电针足三里对开胸手术单肺通气相关肺损伤作用的研究

Effect on Lung Injury of One- Lung Ventilation in Thoracic Surgery Treated with Electroacupuncture at Zusanli( ST36)

目的观察电针足三里对开胸手术单肺通气相关肺损伤的作用。方法全身麻醉下行择期开胸手术患者60例（ASAⅠ～Ⅱ）随机分为两组,每组30例。麻醉诱导给予同样的药物种类和插管程序。试验组在摆体位后,开始电针足三里直至拔除气管导管。分别于T1：麻醉前;T2：摆体位调整后气管导管后,电针刺激前;T3：单肺通气30 min后;T4：恢复双肺通气30 min后;T5：拔管后10min;T6：术后24 h;T7：术后3 d 7个时间点观察血流动力学、呼吸力学、血气分析及血清学指标。结果试验组平均动脉压（MAP）在T3时间点高于对照组,HR在T3、T4及T5时间点均低于对照组（P〈0.05）;试验组SPO2在T5时间点,Pa O2、氧和指数在T3～T6各时间点均大于对照组（P〈0.05）。试验组白细胞数在T6时间点,SP-A在T3～T6各时间点,肿瘤坏死因子-α（TNF-α）在T4～T6各时间点,白细胞介素-8（IL-8）在T4～T6各时间点均低于对照组（P〈0.05）。试验组患者住ICU天数短于对照组,术毕3 d并发症例数显著少于对照组（P〈0.05）。结论电针足三里可以减轻开胸手术单肺通气相关的炎症反应,并对该反应所导致的肺损伤有一定的减轻作用。

Objective To observe the effect on lung injury of one - lung ventilation in thoracic sur-gery treated with electroacupuncture（EA）at Zusanli（ST36）. Methods Sixty patients with elective thoracic surgery under general anesthesia（ASA Ⅰ to Ⅱ）were randomized into two groups,30 cases in each one. The same drug and intubation was applied to anesthesia induction in the two groups. In the trial group,after posi-tioning,EA at Zusanli（ST36）was given till the tube removal. Separately,before anesthesia（T1 ）,after position adjustment and intubation and before EA stimulation（T2 ）,30 min after one - lung ventilation（T3 ）,30 min after recovery of two - lung ventilation（T4 ）,10 min after tube removal（T5 ）,24 h after surgery（T6 ）and 3 days after surgery（T7 ）,the indicators of hemodynamics,breathing mechanics,blood gas analysis and serology were observed. Results In the trial group,MAP was higher than that in the control group at T3 ,HR was low-er than that in the control group at T3 ,T4 and T5（P ﹤ 0. 05）. In the trial group,SPO2 at T5 ,PaO2 ,PaO2 / FiO2 at T3 to T6 were all higher than those in the control group（P ﹤ 0. 05）. In the trial group,WBC at T6 ,SP - A at T3 to T6 ,TNF - α at T4 to T6 and IL - 8 at T4 to T6 were all lower than those in the control group（P ﹤0. 05）. In the trial group,the days in ICU were shorter than that in the control group and the cases of compli-cations in 3 days after surgery were significantly less than those in the control group（P ﹤ 0. 05）. Conclusion EA at Zusanli（ST36）alleviates the inflammatory reaction of one - lung ventilation in thoracic surgery as well as lung injury induced by the reaction to a certain extent.