不同针刺干预时机对女性全麻腹腔镜手术患者围手术期免疫功能及术后恶心呕吐的影响  

The influence of perioperative immune function and postoperative nausea and vomiting of different intervention time of general anesthesia acupuncture intervention in the patients with laparoscopic surgery

作　　者：刘智[1] 滕永杰[1] 

机构地区：[1]湖南中医药大学第一附属医院麻醉科,长沙410007

出　　处：《国际中医中药杂志》2017年第11期993-998,共6页International Journal of Traditional Chinese Medicine

摘　　要：目的 探讨不同针刺干预时机对全麻腹腔镜手术患者围手术期免疫功能及术后恶心呕吐（postoperative nausea and vomiting,PONV）的影响.方法 将符合入选标准的行全麻腹腔镜手术的女性患者104例,按随机数表法分为A、B、C、D组,每组26例.A组于麻醉前0.5h针刺,B组于术中针刺,C组于术后针刺,D组不针刺.分别于麻醉诱导前0.5h（T0）、手术结束（T1）、术后第1天（T2）、术后第3天（T3）检测总T淋巴细胞（CD3＋）、T辅助细胞（CD4^＋）和T抑制细胞（CD8＋）,并计算CD4＋/CD8＋比值;采用混悬计检法检测血液中的免疫球蛋白IgA、IgM、IgG水平;分别于术后6h（T4）、术后12h（T5）和术后48h（T6）观察患者PONV发生情况并进行评分.术后1周,观察并记录患者的不良反应.结果 T3时,A组CD3^＋[（62.12±8.37）%比（58.15±3.92）%、（57.15±7.83）%、（55.32±7.66）%,F=132.238]、CD4^＋[（37.99±6.92）%比（34.03±6.32）%、（34.00±6.49）%、（33.85±6.73）%,F=2.794]、CD8^＋[（25.07±5.06）%比（22.89±1.32）%、（22.91±1.24）%、（22.78±1.75）%,F=2.849]、CD4^＋/CD8^＋[（1.30±0.34）比（1.27±0.34）、（1.29±0.31）、（1.25±0.27）,F=5.413]、IgA[（151.15±36.83）IU/ml比（135.24±15.17）IU/ml、（135.16±16.09）IU/ml、（132.05±17.37）IU/ml,F=3.044]、IgM[（169.35±53.69）IU/ml比（146.26±23.06）IU/ml、（145.73±24.66）IU/ml、（143.12±21.43）IU/ml,F=2.839]、IgG[（131.89±28.13）IU/ml比（118.88±15.35）IU/ml、（116.92±20.25）IU/ml、（115.06±20.55）IU/ml,F=3.165]水平均高于B、C、D组（P〈0.05）.T5时,A组患者PONV评分[（1.76±0.24）分比（1.98±0.31）分、（1.96±0.37）分、（2.09±0.33）分,F=4.918]低于B、C、D组（P〈0.05）;T6时,PONV评分[（1.33±0.36）分比（1.52±0.26）分、（1.54±0.28）分、（1.73±0.35）分,F=6.984]低于B、C、D组（P〈0.05）;A组患者不良反应发生率[11.5%（3/26）比38.5%（10/26）,χ2=5.026]低于D组Objective To explore the influence of perioperative immune function and postoperative nausea and vomiting （PONV） of different intervention time of general anesthesia acupuncture intervention in the patients with laparoscopic surgery. Methods According to random number table method, 104 patients with laparoscopic surgery using general anesthesia from October 2015 to December 2016 in our hospital were divided into A, B, C, D group with 26 patients in each group. All patients were treated with tracheal intubation anesthesia. Patients in group A （acupuncture half an hour before anesthesia）, group B （acupuncture in the surgery）, group C （acupuncture after the end of the surgery） and group D （without acupuncture）. The levels of T lymphocyte subsets, including total T lymphocytes （CD3^＋）, T helper cells （CD4^＋） and T suppressor cell （CD8^＋）, and the CD4^＋/CD8^＋, were detected at half an hour before anesthesia induction （T0）, the end of surgery （T1）, postoperative day 1 （T2） and postoperative day 3 （T3）. At the same time, the levels of IgA, IgM and IgG were calculated by suspension method. In addition, the occurrence and score of PONV were observed in postoperative 6h （T4）, 12h after surgery （T5） and 48h after surgery （T6）. The occurrence of adverse reactions was observed postoperative 1 week. Results The various immune index at T3 CD3＋ （62.12% ± 8.37% vs. 58.15% ± 3.92%,57.15% ± 7.83%,55.32% ± 7.66%,F=132.238）,CD4^＋（37.99% ± 6.92% vs.34.03% ± 6.32%, 34.00% ± 6.49%,33.85% ± 6.73%,F=2.794）,CD8＋（25.07% ± 5.06% vs.22.89% ± 1.32%,22.91% ± 1.24%, 22.78% ± 1.75%,F=2.849）,CD4＋/CD8＋（1.30 ± 0.34 vs.1.27 ± 0.34,1.29 ± 0.31,1.25 ± 0.27,F=5.413）,IgA （151.15 ± 36.83 IU/ml vs.135.24 ± 15.17 IU/ml,135.16 ± 16.09 IU/ml,132.05 ± 17.37 IU/ml,F=3.044）,IgM （169.35 ± 53.69 IU/ml vs.146.26 ± 23.06 IU/ml,145.73 ± 24.66 IU/ml,143.12 ± 21.43 IU/ml,F=2.839）,IgG 131.89 ± 28.13 IU/ml vs.118.88 ± 15.35 IU/ml,116.92 ± 20.

关 键 词：针刺 麻醉 全身 腹腔镜 时间医学 围手术期 免疫功能 手术后恶心呕吐 

分 类 号：R614[医药卫生—麻醉学]