电针内关联合右美托咪啶对高血糖冠心病患者围术期心肌损伤的疗效观察

Efficacy of electro-acupuncture on Neiguan combined with dexmedetomidine to myocardial injury of high blood sugar patients with coronary heart disease in perioperative period

目的探讨电针内关联合右美托咪啶对高血糖冠心病患者非心脏手术心肌损伤的影响。方法选取择期行下肢骨科手术患者60例,并将患者随机均分为D组（右美托咪定）、C组（电针）和N组（电针内关联合右美托咪啶）。3组患者分别于插管前（T0）、插管后即刻（T1）、插管后5 min（T2）、拔管后即刻（T3）、拔管后5 min（T4）、拔管后60 min（T5）、拔管后180 min（T6）测定血糖、血浆TXB2和6-keto-PGF1a浓度,计算血糖变异系数（GluCV）和TXB2/6-keto-PGF1a的比值;记录ST段高度变化及HR、MBP的改变。结果插管和拔管前后3组TXB2和6-keto-PGF1α均显著升高（P〈0.05）;N组TXB2明显低于D、C组（P〈0.05）,6-keto-PGF1α明显高于D、C组（P〈0.05）;D、C组TXB2/6-keto-PGF1α显著升高,且明显高于N组（P〈0.05）。N组T1-T4时HR、MAP、∑ST明显低于D、C组（P〈0.05）,且N组GluAve、GluSD、GluCV变化明显低于D、C组（P〈0.05）。结论内关穴的双向调节作用可能加强α2肾上腺素能受体激动剂右美托咪定的作用并减轻其不良反应,抑制手术应激所致的血糖波动和TXA2/PGI2失衡,改善心肌缺血损伤。

Objective To investigate the efficacy of electro-acupuncture on Neiguan combined with dexmedetomidine to non-cardiac surgery myocardial injury of high blood sugar in patients with coronary heart disease. Methods Sixty patients undergoing lower limb orthopedic surgery were included in the study and were randomly divided into three groups： Group D （dexmedetomi- dine）, Group C （electro-acupuncture on Neiguan）, and Group N （electro-acupuncture on Neiguan combined with dexmedetomidine）. At the time of before intubation （T0）, immediately after intubation （T1）, 5 rain （T2）, immediately after extubation （T3）, 5min （24）, 60 min （Ts）, 180 min （6）, the three groups of patients were respectively determined in terms of glucose, plasma TXtα and 6-keto-PGFla. The glucose coefficient of variation （GluCV） and the ratio TXB2/6-keto-PGFla were calculated. ST-segment elevation changes （mV, after each time sampled 5 times within 1 min, and the mean was taken）, and the changes of HR and MBP were recorded. Results TXB2 and 6-keto-PGF1α of three groups before and after intubation and extubation were significantly high- er （P 〈 0.05 ）. Group N＇ TXB2 was significantly lower than groups C and D （ P 〈 0.05 ）, but 6- Keto- PGF1α was significantly higher than groups C and D （ P 〈 0.0 5 ） . TXP1α / 6 - keto - PGF1α in groups C and D were significantly increased, but significantly higher than group N （P 〈 0.05）. HR, MAP and ST of group N were significantly lower than groups C and D （P〈0.05） at T1 and T4, and the changes of GluAve, GluSD, GluCV of group N were significantly lower than groups C and D （P 〈 0.05）. Conclusion Bi-directional regulation of Neiguan may strengthen the role of α2 adrenergic receptor against dexmedetomidine, mitigate its adverse effects at the same time, and inhibit surgical stress caused by blood sugar fluctuations and the imbalance of TXA2/ PGI2, and then in order to improve myocardial ischemic injury.