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中国当代心脏直视手术的针刺麻醉。

Acupuncture anesthesia for open heart surgery in contemporary China.

机构信息

Department of Cardiothoracic Surgery, Shu Guang Hospital affiliated with the Shanghai Traditional Medicine University, Shanghai, China.

出版信息

Int J Cardiol. 2011 Jul 1;150(1):12-6. doi: 10.1016/j.ijcard.2011.04.002. Epub 2011 May 12.

Abstract

BACKGROUND

Although the use of acupuncture anesthesia for open heart surgery, which was introduced in China four decades ago, has declined in recent years, there is a renewed interest in it in contemporary China due to the escalating medical costs associated with open heart surgery. This study was aimed to determine whether a combined acupuncture-medicine anesthesia (CAMA) strategy reduces early postoperative morbidity and medical costs in patients undergoing open heart operation under cardiopulmonary bypass.

METHODS

From July 2006 to October 2010, CAMA was applied in 100 patients undergoing open heart surgery in comparison with another 100 patients under the conventional general anesthesia (GA). For all the CAMA patients, an abdominal breathing training program was practiced for the 3 consecutive days prior to operation. About 15 to 20 min prior to surgical incision, acupuncture needles were inserted into the bilateral points ZhongFu, LieQue, and XiMen. During operation, patients were kept on spontaneous breathing. Endotracheal intubation was not employed but only prepared as a standby. The narcotic drugs, fentanyl and midazolam, were intravenously injected but in very low doses as compared to GA. Open heart procedures were performed routinely in both groups.

RESULTS

Compared with the GA patients, the CAMA patients had a less usage of narcotic drugs (p<0.001), less postoperative pulmonary infection (p<0.05), shorter stay in intensive care unit (p<0.05), and a lower medical cost (P<0.05).

CONCLUSIONS

A combined acupuncture-medicine anesthesia strategy reduces the postoperative morbidity and medical costs in patients undergoing open heart surgery under cardiopulmonary bypass.

摘要

背景

尽管四十年前在中国引入的用于心脏直视手术的针刺麻醉近年来有所减少,但由于与心脏直视手术相关的医疗费用不断攀升,当代中国对其重新产生了兴趣。本研究旨在确定在体外循环下进行心脏直视手术的患者中,联合针刺-药物麻醉(CAMA)策略是否可以降低术后早期发病率和医疗费用。

方法

从 2006 年 7 月至 2010 年 10 月,将 CAMA 应用于 100 例接受心脏直视手术的患者,并与 100 例接受常规全身麻醉(GA)的患者进行比较。对于所有 CAMA 患者,在手术前连续 3 天进行腹部呼吸训练计划。在手术切口前约 15 至 20 分钟,将针刺入双侧穴位中府、列缺和西门。在手术过程中,患者保持自主呼吸。不使用气管插管,仅作为备用。与 GA 相比,静脉内注射了麻醉药物芬太尼和咪达唑仑,但剂量较低。两组均常规进行心脏直视手术。

结果

与 GA 患者相比,CAMA 患者使用的麻醉药物较少(p<0.001),术后肺部感染较少(p<0.05),重症监护病房停留时间较短(p<0.05),医疗费用较低(P<0.05)。

结论

联合针刺-药物麻醉策略可降低体外循环下进行心脏直视手术患者的术后发病率和医疗费用。

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