经皮穴位电刺激对开颅术围术期脑损伤相关因子的影响

Effect of Transcutaneous Acupoint Electrical Stimulation on Blood Bioactive Compounds Involving Cerebral Injury During Craniotomy

目的：探讨经皮穴位电刺激（TAES）对颅脑手术围术期脑损伤的脑保护效应的机制。方法：选择脑瘤择期手术患者50例，随机分为治疗组和对照组，每组25例。治疗组选取双侧合谷、曲池和足三里、三阴交两组穴位，用HANS穴位刺激仪从麻醉前30min开始实施TAES至术毕，刺激频率2／100HZ，强度8～12mA。对照组采用常规全麻。所有患者麻醉诱导后采用持续吸入七氟醚和间断静脉注射舒芬太尼和维库溴胺维持麻醉。分别在麻醉诱导前（T0）、颅内操作60min（T1）、术毕（T2）、术后24h（T3）、术后48h（T4）抽取颈内静脉血，用放射免疫法测定血浆内皮素（ET）、降钙素基因相关肽（CGRP）和血清白细胞介素-6（IL-6）含量，酶联免疫吸附法测定血清S100β水平。结果：治疗组患者ET水平在T2明显低于对照组（P〈0．01）；CGRP水平在两组各时间点比较差异均无显著性意义（P〉0．05）；IL-6在T1治疗组低于对照组（P〈0．01），在T3治疗组高于对照组（P〈0．05）；S100β在T1、T4治疗组明显低于对照组（P〈0．05）。结论：TAES可以调控CGRP／ET，使脑组织微循环得以改善，还可能通过调节IL-6水平而降低其介导的促炎性反应，发挥其神经营养作用等，对颅脑手术围术期脑损伤起到保护作用。

Objective To observe the effect of transcutaneous acupoint electrical stimulation （TAES） on plasma ET, CGRP and serum IL-6, S100β during craniotomy. Methods Fifty patients scheduled for neurosurgery were randomly divided into TAES group （n=25） and control group （n=25）. TAES （2/100 Hz, 8-12 mA） of bilateral Hegu （LI 4）-Quchi （LI 11）, Zusanli （ST 36）-Sanyinjiao （SP 6） was administrated for patients of TAES group starting 30 min before anesthesia till the end of the operation. Anesthesia of the patients was maintained with sevoflurane inhalation and intermittent intravenous injection of boluses of sulfenany and vecurnium bromide. Jugular venous blood samples were taken at preanesthesia （T0）, 1 hour after craniotomy （T1）, closure complete （T2）, 24 hours （T3） and 48 hours （T4） after operation respectively for detecting contents of plasma endothelin （ET）, calcitonin gene-related peptide （CGRP） and serum interleukin （IL）-6, S100β with radioimmunoassay and enzyme linked immunosorbent assay separately. Results Compared with control group, plasma ET at T2, serum IL-6 at T1, S100β at T1 and T4 in TAES group all decreased significantly（ P〈0.01, 0.05）, while serum IL-6 at T3 increased remarkably （P〈0.05）. It suggests that after TAES, CGRP/ET was improved, favoring cerebral microcirculation to reduce surgery-induced cerebral injury. There were no significant differences between two groups at different time courses in plasma CGRP concentrations （P〉0.05）. Conclusion TAES can regulate plasma CGRP/ET and serum IL-6, lower serum S100β level, which may contribute to its effect in relieving craniotomy-induced brain injury.