经皮穴位电刺激对高龄老年患者止血带引发缺血再灌注损伤的影响  

Effect of Transcutaneous Electrical Acupoint Stimulation on Tourniquet Induced Ischemia-Reperfusion Injury in Very Elderly Patients

作　　者：王明洁 李惠洲 刘飞飞[1] 石娜[1] 赵爽[1] 吴川[1] 杨淑红[2] 王秀丽[1] WANG Ming-jie;LI Hui-zhou;LIU Fei-fei(Department of Anesthesiology,The Third Hospital of Hebei Medical University,Shijiazhuang(050051),China)

机构地区：[1]石家庄市河北医科大学第三医院麻醉科,石家庄050051 [2]石家庄市河北医科大学第三医院手术室,石家庄050051

出　　处：《中国中西医结合外科杂志》2022年第4期468-473,共6页Chinese Journal of Surgery of Integrated Traditional and Western Medicine

基　　金：河北省政府资助临床优秀人才培养和基础课题研究项目(361005)。

摘　　要：目的:探究经皮穴位电刺激(TEAS)对高龄老年患者止血带引发缺血再灌注损伤(IRI)的影响。方法:择期腰硬联合麻醉下行膝关节置换手术患者40例,性别不限,年龄>75岁,体质量指数(BMI)20~30 kg/m^(2),ASA分级II或Ⅲ级,随机均分为两组:TEAS组(T组)和对照组(C组)。T组于麻醉后以G6805-2型低频脉冲治疗仪持续刺激患者双侧内关穴及合谷穴至止血带放气,C组于相同穴位贴电极片,不行电刺激。于患者入室(T0),止血带充气前(T_(1)),止血带充气后30 min(T_(2))、60 min(T_(3)),止血带放气前(T_(4)),止血带放气后1、3和5 min(T_(5-7))记录患者平均动脉压(MAP)、心率(HR)及术中血管活性药用量,于T_(4)、T_(6)和T_(7)分别采集动脉血样,通过血气分析测定血乳酸(Lac)浓度和pH值,于T0、止血带放气后30 min(T_(8))、术后6 h(T_(9))分别采集外周静脉血样,采用ELISA法测定血清肿瘤坏死因子(TNF)-α、白细胞介素(IL)-6、内皮素1(ET-1)浓度,硫代巴比妥酸法测定血清丙二醛(MDA)含量,黄嘌呤氧化酶法测定血清超氧化物歧化酶(SOD)活性。结果:两组患者各时间点MAP和HR比较差异无统计学意义(P>0.05);两组患者与T_(4)时比较,T_(6)和T_(7)时血浆Lac浓度升高,pH值降低(P<0.05);与C组比较,T组患者T_(8-9)时血清TNF-α、ET-1浓度降低,SOD活性升高,T_(9)时血清IL-6浓度降低(P<0.05)。结论:TEAS对止血带引发的血流动力学变化无明显作用,其可通过降低患者血清TNF-α、IL-6、ET-1浓度,提高血清SOD活性,在一定程度上减轻止血带引发的肢体IRI。Objective To explore the effect of transcutaneous electrical acupoint stimulation on limb ischemia-reperfusion injury(IRI)induced by tourniquet in the very elderly patients.Methods Forty patients of both sexes,aged>75 year,with body mass index of 20~30 kg/m^(2),of American Society of Anesthesiologists physical status II orⅢ,undergoing knee arthroplasty under combined spinal-epidural anesthesia were randomly divided into 2 groups(n=20 each):TEAS group(group T)and control group(group C).After anesthesia,patients in group T received continuous TEAS at the bilateral points of Neiguan and Hegu until the tourniquet deflates.In group C,electrodes were applied on the same acupoints,without electrical stimulation.Mean arterial pressure(MAP),heart rate(HR)and intraoperative vasoactive drug dosage were recorded at regular time points:after the patient entered the room(T_(0)),before tourniquet inflation(T_(1)),30 min(T_(2))and 60 min(T_(3))after tourniquet inflation,before tourniquet deflation(T_(4)),1 min(T_(5))and 3 min(T_(6))after tourniquet deflation,5 min after tourniquet deflation(T_(7)).Arterial blood samples were collected at T_(4),T_(6) and T_(7) respectively and the plasma lactic acid(Lac)concentration and pH value were measured by blood gas analysis.Peripheral venous blood samples were collected at T0,30 min(T_(8))and 6 h(T_(9))after tourniquet exhalation for measurement of serum levels of tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),endothelin-1(ET-1),malondialdehyde(MDA)and superoxide dismutase(SOD).Results There was no significant difference in MAP and HR between the two groups at different time points(P>0.05).Compared with T_(4),plasma Lac concentration increased and pH value decreased at T_(6) and T_(7)(P<0.05).Compared with group C,the concentration of serum TNF-αand ET-1was decreased at T_(8-9).The concentration of serum IL-6 was decreased at T_(9) and the activity of serum SOD was increased at T_(8-9) in group T(P<0.05).Conclusion TEAS has no obvious effect on hemodynamic changes induced by tour

关 键 词：经皮穴位电刺激 止血带 再灌注损伤 老年 

分 类 号：R614[医药卫生—麻醉学]