电针对体外循环心脏手术患者的心肌保护效应  

Cardioprotection of electroacupuncture in patients undergoing heart surgery with cardiopulmonary bypass

作　　者：肖红[1] 吴大庆[2] 章放香[2] 陈冰凝 张竞超[2] 罗云鹏[2] Xiao Hong;Wu Daqing;Zhang Fangxiang;Chen Bingning;Zhang Jingchao;Luo Yunpeng(Department of Anesthesiology, Xiamen Hospital of Traditional Chinese Medicine, Xiamen 361009, China;Department of Anesthesiology, People＇s Hospital Affiliated to Guizhou Medical University, Guiy~ ang 550001, Chin)

机构地区：[1]厦门市中医院麻醉科,361009 [2]贵州医科大学附属人民医院麻醉科,贵阳市550001

出　　处：《中华麻醉学杂志》2018年第2期146-149,共4页Chinese Journal of Anesthesiology

摘　　要：目的评价电针对体外循环心脏手术患者的心肌保护效应。方法择期行体外循环下心脏瓣膜置换术患者40例，年龄18-55岁，体重指数18-25kg／m^2，性别不限，ASA分级Ⅲ级，NY-HA心功能分级Ⅱ或Ⅲ级，采用随机数字表法分为2组（n=20）：对照组（c组）和电针组（EA组）。EA组于麻醉诱导前20min至手术结束时采用电针刺激双侧内关、郄门、神门、百会，频率2Hz，电流强度依患者清醒时耐受程度为宜。于电针前、转机30min、停机后30min、1、2h、术后6和24h时抽取中心静脉血标本，采用ELISA法测定血浆心脏型脂肪酸结合蛋白（hFABP）和cTnI浓度，采用羟胺法测定丙二醛（MDA）浓度。于术后1、6和24h时进行心肌收缩力评分，术后24h时进行心律失常评分。结果与C组比较，EA组停机后30min、1、2h和术后6h时血浆MDA浓度、术后24h时血浆cTnI浓度和转机30min、术后24h时血浆hFABP浓度降低，心律失常评分和术后6、24h时心肌收缩力评分降低（P〈0．05）。结论电针可抑制体外循环心脏手术患者脂质过氧化反应，产生心肌保护效应。Objective To evaluate the cardioprotection of electroacupuncture （EA） in the patients undergoing heart surgery with cardiopulmonary bypass （CPB）. Methods Forty American Society of Anes-thesiologists physical status III patients, aged 18-55 yr, of New York Heart Association Ⅱ-Ⅲ, sched-uled for elective cardiac valve replacement with CPB, were divided into 2 groups (n = 20 each） using a random number table ： control group (group C) and group EA. In group EA, bilateral Neiguan, Ximen, Shenmen and Baihui acupoints were stimulated with an electric stimulator with the frequency of 2 Hz from 20 min before anesthesia induction until the end of operation, and the optimal intensity was selected according to the patient＇s tolerance when awake. Before EA and at 30 rain of CPB, 30 rain, 1 h and 2 h after termi-nation of CPB and 6 and 24 h after operation, blood samples were taken from the central vein for determina-tion of concentrations of heart-type fatty acid binding protein and cardiac troponin I in plasma (by enzyme-linked immunosorbent assay） and concentrations of malondialdehyde （using hydroxylamine method）. Cardi-ac contractility was scored at 1, 6 and 24 h after operation, and arrhythmia was scored at 24 h after opera-tion. Results Compared with group C, the plasma concentrations of malondialdehyde at 30 rain and 1 and 2 h after termination of CPB and 6 h after operation, plasma concentrations of cardiac troponin I at 24 h af-ter operation, and plasma concentrations of heart-type fatty acid binding protein at 30 min of CPB and 24 h after operation were significantly decreased, and the arrhythmia score and cardiac contractility score at 6 and 24 h after operation were decreased in group EA （P〈0. 05）. Conclusion EA can inhibit lipid peroxi-dation and exerts cardioorotection in the oatients underzoinz heart surgery with CPB.

关 键 词：电刺激疗法 心肺转流术 

分 类 号：R614[医药卫生—麻醉学]