针刺复合硬膜外麻醉对移植肾早期功能影响.docVIP

针刺复合硬膜外麻醉对移植肾早期功能影响 　　［摘　要］　目的：观察针刺对肾移植术中和术后早期泌尿功能的影响。方法：肾移植手术44例，分别接受硬膜外阻滞、小剂量硬膜外阻滞、针刺复合硬膜外阻滞和针刺复合小剂量硬膜外阻滞，每组11例。针刺取穴：次?、三阴交、太溪、足三里。观察移植肾泌尿开始时间、尿流速度和血浆儿茶酚胺浓度。术后连续观察4天肾功能指标。结果：针刺能明显减少硬膜外阻滞局麻药的需要量；复合针刺有助于维持术中循环功能稳定；改善术中和术后早期移植肾的功能；明显提高血浆肾上腺素浓度，而对去甲肾上腺素影响不大。结论：针刺能促进硬膜外麻醉肾移植术后移植肾早期功能恢复。 　　［主题词］　肾移植；麻醉，硬膜外；针药复合麻醉 　　Effect of Acupuncture Combined with Epidural Anesthesia on Early Function of Transplanted Kidney 　　Wang Zhengping, Li Shitong, Zhuang Xinliang, et al. (Department of Anesthesiology, Shanghai Municipal First People?s Hospital, Shanghai 200080, China) 　　［Abstract］　Purpose　To explore the effect of acupuncture on the function of transplanted kidney during operation and at the early stage after operation. Methods　44 cases were randomly divided into 4 groups, 11 cases in each groups. They received respectively routine epidural blocking, small dosage epidural blocking, compound acupuncture and routine epidural anesthesia, and compound acupuncture and small dosage epidural anesthesia. Points selected were Ciliao (BL 32), Sanyinjiao (SP 6), Taixi (KI 3), and Zusanli (ST 36). The time for starting secretion of urine, urine flow rate and plasma contents of catecholamines were observed for 4 days. Results　〖WT5”BZ〗Acupuncture decreased obviously the dosage of epidural anesthetics, increased the plasma epinephrine content, and improved renal function during the operation and at early stage after operation, and the compound acupuncture anesthesia conduced to maintain stability of circulation function during the operation. Conclusion　 Acupuncture can promote function recovery of the transplanted kidney after operation under epidural anesthesia. 　　［Key words］　Kidney Transplantation; Anesthesia, Epidural; Combined Acup Medic Anesthesia 　　肾移植手术常用的麻醉方法之一为硬膜外阻滞。研究表明针刺与硬膜外麻醉???合不仅改善针刺镇痛不足和减少硬膜外阻滞的局麻药液用量，而且术中血流动力学相对较稳定［1，2］。本研究拟进一步观察针刺对肾移植术中和术后早期移植肾的泌尿功能的影响，观察移植肾泌尿功能的变化与血中儿茶酚胺的关系，探索针刺复合麻醉对移植肾早期泌尿功能影响的机理。 　　 　　1　临床资料 　　 　　肾移植手术病人44例，男女各22例，术前均常规接受血液透析治疗