻达到峰值，在术后1 d迅速下降至正常。在牵拉甲状腺时以及手术结束即刻对照组ACTH水平显著高于研究组，差异有统计学意义（P<0.05）。两组在牵拉甲状腺时、手术结束即刻、术后1 d Cor、E水平比较，差异有统计学意义（P<0.05）。两组在牵拉甲状腺时以及术后即刻血糖水平比较，差异有统计学意义（P<0.05）。 结论 全麻复合电针用于甲状腺手术可显著减轻患者的应激反应。

[關键词] 电针；全身麻醉；甲状腺手术；应激反应

[中图分类号] R614 [文献标识码] B [文章编号] 1673-9701（2018）25-0124-04

[Abstract] Objective To investigate the effect of general anesthesia combined with electro-acupuncture on the stress response in patients undergoing thyroid surgery. Methods 200 patients who underwent elective thyroidectomy in our hospital from May to December 2016 were randomly divided into study group and control group， with 100 cases in each group. The people in the control group received conventional general anesthesia， while those in the study group were treated with general anesthesia combined with electro-acupuncture. The preoperative systolic blood pressure， intraoperative systolic blood pressure， postoperative systolic blood pressure， heart rate， plasma ACTH， Cor， E， and blood glucose levels were compared between the two groups. Results Both systolic blood pressure and heart rate were significantly increased in the two groups when pulling the thyroid gland， and there was a significant difference in two groups when compared with that before entering the anesthesia room（P<0.05）. The systolic blood pressure and heart rate of the control group were significantly higher than those of the study group when pulling the thyroid gland. Statistical significance was observed between two groups（P<0.05）. ACTH in both groups increased significantly during traction of the thyroid gland and peaked immediately at the point of the end of surgery， and rapidly decreased to normal level one day after surgery. At the time of traction of the thyroid gland and at the point of the end of surgery， the ACTH level in the control group was significantly higher than that in the study group（P<0.05）. There was a statistically significant difference in Cor and E levels between the two groups when pulling the thyroid gland， at the point of the end of surgery， and 1 day after operation（P<0.05）. There was a statistically significant difference between the two groups when pulling the thyroid gland and at the point of the end of surgery in the blood glucose level（P<0.05）. Conclusion General anesthesia combined with electro-acupuncture for thyroid surgery can significantly reduce the patients' stress response.

[Key words] Electro-acupuncture； General anesthesia； Thyroid surgery； Stress reaction

应激反应是机体受到伤害性的刺激后，导致交感神经兴奋，下丘脑-垂体前叶-肾上腺皮质功能增强为主要特点的神经内分泌反应，由此而导致各种功能以及代谢变化，是机体的一种防御反应。麻醉与手术对患者来说均为应激源，可导致应激反应，影响机体免疫、代谢、血流动力学等。电针是在针刺疗法基础上发展而来的一种治疗方法，选择适当的穴位进行针刺，可缓解患者术后疼痛，其特点是安全，无麻醉药物过敏或者麻醉药物用药过量导致的相关麻醉并发症等问题[1，2]。目前其在临床上应用也有相关报道。吴学磊等[3]将电针应用于妇科门诊手术，结果显示麻醉效果确切，并且无药物毒副作用，操作简单安全，费用低。本研究将电针复合全身麻醉用于甲状腺手术，探讨对甲状腺患者应激反应的影响。

1 资料与方法

1.1 一般资料

选择2016年5～12月在我院行择期甲狀腺手术的患者200例为研究对象。……