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[不同频率电针的针药复合麻醉对肺叶切除患者免疫功能的影响]

[Influence of acupuncture-drug compound anesthesia with different frequency electroacupuncture on immune function in patients undergoing pneumonectomy].

作者信息

Fan Wen-Chao, Ma Wen, Zhao Chuang, Tong Qiu-Yu, Shen Wei-Dong

机构信息

Department of Acupuncture and Moxibustion, Shuguang Hospital Affiliated to Shanghai University of TCM, Shanghai 201203, China.

出版信息

Zhongguo Zhen Jiu. 2012 Aug;32(8):715-9.

Abstract

OBJECTIVE

To explore different frequency electroacupuncture in acupuncture-drug compound anesthesia on analgesic effect and immune function in the pulmonary resection patients in order to recommend the best electroacupuncture frequency in acupuncture-drug compound anesthesia.

METHODS

One hundred and sixty-three patients scheduled for pneumonectomy were randomly divided into group A (n = 31), B (n = 34), C (n = 32), D (n = 34) and E (n = 32). Houxi (SI 3), Zhigou (TE 6), Neiguan (PC 6) and Hegu (LI 4) were selected in the five groups. Group A was treated with sham acupuncture by pasting needles without needle bodies at acupoints and electroacupuncture at the needle handle, and group B with 2 Hz electroacupuncture, and group C with 2 Hz/ 100 Hz electroacupuncture, and group D with 100 Hz electroacupuncture, and group E with 2 Hz/100 Hz transcetaneous acupoints electrical stimulation, and general anesthesia was produced in all the groups followed by 30 min electrical stimulation and the stimulation was lasted till the end of operation. The dosages of the anesthetics and the changes of surface antigen of leukomonocyte (CD3+ , CD4+ , CD8+ and CD4+/CD8+) and natural killer (NK) cell were observed at 1 day before surgery, intraoperative and 1 day after surgery.

RESULTS

In comparison with group A, the dosages of Propofol in group B and D were decreased, Fentanyl in group B, D and E were decreased. CD3+ and CD4+ in 5 groups increased at first and then decreased over time (all P < 0.01), and group E and C could inhibit the decrease of CD3+ and CD4+ in postoperation in comparison with that in the other three groups (all P < 0.05). CD8+ in 5 groups has no change in different times (all P > 0.05), and group E and D could inhibit the decrease of CD8+ in postoperation in comparison with that in the other three groups (all P < 0.05). CD4+/CD8+ in 5 groups has no change in different times (all P > 0.05), and group E and C could inhibit the decrease of CD4+/CD8+ in postoperation in comparison with that in the other three groups (all P < 0.05). NK cells of 5 groups were increased gradually in different times (all P < 0.01), with the similar regulation of NK cells (all P > 0.05).

CONCLUSION

Acupuncture-drug compound anesthesia with 2 Hz and 100 Hz electroacupuncture together with 2 Hz/100 Hz transcetaneous acupoints electrical stimulation have the best analgesic effect, and 2 Hz/100 Hz transcetaneous acupoints electrical stimulation and 2 Hz/100 Hz electroacupuncture have the best regulation of immune function. Acupuncture-drug compound anesthesia with 2 Hz/100 Hz transcetaneous acupoints electrical stimulation is recommended for that it can not only decrease the dosages of the anesthetics, but also significantly improve the immunosuppression in patients undergoing pneumonectomy.

摘要

目的

探讨不同频率电针在针药复合麻醉中对肺切除患者镇痛效果及免疫功能的影响,以推荐针药复合麻醉中最佳电针频率。

方法

将163例拟行肺叶切除术的患者随机分为A组(n = 31)、B组(n = 34)、C组(n = 32)、D组(n = 34)和E组(n = 32)。五组均选取后溪(SI 3)、支沟(TE 6)、内关(PC 6)和合谷(LI 4)。A组采用在穴位粘贴无针体的针柄进行假针刺并在针柄处进行电针治疗,B组采用2Hz电针,C组采用2Hz/100Hz电针,D组采用100Hz电针,E组采用2Hz/100Hz经皮穴位电刺激,所有组均先实施全身麻醉,随后进行30分钟电刺激,刺激持续至手术结束。观察术前1天、术中及术后1天麻醉药用量及白细胞表面抗原(CD3+、CD4+、CD8+及CD4+/CD8+)和自然杀伤(NK)细胞的变化。

结果

与A组比较,B组和D组丙泊酚用量减少,B组、D组和E组芬太尼用量减少。五组CD3+和CD4+均随时间先升高后降低(均P < 0.01),与其他三组比较,E组和C组可抑制术后CD3+和CD4+的降低(均P < 0.05)。五组CD8+在不同时间无变化(均P > 0.05),与其他三组比较,E组和D组可抑制术后CD8+的降低(均P < 0.05)。五组CD4+/CD8+在不同时间无变化(均P > 0.05),与其他三组比较,E组和C组可抑制术后CD4+/CD8+的降低(均P < 0.05)。五组NK细胞在不同时间逐渐升高(均P < 0.01),NK细胞的变化规律相似(均P > 0.05)。

结论

2Hz和100Hz电针及2Hz/100Hz经皮穴位电刺激的针药复合麻醉镇痛效果最佳,2Hz/100Hz经皮穴位电刺激和2Hz/100Hz电针对免疫功能调节最佳。推荐采用2Hz/100Hz经皮穴位电刺激的针药复合麻醉,因其不仅可减少麻醉药用量,还可显著改善肺切除患者的免疫抑制。

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