经皮穴位电刺激对术后肺部并发症高风险患者预后的影响

Effect of transcutaneous electric acupoint stimulation on prognosis in patients at high risk of postop-erative pulmonary complications

目的评价经皮穴位电刺激对术后肺部并发症高风险患者预后的影响。 方法择期行胸腹腔镜联合食管癌切除术患者60例，年龄65～72岁，性别不限，体重指数18～25 kg/m2，ASA分级Ⅱ或Ⅲ级。采用随机数字表法分为2组（n＝30）：安慰剂组（C组）和经皮穴位电刺激组（TEAS组）。TEAS组于麻醉诱导前30 min采用经皮穴位电刺激（疏密波，频率2/100 Hz，电流强度8～12 mA）双侧足三里穴、合谷穴及肺俞穴30 min。C组诱导前在相同穴位放置刺激电极片，但不给予电流。2组患者均采用全身麻醉。分别于单肺通气前（T1）、单肺通气30 min（T2）、单肺通气2 h（T3）及术后1 h（T4）时采集桡动脉血行血气分析，计算氧合指数和肺泡-动脉氧分压差，于T1-3和术后24 h（T5）时采集颈内静脉血，测定血浆TNF-α、IL-6和IL-10浓度。记录患者术后肺部并发症发生情况、拔除引流管时间和住院时间。 结果与C组比较，TEAS组T2-4时氧合指数和T3时血浆IL-10浓度升高，T2，3时肺泡-动脉氧分压差、T2，3时血浆TNF-α浓度、T3，5时血浆IL-6浓度和术后肺部并发症的发生率降低，拔除引流管时间及住院时间缩短（P〈0.05）。 结论经皮穴位电刺激可改善肺部并发症高风险患者的预后。

Objective To evaluate the effect of transcutaneous electric acupoint stimulation （TEAS） on prognosis in the patients at high risk of postoperative pulmonary complications. Methods Sixty American Society of Anesthesiologists physical status 1I or m patients of both sexes, aged 65-72 yr, with body mass index of 18-25 kg/m2, scheduled for elective thoracoscopic and laparoscopic radical resection of e- sophageal cancer, were divided into placebo control group （group C, n = 30） and TEAS group （n= 30）. In group TEAS, bilateral Zusanli （ST36） , Hegu （LI4） and Feishu （BL13） acupoints were stimulated for 30 min （disperse-dense waves, frequency 2/100 Hz, intensity of currents 8-12 mA） starting from 30 min be- fore anesthesia induction. In group C, electrodes were placed on the same acupoints before anesthesia induc- tion, but no current was given. General anesthesia was performed in two groups. Before one-lung ventilation, at 30 min and 2 h of one-lung ventilation and at I h after operation （ TL-4 ） , blood samples were drawn from the radial artery for blood gas analysis, and oxygenation index and alveolar-arterial oxygen partial pressure difference were calculated. Blood samples were collected from the internal jugular vein at TL-3 and 24 h after surgery （T5） for determination of plasma tumor necrosis factor-alpha, interleukin-6 （IL-6） and IL-10 con- centrations. The development of postoperative pulmonary complications, time for removal of drainage tube and length of hospital stay were recorded. Results Compared with group C, the oxygenation index at TL-4 andplasma IL-10 concentrations at T3 were significantly increased, the alveolar-arterial oxygen partial pressure difference at T2.3, plasma tumor necrosis factor-alpha concentrations at T2,3, plasma IL-10 concentrations at T3,5 and incidence of postoperative pulmonary complications were decreased, and the time for removal of drainage tube and length of hospital stay were shortened in group TEAS （P〈0. 05）. Conclusion TEAS can improve prognosis in the patients at high risk of postoperative pulmonary complications.