电针内关预处理联合α2AR激动剂对老年下肢骨折术中cTnI的影响

Effect of Electroacupuncture Preconditioning at Neiguan Combined with α2AR Agonists on cTnI in Elderly Patients Undergoing Lower Limb Fracture Operation

目的探讨电针内关预处理联合高选择性α2肾上腺素受体(α2AR)激动剂在合并高血糖冠心病的老年下肢骨折患者中对应激抑制及心肌保护作用。方法将80例择期老年下肢骨折手术患者按随机数字表法分为4组,对照组(C组)、电针组(N组)、α2AR激动剂组(D组)和针药复合组(Z组),每组20例。检测各组患者插管前(T_0)、插管后即刻(T_1)、插管后5 min(T_2),拔管后即刻(T_3)、拔管后5 min(T_4)、60 min(T_5)、180 min(T_6)血糖水平和ST段高度变化(∑ST),并计算血糖变异系数(GluCV);于术前1天(T_0)、插管后即刻(T_1)、术后1天(T_7)检测心肌肌钙蛋白I(cTnI)水平;记录术中患者的心血管药物的使用情况。结果与本组T_0比较,C组各时点血糖、∑ST和T_1、T_7时cTnI水平均升高(P<0.05),N组T_1时和D组T_1、T_2时血糖和∑ST升高,N、D组T_1时cTnI升高(P<0.05);与C组同期比较,N组T_2~T_6、D组T_3~T_6及Z组T_1~T_6各时间点血糖、∑ST均下降(P<0.05,P<0.01),D、N和Z组GluAve、GluSD、GluCV明显下降(P<0.05),Z组T_1、T_7时和N、D组T_7时cTnI水平均降低(P<0.01)。结论电针内关预处理可能加强α2AR激动剂作用并减轻其不良反应,抑制手术应激所致的血糖波动,改善心肌缺血损伤。

Objective To investigate the effect of electroacupuncture preconditioning at Neiguan （PC6） combined with α2AR agonist on stress suppression and myocardial protection in elderly patients, which with lower limb fracture complicated with hyperglycemia and coronary heart disease. Methods Eighty elderly patients with lower limb fracture undergoing elective, surgery were assigned to four groups by a random number table, the control group （group C）, the electroacupuncture group （group N）, the α2AR agonist group （group D） and the electroacupuncture combined with （α2AR agonist group （group Z）, 20 cases in each group. The blood glucose levels and the changes of ST-segment elevation （∑ST） were measured and recorded before intubation （T0）, immediately after intubation （T1）, 5 minutes after intubation （T2）, immediately after extubation （T3）, 5 minutes （T4）, 60 minutes （T5） and 180 minutes （T6） after extubation. The glucose coefficient of variation （GluCV） was calculated. The cardiac troponin I （cTnl） were detected at day 1 before the operation （T0）, immediately after intubation （T1） and at day 1 after the operation （TT）. The usage of cardiovascular drugs were recorded. Results Compared with To in the same group, the levels of blood glucose and ∑ST at each time point, and cTnl at T1 and T7 in group C increased （P 〈0.05）. The levels of blood glucose and ∑STat T1 in group N and at T1 and 1-2 in group D, and cTnl at T1 in group D and in group N increased （P 〈0.05）. Compared with the group C, the levels of blood glucose and ∑ST at T2-T6 in group N, at T3-T6 in group D and at T1-T6 in group Z decreased significantly（P 〈0.05）. The changes of GluAve, GluSD and GluCV in group D, group N and group Z were obviously decreased （P 〈0.05）. And cTnl at T1 and T7 in group Z, at T7 in group N and in Group D decreased significantly （P 〈 0.01 ）. Conclusions Electroacupuncture preconditioning at Neiguan （ PC6 ） might enhance the action of α2AR agonist, relieve the adverse reaction of the agonist, stable the fluctuation of blood glucose caused by surgical stress and improve the state of myocardial ischemia.