术前针刺治疗对糖尿病患者围术期胰岛素抵抗和细胞免疫的影响  

Effects of Preoperative Acupuncture Treatment on Perioperative Insulin Resistance and Cellular Immunity in Diabetic Patients

作　　者：郑小兰[1] 肖苏军 张学康[1] 陈世彪[1] 陈陵[2] ZHENG Xiao-lan;XIAO Su-jun;ZHANG Xue-kang;CHEN Shi-biao;CHEN Ling(Department of Anesthesiology,the First Affiliated Hospital of Nanchang University,Nanchang 330006,China;Emergency Office,the First Affiliated Hospital of Nanchang University,Nanchang 330006,China)

机构地区：[1]南昌大学第一附属医院麻醉科,南昌330006 [2]南昌大学第一附属医院应急办,南昌330006

出　　处：《实用临床医学（江西）》2023年第3期26-30,共5页Practical Clinical Medicine

基　　金：江西省卫计委中医药科研计划(2018A150)。

摘　　要：目的探究术前针刺治疗对2型糖尿病(T2DM)患者围术期的血糖水平、胰岛素抵抗(IR)以及T淋巴细胞亚群的影响.方法选取接受全身麻醉腹腔镜下胃肠手术治疗的40例T2DM患者,按随机数字表法分为术前针刺组(A组)和空白对照组(C组),每组20例.A组在进行麻醉诱导前30 min针刺双侧足三里穴、合谷穴持续30 min;C组不进行电针刺激.记录针刺前(T_(0))、手术开始30 min后(T_(1))、手术结束当时(T_(2))、手术后24 h(T_(3))2组空腹血糖水平(Glu)、胰岛素水平(INS)、T淋巴细胞亚群水平(CD3^(+)、CD4^(+)、CD8^(+)和CD4^(+)/CD8^(+)的比值),并计算胰岛素抵抗指数(IRI)和胰岛素敏感指数(ISI).记录2组手术情况(手术时间、术中液体输注量与失血量、术中丙泊酚和瑞芬太尼用量)及术后情况(镇痛泵按压次数,恶心呕吐发生次数和VAS疼痛评分).结果A组在T_(1)、T_(2)时Glu、INS、IRI明显低于C组,ISI明显高于C组(P<0.001).A组在T_(1)、T_(2)、T_(3)时CD3^(+)细胞水平、CD4^(+)细胞水平、CD4^(+)/CD8^(+)比值明显高于C组(P<0.05或P<0.001).结论术前针刺能够改善T2DM患者的胰岛素抵抗,并提高免疫力.Objective To investigate the effects of preoperative acupuncture treatment on perioperative blood glucose levels,insulin resistance(IR)and T-lymphocyte subsets in patients with type 2 diabetes mellitus(T2DM).Methods Forty T2DM patients undergoing laparoscopic gastrointestinal surgery under general anesthesia were randomly divided into two groups,with 20 patients in each group.The preoperative acupuncture group(group A)was given bilateral acupuncture at Zusanli and Hegu for 30 min before anesthesia induction,while the control group(group C)received no electroacupuncture stimulation.The levels of fasting blood glucose(Glu),insulin(INS)and T-lymphocyte subsets(CD3^(+),CD4^(+),CD8^(+)and CD4^(+)/CD8^(+)ratio)were measured before acupuncture(T0),30 min after the start of surgery(T1),at the end of surgery(T2),and 24 h after surgery(T3).Furthermore,IR index(IRI),insulin sensitivity index(ISI),operation time,intraoperative fluid infusion volume,intraoperative blood loss,intraoperative propofol and remifentanil dosages,number of analgesic pump compressions,frequency of nausea and vomiting,and VAS score were recorded in both groups.Results Compared with the group C,the levels of Glu and INS and the IRI decreased and the ISI increased in the group A at T1 and T2(P<0.001).In addition,CD3^(+)and CD4^(+)T cell levels and CD4^(+)/CD8^(+)ratio in the group A were higher than those in the group C at T1,T2 and T3(P<0.05 or P<0.001).Conclusion Preoperative acupuncture can improve IR and enhance immunity in patients with T2DM.

关 键 词：术前针刺 糖尿病 细胞免疫 胰岛素抵抗 围术期 

分 类 号：R246.1[医药卫生—针灸推拿学]