摘要
目的:探讨经皮穴位电刺激内关-足三里-肺俞穴对全麻头低位患者肺功能的影响。方法:择期全麻腹腔镜手术头低位患者60例,采用随机数字表法分为对照组(C组)、经皮穴位电刺激组(T组)和经皮非穴位电刺激组(N组)3组(n=20)。分别于麻醉诱导前(T0)、气腹60 min(T1)、气腹120 min(T2)、气腹结束后30 min(T3)、气腹结束后60 min(T4)时取血样,进行血气分析,计算氧合指数(OI);采用ELISA法检测血清白介素-10(IL-10)、肿瘤坏死因子-α(TNF-α)和Clara细胞分泌蛋白(CC16)的浓度及丙二醛(MDA)含量和超氧化物歧化酶(SOD)活性。结果:T0时点,C组、T组和N组间上述各指标差异无统计学意义(P>0.05);与T0时比较,C组、T组和N组T1~T4时血清TNF-α、IL-10和CC16的浓度及MDA含量显著升高,OI和SOD活性显著降低(P<0.05);T1时,C组和T组血清TNF-α浓度分别为(23.9±1.2)μg/mL、(19.1±0.3)μg/mL,T4时,血清TNF-α浓度分别为(39.4±0.7)μg/mL、(36.5±0.1)μg/mL,T组显著低于C组(P<0.05);T1时,C组和T组血清CC16的浓度分别为(20.7±1.1)mg/L、(16.1±0.4)mg/L,T4时,血清CC16浓度分别为(39.1±1.6)mg/L、(33.4±1.2)mg/L,T组显著低于C组(P<0.05);T1时,C组和T组MDA含量分别为(4.3±0.5)nmol/mL、(3.9±0.1)nmol/mL,T4时,MDA含量分别为(5.7±0.3)nmol/mL、(5.0±0.4)nmol/mL,T组显著低于C组(P<0.05);T1时,C组和T组SOD活性分别为(20.2±0.4)n U/mL、(26.6±1.3)n U/mL,T4时,SOD活性分别为(9.4±0.6)n U/mL、(14.4±1.3)n U/mL,T组显著高于C组(P<0.05);T1时,C组和T组IL-10浓度分别为(28.5±0.8)μg/m、(34.1±1.1)μg/mL,T4时,IL-10浓度分别为(44.9±1.3)μg/mL、(51.2±0.8)μg/mL,T组显著高于C组(P<0.05);T1时,C组和T组OI分别为(300±8)mmHg、(320±11) mmHg,T4时,OI分别为(230±12)mmHg、(253±9)mmHg,T组显著高于C组(P<0.05),N组上述各指标差异无统计学意义(P>0.05)。结论:经皮穴位电刺激肺俞-内关-足三里穴,通过调控机体炎症介质和抗炎介质反应的平衡,减轻氧化应激,对全麻�
Objective To investigate the effects of transcutaneous electric acupoint stimulation （TEAS） of Neiguan, Zusanli and Feishu acupoints on pneumoperitoneum-induced lung injury in general anesthesia patients with Trendelenburg position. Methods Sixty patients scheduled for elective laparoscopic surgery under general anesthesia were randomly divided into 3 groups （n=20）, such as control group （group C）, TEAS group （group T） and Sham TEAS group （group N）. The peripheral venous blood samples were collected before induction of anesthesia （TO）, 60 and 120 rain after pneumoperitoneum （T 1 and T2）, 30 and 60 rain after deflation （T3 and T4） for determinating the content of malondialdehyde （MDA）, activity of superoxide dismutase （SOD）, and levels of tumor necrosis factor-alpha （TNF- α ）, interleukin- 10 （IL- 10） and Clara cell 16 -kDa secretory protein （CC 16）. Moreover, the oxygenation index （OI） was calculated. Results No significant changes were found in the above parameters in groups C, T and N at TO （P〉0.05）. Compared with the baseline, the serum levels of TNF- α, IL-10, CC 16 and MDA were significantly increased, while OI and SOD activities were significantly decreased at T 1, T2, T3 and T4 in groups C, T and N （P〈0.05）. In groups C and T, the concentrations of serum TNF- α were （23.9 ± 1.2） μg/mL and （19.1 ± 0.3） μg/mL at T1, （39.1 ± 1.6） μg/mL and （33.4 ± 1.2）μg/mL at T4, which indicated that the concentrations of serum TNF- α in T group were significantly lower than those of C group （T 1 and T4） （P〈0.05）; the CC16 levels were （20.7 ± 1.1） mg/L and （16.1 ± 0.4） mg/L at T1, （39.1 ± 1.6） mg/L and （33.4 ± 1.2） mg/L at T4, which indicated the CC16 levels in T group were significantly lower than those in C group （T1 and T4） （P〈0.05）; the MDA contents were （4.3 ± 0.5） nmol/mL and （3.9 ± 0.1） nmol/mL at T1, （5.7 ± 0.3） nmol/ mL and （5.0 ± 0.4） nmol/mL at T4, which indic
作者
吴丽丽
余剑波
史佳
王振山
WU Li-li;YU Jian-bo;SHI Jia(Department of Anesthesiology,Tianjin Nankai Hospital,Tianjin（300100）,China)
出处
《中国中西医结合外科杂志》
CAS
2018年第5期589-593,共5页
Chinese Journal of Surgery of Integrated Traditional and Western Medicine
基金
2016年天津医学会麻醉学分会中青年科研培育基金项目(TJMZJJ-2016-01)
关键词
穴位
电刺激
头低位
腹腔镜
成人呼吸窘迫综合征
Acupoint
transcutaneous electric nerve stimulation
Trendelenburg
laparoscope
adult respiratory distress syndrome
