Protecting action of acupuncture-drug compound anesthesia with different frequency electroacupuncture on stress reaction in patients of pneumonectomy

针药复合麻醉中不同频率电针对肺切除患者应激反应的保护作用(英文)

Objective To observe the protective effect of acupuncture-drug compound anesthesia with different frequency electroacupuncture（EA） on stress reaction in patients of pneumonectomy and to explore potential mechanisms.Methods Eighty patients scheduled for pneumonectomy were randomly divided into four groups,group A,B,C and D,20 cases in each group.General anesthesia and single lung protective mechanical ventilation were carried out in all the groups.Acupuncture was given at Hòuxī（后溪 SI 3）,Zhīgōu（支沟TE 6）,Nèiguān（内关 PC 6）,and Hégǔ（合谷 LI 4） 30 min before general anesthesia,and the acupuncture needles were connected with Han＇s acupoint nerve stimulator（HANS-200） in all the groups,but the acupuncture needles without needle bodies were pasted on the acupoints and EA was not given in the group A.2 Hz continuous wave,100 Hz continuous wave and 2 Hz/100 Hz EA were given in the group B,C and D respectively.The supplementary amount of anesthesia medicine,heart rate（HR） and mean arterial pressure（MAP） during pneumonectomy,and CD4^＋/CD8^＋ in venous blood before and one day after the surgery,and the contents of epinephrine（E） and cortisol（Cor） in plasma after entering the operating room and before turning out the operating room were detected.Results ① During the operation,supplementary amounts of Fentanyl in the group B and C were lower than those in the group A and D（P〈0.05,P〈0.01）.② The MAP in the four groups at tracheal intubation（T1） all were higher than those before anesthesia（T0）（all P〈0.01）,and the ascending extents in the group B,C and D were lower than that in the group A（all P〈0.01）;HR at T1 in the group A was higher than that at T0（P〈0.05）,while no significant change in the other groups（all P〈0.05）,and the ascending extents in the group B and D were lower than that in the group A（both P〈0.05）;MAP and HR at the other moments in all the groups were stable.③ CD4^＋/CD8^＋ in the group A after pneumonectomy was lower than that before the surgery（P〈0.05）,while no significant change in the other groups（all P〈0.05）.④ Contents of E and Cor after the operation were significantly increased in all the groups（all P〈0.01）,and the ascending extent of E content in the group D was lower than that in the group A（P〈0.05）;the ascending level of Cor in the group B and D was lower than that in the group A（P〈0.01）,and in the group B was lower that in the group C and D.Conclusion Acupuncture-drug compound anesthesia can attenuate the stress reaction so as to protect organs under the condition of less or same narcotic amount and can alleviate the fluctuation of MAP and HR at tracheal intubation and stabilize CD4^＋/CD8^＋ after pneumonectomy.Among them,2 Hz and 2 Hz/100 Hz EA have better effects.

目的:观察针药复合麻醉对肺切除患者应激反应的保护作用及其可能的机制。方法:将80例择期行开胸肺切除术患者分为A、B、C、D4组,每组20例。各组均行全麻,并予单肺机械通气,全麻前30min开始针刺,穴取后溪、支沟、内关、合谷,接HANS-200韩氏穴位神经刺激仪,A组将无针体针灸针粘贴在穴位处,不开启电针;B组予连续波型,频率2Hz;C组予连续波型,频率100Hz;D组予疏密波型,频率2Hz/100Hz。监测术中麻醉药物追加量、心率(HR)、平均动脉压(MAP),术前、术后1天检测静脉血免疫指标(CD+4/CD+8),入室后及出室前测定患者血浆肾上腺素(E)及皮质醇(Cor)含量。结果:①术中芬太尼追加量,B、C组较A、D组少(P<0.05,P<0.01)。②各组插管(T1)时刻MAP较麻醉诱导前(T0)均明显升高(均P<0.01),B、C、D组升高幅度较A组小(均P<0.01);A组T1时刻HR较T0时刻升高(P<0.05),其他组变化不明显(均P>0.05),B、D组变化幅度较A组明显减少(均P<0.05),其他时刻各组MAP、HR均较平稳。③术后A组CD+4/CD+8较术前降低(P<0.05),其他组变化不大(均P>0.05)。④术后各组患者血浆E及Cor含量均明显升高(均P<0.01),D组E含量较A组增长较少(P<0.05);B、D组较A组,B组较C、D组Cor含量增长较少(均P<0.01)。结论:针刺复合麻醉可以在少用麻醉药或用量相同情况下减轻机体应激反应而保护脏器功能,并且减轻气管插管时MAP、HR的波动,维持术后患者CD+4/CD+8的稳定,其中2Hz电针组与2Hz/100Hz电针组效果较好。