经皮穴位电刺激复合药物全麻行控制性降压至不同水平对肾脏血流的影响

Effects of the Renal Blood Flow at Different Levels by Transcutaneous Electrical Acupoint Stimulation Combined General Anesthesia Induced Controlled Hypotension

目的观察行不同目标平均动脉压(mean arterial pressure,MAP)水平控制性降压时经皮穴位电刺激(transcutanclus electrical acupoint stimulation,TEAS)对肾脏血流的干预效应。方法 42只雄性比格犬随机分为单纯全麻组、50%对照组、40%对照组、30%对照组、50%实验组、40%实验组、30%实验组,每组6只。单纯全麻组不行控制性降压,其余组分别行控制性降压至目标MAP水平并维持60min。实验组在动物生理状态稳定后开始至维持目标MAP60min期间给予TEAS,刺激穴位为双侧合谷(LI4)、足三里(ST36)、三阴交(SP6)、曲池(LI11),强度(4±1)mA,频率2/100Hz。采用激光多普勒组织血流仪监测不同水平相应时间点肾脏表面血流变化。结果在控压开始至血压下降至目标MAP水平,30%对照组肾脏血流显著低于同期单纯全麻组及本组基础水平(P<0.05),而30%实验组在此阶段无明显变化;在血压维持阶段,50%、40%、30%对照组及30%实验组肾脏血流明显低于同期单纯全麻组(P<0.05),而50%、40%实验组肾脏血流无明显改变;至血压回升结束,50%对照组、50%实验组、40%实验组肾脏血流回复至基础水平(P>0.05),而40%对照组、30%对照组、30%实验组未回复至基础水平(P<0.05)。结论 TEAS复合药物全麻行控制性降压能够有效改善术中肾脏血液供应,从而可能起到肾脏保护作用。

Objective To observe the intervention of transcutaneous electrical acupoint stimulation （TEAS） on the renal blood flow at different levels of mean arterial pressure （MAP） in controlled hypotension. Methods Forty-two male beagle dogs were randomly divided into seven groups, i.e., the general anesthesia group, the 50% controlled group, the 40% controlled group, the 30% controlled group, the 50% experimental group, the 40% experimental group, and the 30% experimental group, 6 in each group. Beagles in the general anesthesia group were not treated with controlled hypotension, and the target MAP was achieved in those of the rest groups and maintained for 60 min. In the experimental groups, TEAS was applied to bilateral Hegu （LI4）, Zusanli （ST36）, Sanyinjiao （SP6）, and Quchi （LI11） at 2/100 Hz with the stimulation strength of （4±1）mA starting from the stability of their physiological conditions to 60 min of maintaining the target MAP level. The changes of the renal blood flow were monitored at different time points using laser Doppler. Results From starting pressure control to the target MAP level, the renal blood flow was significantly lower in the 30% controlled group than in the general anesthesia group and the basic level of the same group （P0.05）, while there was no obvious change in the 30% experimental group. In maintaining the blood pressure, the renal blood flow was significantly lower in the 50% controlled group, the 40% controlled group, the 30% controlled group, and the 30% experimental group than in the general anesthesia group （P0.05）, while there was no obvious change in the 50% experimental group or the 40% experimental group. By the end of blood pressure recovery, the renal blood flow restored to the basic level in the 50% controlled group, the 50% experimental group, and the 40% experimental group （P0.05）, while it was not restored to the basic level in the 40% controlled group, the 30% controlled group, and the 30% experimental group （P0.05）. Conclusion TEAS combined general anesthesia in controlled hypotension could effectively improve the renal blood flow, thus protecting the kidney.