不同强度经皮穴位电刺激对使用止血带后下肢手术患者肺功能及氧自由基的影响  

Effect of transcutaneous electrical acupoint stimulation on pulmonary function and oxidative stress response in lower extremity surgery patients using tourniquet

作　　者：庄秀秀[1] 羊丽丽[2] 王露 莫云才 潘媛媛[1] 戴勤学[1] 吕雅[1] 王均炉[1,3] ZHUANG Xiu-xiu;YANG Li-li;WANG Lu;MO Yun-cai;PAN Yuan-yuan;DAI Qin-xue;Lü Ya;WANG Jun-lu(Department of Anesthesiology,The First Affiliated Hospital of Wenzhou Medical University,Wenzhou 325000,Zhejiang Province,China;Department of Anesthesiology,the Fifth Affiliated Hospital of Wenzhou Medical University,Lishui 323000,Zhejiang Province;Wencheng County People’s Hospital,Wenzhou 325300,Zhejiang Province)

机构地区：[1]温州医科大学附属第一医院麻醉科,浙江温州325000 [2]温州医科大学附属第五医院麻醉科,浙江丽水323000 [3]文成县人民医院,浙江温州325300

出　　处：《针刺研究》2019年第8期594-598,共5页Acupuncture Research

基　　金：国家自然科学基金项目（No.81573742、81704180、81603685）;温州市科技局资助项目（No.Y20170141）;浙江省中医药科技计划资助（No.2017ZA133）

摘　　要：目的:观察不同强度经皮穴位电刺激(TEAS)对使用止血带的下肢手术患者肺功能及对氧自由基超氧化物歧化酶(SOD)活性和丙二醛(MDA)含量的影响。方法:下肢手术患者40例按随机数字表法分为对照组和TEAS组,每组20例。麻醉方法均为腰硬膜外联合阻滞麻醉,TEAS组患者术前30 min经皮穴位电刺激健侧足三里穴和三阴交穴,术中针刺维持至手术结束。对照组患者给予的电流强度为患者刚有感觉时的最小值,余同TEAS组。患者入手术室后记录各个时间段的平均动脉压(MAP)和心率(HR),并于电针前(T0)和松止血带后6 h(T5)检测动脉血气以及血浆中的SOD活性和MDA含量。结果:与T0时比较,对照组在T5时动脉氧分压(PaO2)、动脉氧分压与肺泡氧分压比值(a/A)、血浆SOD活性降低(P<0.05),肺泡-动脉氧分压差(PA-aDO2)、肺泡动脉氧分压差与动脉氧分压比值(RI)、血浆MDA含量升高(P<0.05);TEAS组在T5时PaO2下降(P<0.05),PA-aDO2、RI升高(P<0.05)。与对照组比较,TEAS组T5时PaO2、a/A、血浆SOD活性升高(P<0.05),而PA-aDO2、RI和血浆MDA含量降低(P<0.05)。结论:强电流经皮穴位电刺激足三里穴、三阴交穴可通过升高患者术后血浆中SOD活性和降低MDA含量而减轻机体氧化应激反应,改善肺功能。Objective To investigate the effect of transcutaneous electrical acupoint stimulation(TEAS) on pulmonary function,superoxide dismutase(SOD)activity,and malondialdehyde(MDA)content in patients using tourniquet after lower extremity surgery.Methods A total of 40 patients who underwent lower extremity surgery were equally randomized into control group and TEAS group by using a random number table.All patients underwent lumbar epidural anesthesia combined with block anesthesia.The patients in the TEAS group were given TEAS at Zusanli(ST36)and Sanyinjiao(SP6)beginning from 30 min before surgery to the end of surgery,and those in the control group received TEAS at the same acupoints with minimum current intensity.Mean arterial pressure(MAP)and heart rate(HR)were recorded at each time point(T0:pre-surgery/TEAS,T1:5 min after anesthesia,T2:1 min before tourniquet-loosening,T3:1 min after tourniquet-loosening,T4:5 min after tourniquet-loosening,and T5:6 h after tourniquet-loosening).Blood samples(4 mL)was collected from the radial artery before TEAS and 6 h after loosening tourniquet for analyzing blood gas parameters as partial pressure of caron dioxide(PCO2),arterial partial pressure of oxygen(PaO2),alveolar partial pressure of oxygen(PAO2),alveolar-arterial oxygen pressure difference(PA-aDO2)and respiratory index(RI)by using a blood gas analyzer,and plasma SOD activity and MDA content were assayed by using xanthine oxidase method and thiobarbituric acid colorimetry method,respectively.Results Intra-group comparison showed that compared with T0,a significant increase was found in PA-aDO2 and RI at T5 and a significant reduction in PaO2 and PaO2/PAO2(a/A)ratio in the control group(P<0.05),and the same changes in the TEAS group(P<0.05)except a/A ratio.Comparison between two groups showed that at T5,both PaO2 and a/A levels were significantly higher in the TEAS group than in the control group(P<0.05),and both PA-aDO2 and RI levels were obviously lower in the TEAS group than in the control group(P<0.05),suggesting an improv

关 键 词：经皮穴位电刺激 下肢手术患者 止血带 肺功能 氧化应激反应 

分 类 号：R246.2[医药卫生—针灸推拿学]