经皮穴位电刺激对止血带诱发肺损伤的影响

Effect of Transcutaneous Electrical Acupoint Stimulation on Lung Injury Tourniquet-induced in Patients

目的:观察经皮穴位电刺激对止血带诱发的下肢缺血-再灌注肺损伤的影响。方法:选取行单侧下肢手术患者60例,采用随机数字表法分为经皮穴位电刺激干预组和对照组(每组n=30)。两组均采用腰硬联合麻醉,上止血带前30min经皮穴位电刺激干预组开始给予经皮穴位电刺激肺俞穴和足三里穴,一直持续到手术结束。于麻醉前即刻(T1),松开止血带前1 min (T2),松开止血带后30 min(T3)、 2 h(T4)和4 h(T5)时采集桡动脉血,行血气分析,记录动脉血氧分压(PaO_2)和二氧化碳分压(PaCO2),计算肺泡-动脉血氧分压差(A-aDO2)、氧合指数(OI)和呼吸指数(RI);测定血浆丙二醛(MDA)浓度和超氧化物歧化酶(SOD)活性。结果:T5时,经皮穴位电刺激干预组PaO2[(83.9±5.6) mmHg vs (77.6±6.4)mmHg,P<0.05)]和OI[(388.1±26.3) mmHg vs (363.3±29.8) mmHg,P<0.05]较对照组升高;A-aDO2[(18.5±5.2)mmHg vs (22.2±6.3) mmHg,P<0.05]和RI[(0.23±0.09) vs(0.31±0.07),P<0.05]较对照组显著降低;T4、T5时,经皮穴位电刺激干预组血浆MDA浓度分别为(4.1±1.0) nmol/mL、(4.5±1.6) nmol/mL,较对照组[分别为(4.7±1.2)nmol/mL、(5.6±1.1) nmol/mL]降低,SOD活性分别为(77.5±9.3) U/mL、(71.7±7.5) U/mL,较对照组[分别为(67.0±7.8)U/mL、(60.2±8.9) U/mL]显著升高。结论:经皮穴位电刺激肺俞穴和足三里穴,可减轻止血带诱发的肢体缺血-再灌注肺损伤,可能与抑制脂质过氧化反应有关。

Objective To observe the effect of transcutaneous electrical acupoint stimulation（TEAS） on lung injury following tourniquet-induced extremity ischemia-reperfusion. Methods Sixty patients scheduled for unilateral lower extremity surgery were divided into two groups （n=30 each） using a random number table：transcutaneouselectrical acupoint stimulation group and control group.The combined spinalepidural anesthesia was performed in all patients. Patiens in transcutaneouselectrical acupoint stimulation group were given TEAS 30 min before applying tourniquet and continued until the end of surgery. Immediately before induction of anesthesia（T 1 ）, 1 rain before removing the tourniquet（T2）, and 30 min（T3）, 2 h（T4） and 4 h（T 5） after removing the tourniquet, blood samples were collected from the radial artery for blood gas analysis and for measurement of the levels of malondialdehyde（MDA） and superoxide dismutase（SOD）. Arterial partial pressure of oxygen（PaQ） and partial pressure of carbon dioxide（PaCO2） were recorded. Alveolar-arterial oxygen difference（A- aDO2）, oxygenation index（OI）and respiratory index（Rl） were calculated. Results Compared with control group,PaO2[（83.9 ± 5.6） mmHg vs （77.6 ± 6.4） mmHg, P〈0.05）] and OI[（388.1 ± 26.3） mmHg vs （363.3 ± 29.8） mmHg,P〈0.05] in transcutaneouselectrical acupoint stimulation group were significandy increased at T5,while A-aDO2[（18.5 ± 5.2） mmHg vs （22.2 ±6.3） mmHg,P〈0.05]and RI[（0.23± 0.09） vs （0.31 ± 0.07）, P〈0.05] were decreased at T5. At T4 and T 5 ; the levels of MDA in tra_nscutaneouselectrical acupoint stimulation group were decreased compared with control group[（4.1 ±1.0） vs （4.7 ± 1.2） nmol/mL,（4.5 ± 1.6） vs （5.6 ± 1. 1） nmol/mL, P〈0.05],while the levels of SOD were increased[（77.5± 9.3） vs （67.0 ± 7.8） U/mL, （71.7 ± 7.5） vs （60.2 ± 8.9） UhnL, P〈0.05]. Conclusion TEAS could attenuate lung injury following tourniquet-induced extremity ischemia-reperfusion in patients via inhibiting lipid peroxidation.