针药复合麻醉对不停跳冠状动脉移植术患者围术期免疫球蛋白及补体的影响  

Efficacy of acupuncture-drug compound ansthesia on perioperative immunoglobulin and complement in patients undergoing off-pump coronary artery bypass graft

作　　者：司文博 马月华[1] 王岳峰[1] 王嵘[1] 金沐[1] 董秀华[1] 程卫平[1] 卢家凯[1] 

机构地区：[1]北京首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所麻醉科,北京100029 [2]航空总医院麻醉科

出　　处：《心肺血管病杂志》2016年第4期300-303,共4页Journal of Cardiovascular and Pulmonary Diseases

基　　金：科技部国家重点基础研究发展计划“973”资助项目(2013CB531902)

摘　　要：目的：探讨针药复合麻醉对不停跳冠状动脉旁路移植手术患者围术期免疫球蛋白及补体的影响。方法：选择择期行不停跳冠状动脉旁路移植手术的患者50例。随机分为两组,每组25例。针药复合组（A组）25例,对照组（C组）25例。A组于麻醉诱导前30min、术中持续及术后3次（术后6h、24h、48h）行经皮穴位电刺激,频率为2Hz/100Hz,术前术后电刺激强度为引起感觉阈强度的2~3倍即10~15m A,术中麻醉期间刺激强度为30m A,刺激部位是双侧中府、云门、列缺和内关穴,30min/次;C组也以同样的装置和时间点连接在患者相同穴位上以同样频率但以较小电刺激强度4m A进行电刺激。两组患者均采用方案相同的全凭静脉麻醉。对围术期两组患者血浆免疫球蛋白Ig G、Ig A、Ig M及补体C3、C4的数据进行比较。结果：两组患者Ig G、Ig A值在术后24h、72h均较术前明显下降,Ig M、C3、C4值在术后24h较术前明显下降,术后72h恢复到术前水平;与C组相比,A组术后24h、72h Ig G、Ig A值较术前下降幅度相对较小,术后24h Ig M、C3值较术前下降幅度较小,组间差异有统计学意义（均P〈0.05）。结论：针药复合麻醉可有效减轻不停跳冠状动脉旁路移植术患者围术期免疫球蛋白及补体抑制,具有调节围术期机体免疫功能的作用。Objective： To explore the effect of acupuncture-drug compound anesthesia on perioperative immunoglobulin and complement in patients undergoing off-pump coronary artery bypass graft. Methods： 50 patients undergoing off-pump coronary artery bypass graft were randomly divided into two groups,25 in each group. Group A： acupuncture-drug compound anesthesia group; Group C： general anesthesia group. Patients in Group A were treated with transcutaneous electrical acupoint stimulation at 5 timepoints,30 min before induction（ 2Hz/100 Hz,10-15 m A,30min）,intraoperation（ 2Hz/100 Hz,30m A,continuously） and postoperation 6h,24 h,48h（ 2Hz /100 Hz,10-15 m A,30min）,Bilateral Zhongfu（ LU1）,Yunmeng（ LU2）,Lieque（ LU7） and Neiguan（ PC6） were selected as acupoint. Patients in group C were stimulated at the same TEAS points,timepoints and stimulation time with a smaller stimulus intensity（ 2Hz /100 Hz,4m A） except intraoperation. Both groups received total intravenous anesthesia. Peripheral venous blood of patients was collected,before anesthesia,postoperation 24 h and 72 h,the results of immunoglobulins（ Ig G,Ig A,Ig M） and complement（ C3,C4） were recor-ded. Results： The levels of IgG,IgA were significantly decreased in both groups at 24 h and 72 h postoperatively,and the levels of IgM,C3,C4 were significantly decreased in both groups at 24 h,but returned to preoperative levels at postoperative 72h; Compared with group C,the range of IgG,IgA were more less in group A at postoperation 24 h and postoperation 72 h,the range of IgM,C3 were more less in group A at postoperation 24h（ all P〈0. 05）. Conclusion： Acupuncture-drug compound anesthesia can effectively reduce perioperative humoral and complement inhibition in patients undergoing off-pump coronary artery bypass graft,and regulate perioperative immune function.

关 键 词：针药复合麻醉 不停跳冠状动脉搭桥 免疫球蛋白 补体 

分 类 号：R54[医药卫生—心血管疾病]