不同时间电针对直肠癌开腹手术患者围术期应激反应和免疫功能的影响

Effect of Electroacupuncture at Different Time Points on Perioperative Stress Reaction and Immune Function in Laparotomy Patients with Rectal Cancer

目的观察不同时点电针对直肠癌开腹手术患者围术期应激反应及免疫功能的影响。方法240例择期行直肠癌根治性开腹手术而住院的患者,随机分为A组、B组、C组、D组,每组60例。A组设为空白对照组,B组于手术前1 d、C组于手术前1 d和麻醉诱导前30 min、D组分别于手术前1 d、麻醉诱导前30 min及手术后1 d行电针。分别于手术前1 d电针前(T1)、麻醉诱导前电针前(T2)、术毕(T3)和手术后1 d电针后(T4)4个时间采集患者空腹外周静脉血,用Sysmex血细胞分析仪对白细胞与中性粒细胞进行计数;ELISA检测急性期C反应蛋白(CRP)与热反应蛋白70(HSP70)以及细胞因子白介素6(IL-6)、干扰素(IFN-g)、白介素4(IL-4)水平,并计算IFN-g与IL-4比值;采用流式细胞仪测定CD4、CD8的细胞含量并计算两者比值。结果HSP70与CRP水平、白细胞数与中性粒细胞数、IL-4与IL-6水平变化趋势均一致,4组T1、T2时间比较,差异无统计学意义(P>0.05);A组与B组T3和T4时间比较,差异无统计学意义(P>0.05);C组、D组T3和T4时间显著低于A组与B组(P<0.05);D组T4时间显著低于C组(P<0.05);4组T2时间与T1时间比较差异无统计学意义(P>0.05),T3时间高于T2时间(P<0.05),T4时间低于T3时间(P<0.05)。IFN-g变化不显著(P>0.05),IFN-g/IL-4、CD4/CD8变化趋势与以上相反。结论电针术前使用对直肠癌患者无显著疗效,但能够减轻术后应激反应和免疫抑制,并且随着电针次数的合理增加疗效更加显著。

Objective To investigate the effect of electroacupuncture at different time points on perioperative stressreaction and immune function in laparotomy patients with rectal cancer.Method Two hundred and forty patients withrectal cancer hospitalized for elective radical open surgery were randomized to groups A,B,C and D,with 60 cases ineach group.Group A was set as blank control.Electroacupuncture was performed one day before surgery in group B,30 min before anesthesia induction one day before surgery in group C,and 30 min before anesthesia induction one daybefore surgery and one day after surgery in group D.Fasting peripheral venous blood was taken beforeelectroacupuncture one day before surgery(T1),before electroacupuncture followed by anesthesia induction(T2),at theend of surgery(T3)and 4 hrs after electroacupuncture one day after surgery(T4).Leukocytes and neutrophils werecounted using Sysmex whole blood cell analyzer.Acute-stage C reactive protein(CRP)and heat shock protein(HSP70),and cytokines:interleukin-6(IL-6),interferon(IFN-g)and interleukin-4(IL-4)were measured and the ratio of IFN-gto IL-4 was calculated.The contents of CD4﹢and CD8﹢T cells were measured using flow cytometry and their ratio was calculated.Result The levels of HSP70 and CRP,the numbers of leukocytes and neutrophils and the levels of IL-4 and IL-6 tended to a consistent change and there were no statistically significant differences between the four groups at T1 and T2(P>0.05)and between groups A and B at T3 and T4(P>0.05).They were significantly lower in groups C and D than in groups A and B at T3 and T4(P<0.05)and significantly lower in group D than in group C at T4(P<0.05).In the four groups,they had no statistically significant differences between T2 and T1(P>0.05),and were significantly higher at T3 than at T2(P<0.05)and significantly lower at T4 than at T3(P<0.05).IFN-gdid not change significantly.IFN-g/IL-4 and CD4﹢/CD8﹢T cells had a reverse changing tendency.Conclusion Preoperative electroacupuncture has no significant therapeutic effect on rectal cancer but can reduce postoperative stress reaction and immunologic suppression and produce a more marked effect with a reasonable increase in the number of electroacupuncture treatments.