针药复合麻醉在胸腔镜肺癌手术中的肺保护作用临床观察

Clinical observation of lung protection of acupuncture-drug compound anesthesia in thoracoscopic lung cancer surgery

目的:观察针药复合麻醉在胸腔镜肺癌手术中的肺保护作用,验证针药复合麻醉减轻胸腔镜肺癌手术患者的术后肺损伤、改善预后的效应。方法:采用随机、对照的方法,将70例择期行胸腔镜下肺癌根治术的患者随机分为针药复合麻醉组和全麻组,每组各35例。全麻组患者行常规全身麻醉;针药复合麻醉组患者在麻醉诱导前30 min行电针针刺干预,而后行常规麻醉诱导,麻醉药使用剂量为常规麻醉的1/3。分别于术前、术后即刻、术后8 h、术后次日,检测并比较两组患者的氧合指数水平及血清白介素(IL)-2、IL-6、IL-10、肿瘤坏死因子-α(TNF-α)水平;比较两组患者的术后引流量、术后抗生素使用天数、术后住院天数、医疗总费用。结果:(1)术后,两组患者的氧合指数水平均升高(P<0.05),且术后8 h,针药复合麻醉组患者的氧合指数水平高于全麻组(P<0.05)。(2)术后8 h,针药复合麻醉组患者的IL-2水平高于全麻组(P<0.05);术后,两组患者的IL-6水平均较术前升高(P<0.05),但术后即刻,针药复合麻醉组患者的IL-6水平低于全麻组(P<0.05);术后,两组患者的IL-10水平较术前均升高(P<0.05),但组间比较差异无统计学意义(P>0.05)。(3)与全麻组比较,针药复合麻醉组患者的术后抗生素使用天数、术后住院天数均缩短(P<0.05,P<0.01),医疗总费用降低(P<0.05)。结论:针药复合麻醉可改善胸腔镜肺癌手术患者的术后炎症反应、免疫功能,从而减轻患者的术后肺损伤、改善肺的氧合功能,对围手术期患者的肺功能具有一定保护作用。

Objective:To observe the lung protective effect of acupuncture-drug compound anesthesia in thoracoscopic lung cancer surgery,and verify the effect of acupunctur-drug compound anesthesia on reducing postoperative lung injury and improving prognosis in patients undergoing thoracoscopic lung cancer surgery.Methods:A randomized,controlled method was applied.A total of 70 patients undergoing elective thoracoscopic radical resection for lung cancer were randomly divided into the acupuncture-drug compound anesthesia group and the general anesthesia group,35 cases in each group.The patients in the general anesthesia group underwent routine general anesthesia.The patients in the acupuncture-drug compound anesthesia group received electroacupuncture intervention 30 min before anesthesia induction,and then received conventional anesthesia induction,the dose of anesthetic was 1/3 of conventional anesthesia.The levels of oxygenation index,and serum interleukin(IL)-2,IL-6,IL-10 and tumor necrosis factor-α(TNF-α) were detected and compared between the two groups before surgery,immediately after surgery,8 h after surgery and the next day after surgery.The postoperative drainage amount,postoperative antibiotic use days,postoperative hospitalization days and the total medical costs of the two groups were compared.Results:(1)After surgery,the oxygenation index levels in both groups were increased(P<0.05),and 8 h after surgery,the oxygenation index level of the acupuncture-drug compound anesthesia group was higher than that of the general anesthesia group(P<0.05).(2) Eight hours after surgery,the level of IL-2 in the acupuncture-drug compound anesthesia group was higher than that in the general anesthesia group(P<0.05).After surgery,the levels of IL-6 in both groups were increased compared with those before surgery(P<0.05),but immediately after surgery,the level of IL-6 in the acupuncture-drug compound anesthesia group was lower than that in the general anesthesia group(P<0.05).After surgery,the levels of IL-10 in both groups were increased compared with those before surgery(P<0.05),but there was no statistically significant difference between the two groups(P>0.05).(3)Compared with the general anesthesia group,the postoperative antibiotic use days and postoperative hospitalization days of the acupuncture-drug compound anesthesia group were shortened(P<0.05,P<0.01),and the total medical costs were decreased(P<0.05).Conclusion:Acupuncture-drug compound anesthesia can improve the postoperative inflammatory response and immune function in patients undergoing thoracoscopic lung cancer surgery,thus reduces the postoperative lung injury and improves the oxygenation function of lung,and has a certain protective effect on lung function for patients in perioperative period.