穴位经皮电刺激对全麻肛肠手术患者镇痛麻醉效应的机制研究  

Mechanism of acupoint transcutaneous electric stimulation on analgesic anesthesia in the patients undergoing general anesthesia anorectal operation

作　　者：林玉芳[1,2] 杨巍[3] 李亚娟[2] 李寅[2] 童秋瑜[2] 马文[2] 李一婧[2] 沈卫东[2] 

机构地区：[1]上海中医药大学,上海201203 [2]上海中医药大学附属曙光医院针灸科,上海201203 [3]上海中医药大学附属曙光医院肛肠科,上海201203

出　　处：《中国针灸》2017年第7期747-752,共6页Chinese Acupuncture & Moxibustion

基　　金：上海市市属博士学科点建设基金项目:1497

摘　　要：目的:观察穴位电刺激对全麻肛肠手术患者机体镇痛物质及神经-免疫-内分泌系统相关调节作用。方法:将拟肛瘘、痔疮手术患者156例随机分为3组,最终146例纳入分析。Ⅰ组48例,施以常规静脉全麻;Ⅱ组50例,常规静脉全麻联合穴位经皮电刺激,穴取内关、神门、上髎、次髎;Ⅲ组48例,常规静脉全麻联合穴位经皮电刺激,穴取上髎、次髎,电刺激一直持续到手术结束。手术前0.5 h及手术后1 h内分别采集患者唾液,检测反映机体疼痛调节及神经免疫内分泌指标opiophin蛋白(OPI)、分泌型免疫球蛋白A(SIgA)、唾液淀粉酶(sAA)、皮质醇(Cor)及肿瘤坏死因子-α(TNF-α);并对术后1h疼痛程度进行观察。结果:Ⅱ组OPI手术后高于手术前(P<0.05),Ⅱ组OPI组内差值明显高于Ⅰ组、Ⅲ组(均P<0.05)。Ⅰ组SIgA手术后高于手术前(P<0.05),Ⅱ组SIgA、sAA、Cor组内差值明显低于Ⅰ组(P<0.05,P<0.01),而TNF-α手术前后及其组内差值的组间比较差异均无统计学意义(均P>0.05)。Ⅱ组、Ⅲ组术后1 h疼痛程度明显低于I组(P<0.05,P<0.01)。结论:在全麻肛肠手术中,穴位经皮电刺激可有效促进体内镇痛物质的释放,缓解术中应激水平,达到麻醉镇痛效应。局部取穴辅以内关、神门整体取穴疗效优于单纯局部取穴。Objective To observe the regulatory effects of acupoint electric stimulation on the analgesic substances and the relevant indices of nerve-immunity-endocrine system in the patients undergoing general anesthesia anorectal operation.Methods One hundred and fifty-six patients undergoing hemorrhoids and anal fistula operation were randomized into three groups, 146 cases were included in the analysis. In the No.1 group（48 cases）, the conventional intravenous general anesthesia was applied. In the No.2 group（50 cases）, besides the conventional intravenous general anesthesia, the acupoint transcutaneous electric stimulation was combined at Neiguan（PC 6）, Shenmen（HT 7）, Shangliao（BL 31） and Ciliao（BL 32）.In the No.3 group（48 cases）, besides the conventional intravenous general anesthesia, the acupoint transcutaneous electric stimulation was combined at Shangliao（BL 31） and Ciliao（BL 32）. The electric stimulation was maintained till the end of operation. The patients＇ saliva was collected 0.5 h before operation and 1 h after operation separately. The indices that reflect the body pain regulation and nerve-immune-endocrine secretion were detected, such as opiophin protein（OPI）, secretory immunoglobulin A（SIgA）, saliva amylase（sAA）, cortisol（Cor） and tumor necrosis factor α（TNF-α）. The pain degree was observed 1 h after operation. Results In the No.2 group, OPI after operation was higher than that before operation（P〈0.05）.The difference value of OPI in the No.2 group was higher apparently than that in the No.1 group and the No.3 group（both P〈0.05）. SIgA after operation was higher than that before operation in the No.1 group（P〈0.05）. The difference values of SIgA, sAA, Cor in the No.2 group were lower apparently than those in the No.1 group（P〈0.05, P〈0.01）. TNF-αbefore and after operation and its difference value among the groups were not significant statistically（all P〈0.05）. The pain degrees in 1 h after operation in the No.2 and N

关 键 词：麻醉镇痛 穴位经皮电刺激 应激 免疫 肛肠手术 

分 类 号：R246.2[医药卫生—针灸推拿学]