摘要
目的观察电针刺激内麻点和内关穴对择期行胃癌根治术的老年冠心病患者术后镇痛及应激因子β-内啡肽(β-EP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)的影响。方法选取择期行胃癌根治术患者80例,按随机数字表法随机分为对照组和观察组,每组40例。两组患者均采用全凭静脉麻醉,术中采用脑电双频指数(BIS)监测麻醉深度。对照组术后选用舒芬太尼静脉自控镇痛(PCIA);观察组麻醉诱导前电针刺激内麻点和内关穴30 min,手术结束后再次刺激30 min后拔针。记录两组患者术中瑞芬太尼和丙泊酚的使用量。记录两组患者针刺前(T0)、术后2 h(T1)、术后12 h(T2)、术后24 h(T3)、术后48 h(T4)5个时间点的VAS评分,采用放射免疫法测定各时间点血液标本中应激因子β-EP、TNF-α、IL-6的含量。结果两组患者术中药物用量比较,观察组丙泊酚用量与对照组比较差异无统计学意义(P>0.05);观察组瑞芬太尼使用量低于对照组(P<0.05)。两组VAS评分在T1时间点与T0比较,显著升高(P<0.05);对照组VAS评分在T1、T2、T3时间点与观察组比较,显著升高(P<0.05)。观察组β-EP在T1、T2、T3和T4时间点与T0比较,显著升高(P<0.05),对照组β-EP在T1时间点与T0相比,明显升高(P<0.05);对照组TNF-α和IL-6在T1、T2和T3时间点与T0比较;显著升高(P<0.05)。观察组β-EP在T2、T3时间点与对照组比较,显著升高(P<0.05);对照组TNF-α和IL-6在T1、T2和T3时间点与观察组比较,显著升高(P<0.05)。结论在老年冠心病患者行胃癌根治术的麻醉中,电针刺激内麻点与内关穴不仅能减少术中镇痛药物的用量,还能为患者提供良好的术后镇痛。其机制可能是电针能促进β-EP的释放和抑制TNF-α和IL-6的分泌有关。
Objective To observe the effects of electroacupuncture at Neimadian(extra)and Neiguan(PC6)on postoperative analgesia and stress factorsβ-endorphin(β-EP),tumor necrosis factor-α(TNF-α)and interleukin(IL)-6 in elderly coronary heart disease(CHD)patients undergoing radical gastrectomy.Method Eighty patients undergoing radical gastrectomy were randomized into a control group and an observation group using the random number table method,with 40 cases in each group.The two groups of patients all received total intravenous anesthesia(TIA)and the anesthesia state was monitored by bispectral index(BIS)during operation.The control group received patient-controlled intravenous analgesia(PCIA)with Sufentanil after operation;the observation group was given electroacupuncture stimulation at Neimadian and Neiguan for 30 min before anesthesia induction and the needles were removed after stimulation for another 30 min at the end of the operation.The consumptions of Remifentanil and Propofol during operation were recorded.The Visual Analogue Scale(VAS)scores of the two groups were recorded at five time points:before acupuncture(T0),and at 2 h,12 h,24 h and 48 h after operation(T1,T2,T3 and T4,respectively).The contents of stress factorsβ-EP,TNF-αand IL-6 in blood samples were determined using radioimmunoassay at each time point.Result In comparison of the drug consumptions in the two groups during operation,there was no significant difference in the consumption of Propofol between the observation group and the control group(P>0.05),while the consumption of Remifentanil in the observation group was lower than that in the control group(P<0.05).The VAS score at T1 was significantly higher than that at T0 in the two groups(P<0.05);the VAS score in the control group was significantly higher than that in the observation group at T1,T2 and T3(P<0.05).The content ofβ-EP was significantly higher at T1,T2 and T3 than at T0 in the observation group(P<0.05),and the content ofβ-EP at T1 was significantly higher than that at T0 in the c
作者
周民涛
张彩举
付金厚
何金乾
ZHOU Min-tao;ZHANG Cai-ju;FU Jin-hou;HE Jin-qian(First People’s Hospital of Nanyang,Nanyang 473010,China)
出处
《上海针灸杂志》
2020年第8期1027-1032,共6页
Shanghai Journal of Acupuncture and Moxibustion
基金
河南省医学科技攻关计划项目(2018020976)。
关键词
电针
胃切除术
疼痛
手术后
应激因子
VAS评分
Electroacupuncture
Gastrectomy
Pain
postoperative
Stress factor
VAS scale
