穴位电刺激辅助麻醉对腔镜直肠癌手术患者胃肠激素及免疫功能影响  

Effect of transcutaneous electrical acupoint stimulation-assisted general anesthesia on gastrointestinal hormones and immune function in patients undergone laparoscopic colorectal surgery

作　　者：黄彦逵 刘慧慧[1] HUANG Yankui;LIU Huihui(Department of Anesthesiology,The First Affiliated Hospital,Guangzhou University of Traditional Chinese Medicine,Guangzhou 510440 China)

机构地区：[1]广州中医药大学第一附属医院麻醉科

出　　处：《新疆医科大学学报》2019年第12期1630-1634,共5页Journal of Xinjiang Medical University

基　　金：广东省中医药局科研项目(20172054)

摘　　要：目的探究经皮穴位电刺激(TEAS)辅助麻醉对腹腔镜直肠癌手术患者胃肠激素及免疫功能的影响。方法选择2017年6月-2018年9月于广州中医药大学第一附属医院择期在全麻下行腹腔镜直肠癌根治术治疗的92例患者为研究对象,采取随机数字表法将其随机分成观察组(n=46)与对照组(n=46)。两组患者均采用全凭静脉麻醉,观察组于麻醉诱导前30 min取百会、内关、足三里及三阴交穴,连接经皮穴位刺激仪行电针持续刺激40 min,对照组接受假针刺处理,分别于术后1、3、6、12、24和48 h采用视觉模拟评分法(visual analogue scale.VAS)评价疼痛程度,于术后12、24、48 h统计两组舒芬太尼用量;并于术前及术后1、3和5 d检测两组外周血T淋巴细胞亚群[CD3+(总T淋巴细胞)、CD4^+(辅助/诱导T淋巴细胞)、CD8^+(抑制/细胞毒T淋巴细胞)、CD4^+/CD8^+比值],自然杀伤细胞(NK)细胞表达水平和血清胃动素(MTL)水平,对比两组患者术后胃肠功能恢复情况。结果与对照组比较,观察组患者术后1、3、6、12和48 h VAS评分均降低,差异有统计意义(P<0.05);观察组患者术后12、24和48 h舒芬用量均降低,差异有统计意义(P<0.05)。与术前比较,两组患者术后1 d外周血CD3+、CD4^+、NK水平及CD4^+/CD8^+比值均降低,差异有统计学意义(P<0.05);两组患者术后3 d和5d外周血CD3+、CD4^+、NK水平和CD4^+/CD8^+比值均升高,差异有统计学意义(P<0.05);观察组患者术后1 d血清MTL水平降低,对照组患者术后1 d和3 d血清MTL水平降低,差异有统计学意义(P<0.05)。与对照组比较,观察组患者术后1 d和3 d血清MTL水平升高,术后肠鸣音恢复、首次排气和首次排便时间均缩短,差异有统计学意义(P<0.05)。结论TEAS辅助麻醉能有效调节腹腔镜直肠癌手术患者术后胃肠激素表达水平,加快胃肠功能恢复,能有效增强直肠癌患者的免疫功能。ObjectiveTo investigate the effect of transcutaneous electrical acupoint stimulation(TEAS)-assisted general anesthesia on gastrointestinal hormones and immune function in patients undergone laparoscopic colorectal surgery.MethodsThe subjects of this study,totaling 92 patients who received selective laparoscopic colorectal surgery under general anesthesia in Department of Anesthesiology,first affiliated Hospital of Guangzhou University of traditional Chinese Medicine from June 2017 to September 2018,were randomly divided into observation group(n=46)and control group(n=46).Total intravenous anesthesia was adopted for all patients from 2 groups,but prior to anesthesia induction the observation group was administrated with TEAS at acupoints of baihui,neiguan,zusanli and sanyin 30 min after the suegery,while the control group sham acupuncture.The pain 2 groups 1,3,6,12,24 and 48h after operation was evaluated by visusl analogue scale(VAS).The dosage of sulfentanil 2 groups used 12,24,48 h after operation was recorded,and levels of T lymphocyte subsets in peripheral blood[CD3+(total T lymphocyte),CD4^+(assist/induce T lymphocytes),CD8^+(inhibitory/cytotoxic T lymphocytes),CD4^+/CD8^+value],natural killer(NK)cells,serum motilin(MTL)before and 1 d,3 d,5 d after operation were detected,meanwhile postoperative recovery of gastrointestinal function was compared between 2 groups.ResultsCompared with the control group,the VAS scores of the observation group were significantly decreased at 1,3,6,12 and 48 hours after operation(P<0.05);the Sufen dosage of the observation group was significantly decreased at 12,24 and 48 hours after operation(P<0.05).The levels of CD3+,CD4^+,NK and the ratio of CD4^+/CD8^+in peripheral blood of the two groups remarkably decreased 1 day after operation(P<0.05);the levels of CD3+,CD4^+,NK and the ratio of CD4^+/CD8^+in peripheral blood of the two groups markedly increased 3 and 5 days after operation(P<0.05);the level of MTL in serum of the observation group significantly decreased 1 day after ope

关 键 词：直肠癌 穴位电刺激 全身麻醉 腹腔镜直肠癌手术 胃肠激素 

分 类 号：R245[医药卫生—针灸推拿学]