不同时点电针处理对结直肠癌根治术患者术后炎性反应及内环境的影响

Effect of Electroacupuncture Combined with Intravenous Anesthesia at Different Time on Inflammatory Response and Internal Environment in Patients Undergoing Radical Resection of Colorectal Cancer

目的探讨不同时点电针刺激对结直肠癌手术患者术后炎性反应及内环境的影响。方法选择宁夏医科大学总医院择期行开腹结直肠癌根治性手术的患者80例,年龄18~59岁,ASA分级Ⅰ~Ⅲ级。随机分为4组,全凭静脉麻醉组(C组)、电针刺激EA1组、EA2组、EA3组,每组20例。给予相同的麻醉方法及镇痛处理。EA1组术前1天,EA2组术前1天、术前30min,EA3组术前1天、术前30min、术后1天行电针刺激治疗。术前穴位取中脘及右侧天枢、内关、足三里、上巨虚、下巨虚,术后1d穴位取右侧内关、足三里、上巨虚、下巨虚,穴位电针刺激治疗持续30min。记录患者术前(T1)、术后1天(T4)、术后5天(T5)静脉血白细胞、中性粒细胞计数;术前(T1)、术中冲洗后(T2),术后1天(T4)动脉血乳酸值;术前(T1)、术毕(T3)、术后1天(T4)、术后5天(T5)静脉血钾离子(K+)、钠离子(Na+)、氯离子(Cl-)。结果四组患者白细胞及中性粒细胞计数在T1时间点差异无统计学意义(P>0.05)。与C组比较,T4时EA1、EA3组白细胞、中性粒细胞计数减少(P<0.05),EA2组差异无统计学意义(P>0.05)。与EA1组比较,EA2、EA3组白细胞、中性粒细胞计数差异无统计学意义(P>0.05)。与EA2组比较,EA3组白细胞、中性粒细胞计数无统计学意义(P>0.05)。组内比较:与T1比较,T4时点4组白细胞、中性粒细胞计数升高(P<0.01),在T5时点EA1组白细胞、中性粒细胞及EA3组中性粒细胞计数升高(P<0.01)。与T4比较,4组白细胞及中性粒细胞在T5时点降低(P<0.01)。四组不同时间点血乳酸值组间比较差异无统计学意义(P>0.05)。组内比较:与T1比较,四组乳酸值在T2增高(P<0.01),在T4四组乳酸值趋近于T1水平,差异无统计学意义(P>0.05);与T2比较,T4时点EA2组乳酸值降低(P<0.05),C、EA1、EA3组乳酸值降低(P<0.05或<0.01)。四组患者不同时点电解质浓度组内比较、组间比较差异均无统计学意义(P均>0.05)。结论电针刺激对肠癌患者术后炎症反应有调节作用,可以降低术后白细胞和中性粒细胞水平:对术后正常范围乳酸及电解质水平无明显影响。

Objective To investigate the efficacy of electroacupuncture（EA） at different time points on inflammatory response and internal environment in patients with colorectal cancer surgery. Methods A prospective study was performed on 80 patients,18-59 years of age,diagnosed with colorectal cancer undergoing laparotomy from April 2017. According to Ⅰ-Ⅲ grade of American Society of Anesthesiology（ASA）,the patients were randomly divided into 4 groups. Group C： 20 patients were given total intravenous anesthesia and gastrointestinal decompression. Group EA1： 20 patients were given total intravenous anesthesia,gastrointestinal decompression combined with EA stimulation 24 hours before surgery. Group EA2： 20 patients were given total intravenous anesthesia,gastrointestinal decompression combined with EA stimulation 24 hours and 30 minutes before surgery. Group EA3： 20 patients were given total intravenous anesthesia,gastrointestinal decompression combined with EA stimulation 24 hours and 30 minuites before surgery and 24 hours after surgery. Groups EA1,EA2,and EA3 received EA pretreatment at right acupoints Zhongwan（CV 12）,Tianshu（ST 25）,Zusanli（ST 36）,Neiguan（PC 6）,Shangjuxu（ST 37）,Xiajuxu（ST 39）. In addition,because of surgical incision,group EA3 received EA posttreatment at right acupoints Neiguan（PC 6）,Zusanli（ST 36）,Shangjuxu（ST 37）and Xiajuxu（ST 39）24 hours postoperatively. All EA treatments lasted 0.5 hours.Venous blood was collected to record white blood cell（WBC）count and neutrophil（NEUT）count before surgery（T1）,1 days after surgery（T4）,and 5 days after surgery（T5）. Arterial blood was collected to record lactate levels before surgery（T1）,after Intraoperative irrigation（T2）,and 1 days after surgery（T4）,and to record potassium（K＋）,sodium ion（Na＋）,chloride（Cl-）before operation（T1）,after operation（T3）,1 days after operation（T4）,5 days after operation（T5）. Results The WBC and NEUT count in the four groups showed no statistical significance at T1 time points（P〉0.05）. Compared with T1,four groups of WBC and NEUT count was significantly increased in T4（P〈0.01）,WBC and NEUT in group EA1 and NEUT in group EA3 was significantly higher in T5 than in T1（P〈0.01）. Compared with T4,four groups of WBC and NEUT count were reduced at T5（P〈0.01）. Comparison between groups,at T4,WBC and NEUT count of group EA1 and EA3 were less than group C（P〈0.05）. At T5,WBC and NEUT count of group EA1 and EA3 were less than group C（P〈0.05）. Group EA2 and group C,EA1,EA3 had no statistical significance（P〉0.05）,group EA1 and group EA3 had no statistical significance（P〉0.05）. The four groups at different time points of blood lactate were no significant differences between groups（P〉0.05）. Compared with T1,four groups of lactic acid values were significantly increased in T2（P〈0.01）;compared with T2,four groups of lactic acid value decreased at T4（P〈0.05 or 〈0.01）. There was no significant difference between the four groups in the electrolyte levels（P〉0.05）. Conclusion EA alleviate the inflammatory reaction of patients in patients with colorectal cancer laparotomy,and can decrease the levels of WBC and NEUT after operation. This terapy has no effect on blood lactic acid and electrolyte.