针药平衡麻醉改善患儿体外循环下法洛四联症根治术后转归

Improvement in outcomes by acupuncture-drug balanced anesthesia following radical correction of tetralogy of Fallot under cardiopulmonary bypass in pediatric patients

目的评价针药平衡麻醉对患儿体外循环(CPB)下法洛四联症(TOF)根治术后转归的改善效果。方法择期CPB下TOF根治术患儿100例,年龄3~8岁,体重9~24 kg,ASA分级Ⅱ或Ⅲ级,采用随机数字表法分为2组:针药平衡麻醉组(ADBA组)和常规麻醉组(CA组),每组50例。ADBA组于全身麻醉诱导后,采用经皮穴位电刺激(疏密波型、频率2/100 Hz、电流强度6 mA、脉冲宽度0.2~0.6 ms),持续刺激百会、双侧内关、合谷和郄门穴,直至术毕;CA组行常规静吸复合全身麻醉,并于相同穴位上只贴电极片不进行电刺激。于术前30 min(T1)、手术30 min时(T2)及术后1 h(T3)、1 d(T4)、2 d(T5)、3 d(T6)和5 d(T7)时,采集静脉血样,检查血常规,并采用ELISA法测定血浆IL-6、IL-8和TNF-α的浓度。记录住院时间和术后主要不良事件发生情况。结果与CA组相比,ADBA组T2-7时血浆IL-6、IL-8、TNF-α的浓度和T4-7时白细胞计数、中性粒细胞计数、中性粒细胞百分比均降低,住院时间缩短,术后急性肺损伤发生率降低(P<0.05)。结论针药平衡麻醉可在一定程度上改善患儿CPB下TOF根治术后转归,其机制与抑制炎症反应有关。

Objective To evaluate the efficacy of acupuncture-drug balanced anesthesia in improving the outcomes following radical correction of tetralogy of Fallot(TOF)under cardiopulmonary bypass(CPB)in the pediatric patients.Methods A total of 100 pediatric patients,aged 3-8 yr,weighing 9-24 kg,with American Society of Anesthesiologists physical statusⅡorⅢ,scheduled for elective radical correction of TOF with CPB,were divided into 2 groups(n=50 each)using a random number table method:acupuncture-drug balanced anesthesia group(group ADBA)and conventional anesthesia group(group CA).In group ADBA,transcutaneous acupoint electrical stimulation(disperse-dense wave,frequency 2/100 Hz,current intensity 6 mA,pulse width 0.2-0.6 ms)of Baihui(GV20)and bilateral acupoints of Neiguan(PC6),Hegu(LI4),and Ximen(PC4)acupoints was performed after induction of general anesthesia and maintained until the end of surgery.In group CA,the children received combined intravenous-inhalational anesthesia,and electrodes were only applied on the same acupoints without electrical stimulation.Venous blood samples were collected for blood routine examination and for determination of the concentrations of interleukin-6(IL-6),IL-8 and tumor necrosis factor-alpha(TNF-α)at 30 min before surgery(T1),30 min after the start of surgery(T2)and 1 h and 1,2,3 and 5 days after surgery(T3-7).The length of hospital stay and development of postoperative major adverse events were recorded.Results Compared with group CA,the plasma concentrations of IL-6,IL-8 and TNF-αat T2-7 and white blood cell count,neutrophil count and neutrophil percentage at T4-7 were significantly decreased,postoperative length of hospital stay was shortened(P<0.05),and the incidence of acute lung injury was decreased obviously in group ADBA(P<0.05).Conclusion Acupuncture-drug balanced anesthesia can improve the outcomes following radical correction of TOF under CPB to a certain extent,and the mechanism is related to inhibiting inflammatory responses in pediatric patients.