温阳散寒法对瑞芬太尼全麻患者皮肤神经肽及其受体表达的影响

目的:观察温阳散寒法对瑞芬太尼全麻患者皮肤神经肽及其受体表达的影响。方法:60例分成两组各30例。治疗组术前连续3天输入参附注射液,手术切皮前皮下泵注高乌甲素注射液。对照组手术切皮前皮下泵注氯诺昔康。手术切皮时和手术缝皮前取出两组皮肤观察感觉神经末梢在表皮层的支配情况(包括形态、密度等),检测两组皮肤组织β-内啡肽、强啡肽A的表达情况。结果:对照组可见皮肤表皮层大量棘细胞肿胀变形,治疗组则少见。治疗组手术后皮肤神经构筑的密度较术前无明显差异,对照组则较术前明显减少。两组术前皮肤组织中均有大面积β-内啡肽、强啡肽A的表达,而术后两组阳性表达面积明显减少,平均灰度值比较差异均有统计学意义(P<0.05);治疗组术后β-内啡肽、强啡肽A的平均灰度值均高于对照组(P<0.05)。结论:温阳散寒法可能对瑞芬太尼麻醉患者的皮肤免疫功能有一定的调节作用。

Objective： To observe the effect of warming Yang to expel coldness method on the expression of neuropeptide and its receptors in general anesthesia patients with Remifentanil.Method： 60 cases were divided into 2 groups,30 cases in each group.The study group were injected Shenfu injection for 3 days continuously before operation and were injected lappaconitine hydrobromide injection with subcutaneous pump before incision.The control group were injected Lornoxicam with subcutaneous pump before incision.The skin of both groups was taken to be observed the sensory nerve endings innervation in epidermis,including the morphology,the density,and so on.Result： A quantity of spiny neurons were observed swelling and deformation in the control group while rare phenomenon was observe in the study group.There wasn＇t significant difference in the skin nerve innervation density of the study group between pre-operation and post-operation.Compared that of the pre-operation,the skin nerve innervation density of post-operation decreased significantly in the control group.There was large-area expression of β-endorphin and dynorphin A in the skin tissue before operation while the positive expression areas in both groups decreased significantly after operation and the comparison of differences of average gray value had statistical significance（P0.05）.The average gray value of β-endorphin and dynorphin A of the study group was higher than that of the control group after operation（P0.05）.Conclusion： Warming Yang to expel coldness method has some regulation effect on the skin immune function of general anesthesia patients with Remifentanil.