不同麻醉方法对腹腔镜胆囊切除术患者T淋巴细胞免疫功能的影响及术后镇痛效果

Effects of laparoscopic cholecystectomy under different anesthetic methods on T-lymphocyte immune function and postoperative analgesia

目的：比较不同麻醉方法对腹腔镜胆囊切除术患者T淋巴细胞免疫功能的影响及术后镇痛效果的差异，验证穴位的特异性。方法：选择90例腹腔镜胆囊切除术患者随机分为3组：A组为经穴复合全麻组，B组为非经非穴复合全麻组，C组为全麻组。A组先行电针刺激15～30min，穴取双侧合谷、内关、足三里、阳陵泉、曲池，然后行全身麻醉，电针刺激至手术结束；B组选用A组每个经穴所在经脉与外侧相邻经脉连线的中点，与经穴相平处取穴，电针刺激方法及时间与A组相同；C组单纯采用全身麻醉。分别于麻醉前、术毕2h、术后第1天、术后第3天检测T淋巴细胞亚群的变化，并记录术中麻醉药用量及术后4、6、8、24、44h镇痛泵用量。结果：（1）术后2h与术前比较，3组CD3＋、CD4＋、CD8＋均低于术前，除A组CD4＋与术前比较差异无统计学意义（P〉0．05）外，其余差异均有统计学意义（均P〈0．05），3组CD4＋／CD8＋比值均高于术前，A组差异有统计学意义（P〈0．05）；术后第3天3组CD3＋、CD4＋及CD4＋／CD8＋均高于术前，除B组CD4＋／CD8＋与术前比较差异无统计学意义（P〉0．05）外，其他两组差异均有统计学意义（均P〈0．05）。（2）A组术中麻醉药用量明显减少（P〈0．05）。（3）A组术后4、6、8h镇痛泵用量显著减少（均P〈0．05）。结论：经穴复合全麻能提高人体痛阈，减少术中麻醉药用量，减轻全麻及手术应激反应对机体免疫调节功能的抑制效应，并可延长术后镇痛时效，阐明经穴具有特异性。

Objective To compare the differences in the effect of laparoscopic cholecystectomy （LC） with different anesthetic methods on T-lymphocyte immune function and postoperative analgesia as well as validate the specificity of meridian points. Methods Ninety cases of LC were randomized into three groups, named group A （compound general anesthesia group with meridian points involved）, group B （compound general anesthesia group with placebo points involved） and group C （general anesthesia group）. In group A, electroacupuncture was applied at first for 15 to 30 rain to bilateral Hegu （LI 4）, Neiguan （PC 6）, Zusanli （ST 36）, Yanglingquan （GB 34） and Quchi （LI 11）. Afterwards, the general anesthesia was conducted and electric stimulation lasted till the end of operation. In group B, the points adopted were the midpoints between the meridians in which the acupoints were selected in group A and the adjacent meridians on the lateral side, at the level of selected meridian points correspondingly. The method and time of electroacupuncture were same as those in group A. In group C, the general anesthesia was adopted simply. The changes of T-lymphocyte subgroup were detected before anesthesia, in 2 h, 1 day and 3 days after operation separately and the dose of narcotic in operation as well as the dose of analgesia pumper in 4 h, 6 h, 8 h, 24 h and 44 h after operation separately. Results （1） In comparison between the result 2 h after operation and that before operation, the levels of CD＋ , CD＋ and CD＋ in all of three groups were lower than those before operation. Except that the change in CD in group A did not present significant statistical difference as compared with that before operation （P〈0. 05）. all of the other differences in T-lymphocyte subgroup indicated statistical significance （all P〈0.05）. The ratio of CD4＋/CD8＋ in three groups was higher than that before opera- tion, but the difference in group A was significant statistically （P〈0.05）. In 3 days after operation, the levels of CD4＋/ CD8＋ and CD4＋/CD8＋ were all higher than those before operation, indicating significant statistical differe-nces （all P〈0.05） except CD4＋/CD8＋ in group B（（P〉0.05）. （2）In group A, during operation, the dose of narcotic reduced apparently （P（0.05）. （3） Separately, in 4, 6 and 8 h after operation, the dose of analgesia pumper reduced significantly in group A （all P〈0. 05）. Conelusion Compound general anesthesia with meridian points involved can increase pain threshold of human body. reduce the dose of narcotic during operation, alleviate the suppression m body immune regulation due to stress reaction of general anesthesia and operation, prolong the timeeffect of postoperative analgesia and explain the specificity of meridian points.