围术期经皮穴位电刺激对脊柱后路内固定术后患者细胞免疫功能的影响

Effect of perioperative transcutaneous electrical acupoint stimulation on postoperative cellular immune function in patients undergoing posterior spinal internal fixation

目的评价围术期经皮穴位电刺激(TEAS)对脊柱后路内固定术后患者细胞免疫功能的影响。方法选择本院择期行腰椎后路减压植骨融合内固定术患者90例,年龄40~70岁,ASA分级Ⅰ或Ⅱ级,采用电脑随机数字法将患者分为2组(n=45):常规组采用全凭静脉麻醉,试验组采用全凭静脉麻醉联合TEAS。试验组麻醉诱导前30 min以2/15 Hz疏密波刺激双侧足三里、三阴交穴,刺激强度以患者耐受为宜,诱导结束后以2/100 Hz疏密波维持至术毕,刺激强度同诱导前。术后第1~4天以2/15 Hz疏密波刺激双侧内关、太冲穴,强度以患者耐受为宜,1次/d,30 min/次。常规组于相同时间段接电极片,但不予刺激。于麻醉诱导前、术后1 h、术后第1、3和5天采集静脉血标本,采用流式细胞术检测CD3^(+)、CD4^(+)、CD8^(+)T淋巴细胞百分比、CD4^(+)/CD8^(+)比值、WBC计数和中性粒细胞百分比(NE%)。记录术中麻醉药用量、术后镇痛药使用情况、恶心呕吐、头晕、感染发生情况和住院时间。结果与常规组比较,试验组瑞芬太尼总用量及消耗指数降低,术后第3和5天CD3^(+)T淋巴细胞百分比升高,术后第1天NE%降低,头晕发生率降低(P<0.05),其余指标差异无统计学意义(P>0.05)。结论围术期TEAS可改善脊柱后路内固定术后患者细胞免疫功能,对预防术后感染有一定潜在价值。

Objective To evaluate the effect of perioperative transcutaneous electrical acupoint stimulation(TEAS)on postoperative cellular immune function in the patients undergoing posterior spinal internal fixation.Methods Ninety patients,aged 40-70 yr,of American Society of Anesthesiologists physical statusⅠorⅡ,undergoing elective posterior spinal internal fixation in our hospital,were divided into 2 groups(n=45 each)using a computer-generated table of random numbers:routine group and experiment group.Total intravenous anesthesia was used in routine group,while total intravenous anesthesia combined with TEAS was applied in experiment group.In experiment group,bilateral Zusanli and Sanyinjiao acupoints were stimulated with 2/15 Hz disperse-dense waves at the intensity that could be tolerated by patients at 30 min before induction of anesthesia,maintaining with 2/100 Hz disperse-dense waves from the end of induction until the end of operation at the same stimulation intensity before induction.Bilateral Neiguan and Taichong acupoints were stimulated for 30 min each time with 2/15Hz disperse-dense waves once a day at 1st-4th days after operation.In routine group,the electrodes were connected at the same time period,but no stimulation was given.Venous blood samples were collected before induction of anesthesia,at 1 h after surgery,and on 1st,3rd,and 5th days after surgery,and the percentage of CD3^(+),CD4^(+),CD8^(+)T lymphocytes,CD4^(+)/CD8^(+)ratio,WBC count and percentage of neutrophils(NE%)were determined by flow cytometry,and the consumption of intraoperative anesthetics,use of postoperative analgesics,nausea and vomiting,dizziness,infection and length of hospital stay were recorded.Results Compared with routine group,the total consumption and consumption index of remifentanil were significantly decreased,the percentage of CD3^(+)T lymphocytes was increased on 3rd and 5th postoperative days,the NE%was decreased on 1st postoperative day,and the incidence of dizziness was decreased(P<0.05),and no significant change was found in the other indicators in experiment group(P>0.05).Conclusions Perioperative TEAS can improve postoperative cellular immune function and has a certain potential value in preventing postoperative infection in the patients undergoing posterior spinal internal fixation.