经皮穴位电刺激复合全麻/控制性降压对术后海马神经保护的炎性反应调控机制  

Inflammatory-modulating mechanism of transcutaneous electrical acupoint stimulation combined with general anesthesia or controlled hypotension on postoperative hippocampal neuroprotection

作　　者：刘喆[1] 沈颖洁[1] 连林立[1] 邵晓梅[1] 方剑乔[1] 

机构地区：[1]浙江中医药大学第三临床医学院,杭州310053

出　　处：《中国针灸》2013年第2期149-155,共7页Chinese Acupuncture & Moxibustion

基　　金：国家重点基础研究发展计划(973)项目:2007CB51250;浙江省"重中之重"学科(针灸推拿学)资助项目:浙教高科(2008)255

摘　　要：目的:观察经皮穴位电刺激(TEAS)复合全麻/控压对术后中枢内外炎性反应及海马神经元损伤的影响,探讨其对脑保护作用机制。方法:18只6～8月龄雄性健康比格犬,随机分为全麻组、控压组和干预组,每组6只。全麻组采用异氟醚麻醉后行剖腹探查术;控压组在麻醉基础上联合硝普钠行控制性降压,达到目的血压后施行手术;干预组在控压基础上行TEAS,穴取"曲池""合谷""足三里""三阴交",干预至术毕血压回升,术后72h取脑。采用ELISA法检测不同时间点血清细胞因子白介素(IL-1β)、肿瘤坏死因子(TNF-α)的含量;免疫组化法检测海马CA1和CA3区细胞因子IL-1β、TNF-α和凋亡相关蛋白Bcl-2、Bax及活化型胱冬酶(Caspase-3)蛋白表达;原位末端转移酶标记法检测海马细胞凋亡情况。结果:①从麻醉诱导开始至术后72h,控压组与干预组TNF-α浓度表现出先升后降的趋势,而IL-1β浓度则呈现先降后升的趋势,细胞因子组间比较差异无统计学意义(P>0.05)。②控压组和干预组CA1区和CA3区IL-1β、TNF-α和Caspase-3阳性细胞率较全麻组显著升高(P<0.01),干预组相关细胞因子较控压组降低显著(P<0.01),干预组CA1区Caspase-3较控压组显著减少(P<0.01);控压组和干预组CA1和CA3区Bcl-2/Bax阳性细胞比值均低于全麻组(P<0.01),干预组比值高于控压组(CA1区:P<0.01,CA3区:P<0.05)。③控压组和干预组CA1区、CA3区神经细胞凋亡指数均较全麻组显著增多(P<0.01),其中干预组CA1区较控压组显著减少(P<0.01)。结论:TEAS可调控全麻/控压手术动物海马炎性因子的表达,进而提高Bcl-2/Bax比值、抑制活化型Caspase-3的表达,减少海马神经元凋亡,发挥保护神经作用。Objective To observe the effects of transcutaneous electrical acupoint stimulation （TEAS） com- bined with general anesthesia or controlled hypotension on hippocampal neuronal damage and the inflammatory re- sponse in peripheral circulation and central nervous system （CNS） after surgery, and to investigate its brain pro- tection mechanism. Methods Eighteen healthy male beagles aged 6--8 months were randomly divided into a ge- neral anesthesia group （group G）, a controlled hypotension group （group C） and a compound anesthesia acupunc- ture group （group A）, 6 cases in each group. Dogs in group G was anesthetized by isoflurane inhalation, and group C was combined with intravenous infusion of sodium nitroprusside based on isoflurane inhalation to induce hypotension, and followed surgery after achieving the target blood pressure, and group A was combined with TEAS at ＂Quchi＂ （LI 11）, ＂Hegu＂ （LI 4） ＂Zu sanli＂ （ST 36） and ＂Sanyinjiao＂ （SP 6） based on controlled hypo- tension, and then brain tissue was taken out on the 72 h after mean arterial pressure （MAP） was returned to base- line levels. The concentration of IL-1β.TNF-a in serum at different time points were detected by ELISA. The ex- pression of IL-1β, TNF-a, Bcl-2, Bax and cleaved caspase-3 were measured by immunohistochemistry, and the ap- optosis of hippoeampus were detected by TUNEL. Results @ At different time points, the concentration of TNF- a showed the trend of increase first and then decrease, while IL-1β concentration represented a trend of decrease first and then increase in both group C and group A, but there were no significant differences in cytokine expres- sion between the two groups （all P〉0.05）. Q The ratio of positive cells of IL-113, TNF-a and caspase-3 in CA1 and CA3 of hippocampus in both group C and A were higher than those in group G （all P（0.01）, and cytokines expression in group A were lower than those in group C （all P（0.01）, and caspase-3 in CA1 in group A was l

关 键 词：针刺麻醉 经皮穴位电刺激 控制性降压 炎性反应 细胞凋亡 神经保护 海马 

分 类 号：R245.9[医药卫生—针灸推拿学]