不同麻醉方法对腹腔镜胆囊切除术患者围术期免疫功能的影响

Effect of different anesthesia methods on immune function in patients of laparoscopic cholecystectomy in peri-operational period

目的：比较针药复合麻醉和全身麻醉对腹腔镜胆囊切除术（LC）患者围术期免疫功能影响的差异。方法：选取择期行LC患者39例，随机分成针药复合麻醉组（针药组）和全麻组。针药组先行电针刺激15～30min，穴取合谷、内关、足三里、阳陵泉，然后行全身麻醉，电针刺激至手术结束；全麻组单纯行全身麻醉。分别观察两组患者麻醉诱导前、术后2h、术后第1、3天T淋巴细胞亚群、肿瘤坏死因子－α（TNF－α）、白细胞介素-6（IL-6）的变化及术后不良反应的发生情况。结果：术后2h两组总T淋巴细胞（CD产）、抑制T淋巴细胞（CD8^＋）较麻醉诱导前降低（均P〈0．05）。全麻组辅助T淋巴细胞（CD乒）显著降低（P〈0．05），针药组CD≯无显著改变，CD4^＋／CD8^＋显著上升（P〈0．05）。术后第3天针药组TNF－α与麻醉诱导前比较显著降低（P〈0．05）。针药组患者术后恶心例数明显少于全麻组（P〈0．05）。结论：针药复合麻醉对LC患者免疫功能影响较小，术后不良反应发生低。

Objective To compare the influence of acupuncture combine with general anesthesia （ACGA） and general anesthesia （GA） on immune function in patients of laparoscopic cholecysteetomy （LC） in peri-operational period. Methods Thirty-nine cases undergoing LC were randomly divided into an ACGA group and a GA group. The ACGA group was treated with electroacupuncture at Hegu （LI-4）, Zusanli （ST 36） and Yanglingquan （GB 34） for 15--30 minutes and subsequently with the general anesthesia followed by continuous electroacupuncture stimulation till the operation finished. The GA group was treated with simple general anesthesia. Changes of T cell subset,tumor necrosis factor-apha （TNF-α） and interieukin-6 （IL-6） were observed at time points of before anesthesia induction, 2 hours after operation, 1 and 3 days after operation and the occurrence of adverse reaction after operation was recorded. Results The percentages of CD＋ and CD＋ in both groups at 2 hours after operation were significant lower than that before anesthesia induction （all P%0.05）, and the percentage of CD4^＋ in the GA group decreased significantly at that time point （P〈0.05）, while there was no significant difference in the ACGA group and CD4^＋/CD8^＋ increased significantly （P〈0.05）. The level of TNF-α in the ACGA group decreased significantly at 3 days after operation as compared with that of before anesthesia induction （P〈0.05）. There were significantly less cases nauseated after operation in the ACGA group than that in the GA group（P〈0.05）. Conclusion Acupuncture combine with general anesthesia has very little effect on immune function in patients of LC with less adverse reactions.