电针对高血糖冠心病老年患者全麻手术围手术期心肌损伤的影响

Effects of Electro-acupuncture Combined General Anesthesia on Myocardial Injury of High Blood Sugar Patients with Coronary Heart Disease in the Perioperative Phase

目的探讨电针复合全麻对高血糖冠心病患者围手术期心肌损伤的影响。方法选择40例糖化血红蛋白(HbA1c)>6.5%,60岁以上行四肢创伤后骨折复位手术的老年冠心病患者40例患者随机分为两组(每组20例):全凭静脉麻醉组(N组),电针复合全麻组(D组)。两组均以丙泊酚、芬太尼及维库溴铵诱导维持麻醉。D组在麻醉诱导前以电针仪取穴内关及百会行电针诱导20min,维持针刺至术毕。两组患者分别于插管前(T0)、插管后即刻(T1)、5min(T2)、拔管后即刻(T3)、5min(T4)、60min(T5)、180min(T6)测定血糖(FBG)、血浆血管活性物质血栓素B2(TXB2)和6-酮-前列环素F1α(6-K-PGF1α)浓度,计算血糖变异系数(GluCV)和TXB2/6-K-PGF1α的比值,记录心电图ST段高度变化(mV,各时间点1min内采样,取均值)。结果 T0时两组所有检测值比较,差异无统计学意义(P>0.05)。N组各时间点血糖、ST变化和TXB2/6-K-PGF1α均显著高于T0(P<0.05),D组变化无统计学意义(P>0.05)。N组TXB2/6-K-PGF1α及ST变化显著高于D组(P<0.01)。两组各时点TXB2和6-K-PGF1α均显著高于T0(P<0.05),D组TXB2升高幅度明显低于N组(P<0.05),而6-K-PGF1α升高幅度明显高于N组(P<0.05)。结论电针通过调节中枢神经系统、心血管活性物质,抗氧自由基等作用,降低围手术期的应激反应对冠状动脉血管内皮细胞的损伤,改善心肌缺血,改善冠心病患者的手术预后。

Objective To investigate the effects of electro-acupuncture （EA） combined general anesthesia on myocardial injury of high blood sugar patients with coronary heart disease （CHD） in the perioperative phase. Methods Recruited were 40 senile patients with glycosylated hemoglobin （HbAlc） more than 6.5%. They were more than 60 years old. They received post-traumatic fracture reduction surgery of four limbs. They were randomly assigned to two groups, Group N （treated by general intravenous anesthesia） and Group D （treated by EA combined with general intravenous anesthesia）, 20 in each group. All patients were maintained anesthesia by propofol, fentanyl, and vecuronium. Prior to the induction of anesthesia, patients in Group D received induction of EA at Neiguan （PC6） and Baihui （DU20） for 20 min, which lasted to the end of the surgery. At before intubation （T0） , immediately after intubation （T1 ）, 5 min （T2 ）, immediately after extubation （T3 ）, 5 min （T4） , 60 min （T5） , 180 min （T6） , the fast blood glucose （ FBG）, plasma vasoactive substance TXB2 and 6-K-prostacycline （6-K-PGF1α） were detected in the two groups. The glucose coefficient of variation （GluCV） and the ratio of TXB2/6-K-PGF1α were calculated. The changes of ST-segment elevation （ mV, sampling 1 min after each time point, and the mean calculated） was recorded. Results There was no statistical difference in all the tested values between the two groups at To （ P 〉 0. 05）. The FBG, ST elevation, and the ratio of TXB2/6-K- PGF1α were significantly higher at each time point than at To in Group N （ P 〈0.05）, while there was no statistical difference in Group D （ P 〉 0.05）. The ratio of TXB/6-K-PGF1α and ST elevation were significantly higher in Group N than in Group D （ P〈0. 01 ）. The TXB2 and 6-K-PGF1α were significantly higher at each time point than at To in the two groups （ P 〈 0. 05）. The increment of TXB2 was obviously lower in Group D than in Group N （P〈0.05）, but the increment of 6-K-PGF1α was obviously higher in Group D than in Group N （ P 〈0.05）. Conclusion EA could reduce the perioperative stress response to the injury of coronary vascular endothelial cells, and improve myocardial ischemia and CHD patients＇ prognosis by regulating the central nervous system, the cardiovascular active substances, and anti-oxygen free radicals.