经皮穴位电刺激对直肠癌根治术患者围术期T淋巴细胞免疫功能和术后镇痛效果的影响

Effects of transcutaneous electric stimulation of acupuncture points on perioperative T-lymphocyte immune function and postoperative analgesia in patients undergoing radical rectal cancer operation

目的 探讨经皮穴位电刺激对直肠癌根治术患者围术期T淋巴细胞免疫功能和术后镇痛效果的影响。方法择期行直肠癌根治术患者60例，年龄40～64岁，ASAⅠ或Ⅱ级，随机分为2组（n=30）：全麻＋硬膜外麻醉组（Ⅰ组）和经皮穴位电刺激＋全麻＋硬膜外麻醉组（Ⅱ组）。Ⅱ组全麻诱导前30min至术毕持续行经皮穴位电刺激，术后连续3d间断行经皮穴位电刺激，刺激部位取双侧合谷和内关穴。2组患者术后行病人自控硬膜外镇痛。于麻醉诱导前、术毕、术后1、3、5d抽取外周静脉血，测定CD3^＋、CD^4＋和CD8’水平及CD4^＋／CD8^＋。于术后4、8、12、24、48、72h进行视觉模拟评分法（VAS）评分。记录术后24、48、72h镇痛药用量。结果与Ⅰ组相比，Ⅱ组术后5d内CD3^＋水平升高，术后1d内CD4^＋水平升高，术后3、5d时CD4^＋／CD8^＋升高，Ⅱ组术后4、8h时VAS评分降低，术后24、48、72h镇痛药用量减少（P〈0．05）。结论 经皮穴位电刺激可增强直肠癌根治术患者围术期T淋巴细胞免疫功能，增强术后镇痛的效果，减少镇痛药用量。

Objective To evaluate the effects of transcutaneous electric stimulation of acupuncture points （TEAS） on perioperative T-lymphocyte immune function and postoperative analgesia in patients undergoing radical rectal cancer operation. Methods Sixty ASA Ⅰ or Ⅱ patients of both sexes aged 40-64 yr undergoing elective radical rectal cancer operation were randomly divided into 2 groups （ n = 30 each） ： Ⅰ control group and Ⅱ TEAS group. The operation was performed under general anesthesia combined with epidural block in both groups. The patients were unpremedicated. Anesthesia was induced with midazolam, fentanyl, propofol and vecuronlum and maintained with isoilurane inhalation and intermittent iy boluses of vecuronium supplemented with epidural block. The patients were mechanically ventilated after tracheal intubation. Epidural catheter was inserted into epidural space at T12-L1 interspace and was advanced 4 cm cephalad. Correct placement of the epidural catheter was identified by a test dose of 5 ml 1.33% lidocaine. In TEAS group bilateral He-gu and Nei-guan were stimulated with an electric stimulator for 30 rain before induction of anesthesia. TEAS was continued throughout the operation, and was performed 30 rain a day for 5 days after operation. All of the patients received patient-controlled epidural analgesia （PCEA） after operation. Blood samples were taken before induction of anesthesia, at the end of operation and on the 1st, 3rd 5th day after operation for determination of CD3^＋ ,CD4^＋ and CD8^＋ levels and CD4^＋/CD8^＋ ratio. VAS scores and the total amount of analgesics consumed were recorded. Results The CD3^＋ and CD4^＋ levels and CD4^＋/CD8^＋ ratio were significantly higher after operation in TEAS group than in control group. VAS scores were significantly lower and significantly less PCEA solution was consumed in TEAS group than in control group. Conclusion TEAS can attenuate the suppression of T-lymphocyte immune function and decrease analgesic requirement after radical rectal cancer operation.