电针内关联合右美托咪定对高血糖冠心病患者围术期心肌损伤的保护作用

Electroacupuncture in neiguan and dexmedetomidine for hyperglycemia patients with coronary heart disease in protection of myocardial injury during perioperative period

目的 探讨电针内关联合α2AR激动剂右美托咪定对高血糖冠心病患者非心脏手术围术期心肌损伤的保护作用。方法 选择择期行下肢骨科手术的患者共120例,随机均分为对照组、D组（右美托咪定）、A组（电针）和N组（电针内关联合右美托咪定）。4组患者局麻下行左侧桡动脉及右颈内静脉穿刺置管,分别于插管前（T0）、插管后即刻（T1）、拔管后即刻（T2）、拔管后60 min（T3）采集静脉血5 m L,测定丙二醛（MDA）、超氧化物歧化酶（SOD）、一氧化氮（NO）浓度,real-time PCR测定Bcl-2和Bax mRNA表达变化。心肌肌钙蛋白I、B型钠尿肽于术前一天（T0）、插管后即刻（T1）、拔管后即刻（T2）、术后69 h（T3）采集静脉血样进行测定。结果 进行插管手术后,对照组c Tn I和BNP均随时间（T0T3）明显升高（P〈0.05）,D组和N组与对照组相比有显著性差异（P〈0.05）。与T0相比,T1T3血清SOD和NO活性均有所下降,而MDA的浓度升高（P〈0.05）。与对照组相比较,A组患者SOD和NO、MDA的变化无显著差异,而D组和N组患者3个指标均有显著差异（P〈0.05）。对照组Bcl-2的表达随T0T3有所下降,但是变化无显著差异。D组患者在T1T3时间,Bcl-2表达有所上调,可以达到1.5倍左右,而N组在T1T3时间与对照组相比有显着差异（P〈0.05）,Bcl-2的表达均达到T0时间的2倍多。对照组、A组Bax表达随时间T1T3逐渐升高,可达到2倍,与对照组相比,D组Bax表达仍可到达T0的1.5倍左右,N组Bax表达与对照组相比明显下调（P〈0.05）。结论 内关穴的双向调节作用可能加强a2肾上腺素能受体激动剂右美托咪定的作用。

Objective To investigate electroacupuncture in Neiguan and Dexmedetomidine for hyperglycemia patients with coronary heart disease for protection of myocardial injury during perioperation. Methods A total of 120 cases with lower extremity orthopedic surgery were randomly divided into control group, and group D （dexmedetomidine）, group A （electroacupuncture） and group N （ electroacupuncture and dexmedetomidine）. Lower left radial artery and right internal jugular vein of four groups were indwelling punctured, and venous blood was collected for 5 mL before intubation （ T0 ）, immediately after intubation （ T1 ）, immediately after extubation （ T2 ）, and 60 min after extubation （T3 ）. Malondialdehyde （ MDA）, superoxide dismutase （ SOD ）, nitric oxide （NO） concentration were determined, and realtime PCR was used to determine Bcl-2 and Bax mRNA expression changes . Myocardial troponin I , b - type natriuretic peptide before intubation （ To ） , immediately after intubation （ T1 ）, immediately after extubation （ T2 ）, and postoperative 6 - 9 hours were determined after venous blood sample collection. Results After intubation, CTnI and BNP were increased in the control group from TO to T3 （ P 〈 0.05 ）, there was significant difference in group D and group N compared with the control group （P 〈 0.05 ）. Compared with To, SOD and NO were decreased at Tl , T3, but the concentration of MDA was increased （ P 〈 0.05）. Compared with control group, there was no difference in changes of SOD, NO and MDA in group A, and patients with group D and group N showed significant difference in above indicators （P 〈 0.05 ）. The expression of Bcl-2 in the control group was declined from TO to T3 , but there was no significant difference. The Bcl-2 expression was increased as high as 1.5 times, and group N showed significant difference on T1 to T3 compared with the control group （P 〈 0.05 ）. The expression of Bcl-2 reached more than 2 times at T0. Bax expression of group A and control group was increased from T1 to T3, and was up to 2 times. Compared with control group, Bax expression in the group D could reach 1.5 times at To, Bax of group N was significantly reduced compared to control group （ P 〈 0.05 ）. Conclusion Bidirectional regulation of Neiguan may strengthen function of dexmedetomidine, a2 adrenergic agonists.