经皮穴位电刺激对胸腔镜肺叶切除术患者围手术期炎症反应的影响

Effects of transcutaneous electrical acupoint stimulation on inflammation in patients undergoing video-assisted thoracoscopic lobectomy

目的研究经皮穴位电刺激对胸腔镜肺叶切除术患者炎性反应的影响。方法选择在电视辅助胸腔镜下行肺叶切除术的患者60例,随机分为经皮穴位电刺激(transcutaneous electrical acupoint stimulation, TEAS)组和假经皮穴位电刺激组(Sham组),每组30例。TEAS组于麻醉诱导前30 min经皮穴位电刺激双侧合谷穴、内关穴、后溪穴及支沟穴,电刺激持续至手术结束。Sham组于上述穴位贴电极片,但不给予电刺激。分别于手术前30 min(T1)、单肺通气1 h(T2)、手术结束后双肺通气10 min(T3)及术后24 h(T4)采集颈内静脉血,用流式细胞术检测血清IL-6、IL-10、TNF-α浓度;记录术后3 d内的肺部并发症发生率、术后拔除胸管时间和平均住院日。结果与Sham组比较,TEAS组血清IL-6及IL-10浓度在手术结束双肺通气10 min时均显著降低( P <0.05);组内比较,两组患者血清IL-6及IL-10水平在手术结束双肺通气10 min时均高于术前( P <0.05);两组术后肺部并发症、胸管拔除时间及平均住院日差异无统计学意义。结论经皮穴位电刺激可降低全身麻醉下胸腔镜肺叶切除术患者术中炎性因子的表达,可能对胸腔镜肺叶切除术患者围手术期肺保护存在积极作用。

Objective To explore effects of transcutaneous electrical acupoint stimulation(TEAS) on inflammation in patients undergoing video-assisted thoracoscopic lobectomy. Methods Sixty patients undergoing video-assisted thoracoscopic lobectomy (VATS) were randomly divided into transcutaneous electrical acupoint stimulation(TEAS) group and Sham group with 30 cases in each group. In TEAS group, TEAS was implemented 30 min before anesthesia induction,stimulating at Hegu, Neiguan, Houxi and Zhigou points, and discontinued until the end of operation. The electrodes were attached to the above-mentioned acupoints but without electrical stimulation in Sham group. Flow cytometry was used to measure the concentrations of plasma IL-6, IL-10 and TNF-α at 30 min before surgery (T1), one lung ventilation 1 h (T2), two lung ventilation 10 min after surgery (T3) and 24 h after surgery (T4), respectively.Postoperative outcome measures were recorded, including the postoperative pulmonary complications within 3 days、The removal time of the thoracic drainage tube and the length of postoperative hospital stay were documented. Results Compared with the Sham group, the levels of plasma IL-6 and IL-10 were decreased significantly at two lung ventilation 10 min after surgery ( P <0.05). The serum IL-6 and IL-10 levels at two lung ventilation 10 min after surgery were higher than those before operation in both groups ( P <0.05). There were no significant differences in the incidence of postoperative pulmonary complications, the removal time of the thoracic drainage tube and the average length of stay between the two groups. Conclusion Transcutaneous electrical acupoint stimulation may reduce the expression of inflammatory factors in patients undergoing VATS under general anesthesia to alleviate the severity of lung injury during operation.