李 娟,曹福羊,李 亮,李 军,杨 璐.经皮穴位电刺激对体外循环下冠状动脉搭桥术患者肺功能的影响[J].转化医学杂志,2021,10(5):302-306
经皮穴位电刺激对体外循环下冠状动脉搭桥术患者肺功能的影响
Effects of Transcutaneous Electrical Acupoint Stimulation on Pulmonary Function in Patients Undergoing Coronary Artery Bypass Grafting Surgery with Cardiopulmonary Bypass
  
DOI:
中文关键词:  经皮穴位电刺激  体外循环  冠状动脉搭桥术  肺损伤
英文关键词:Transcutaneous electrical acupoint stimulation (TEAS)  Cardiopulmonary bypass (CPB)  Coronary artery bypass grafting (CABG)  Pulmonary injury
基金项目:
作者单位
李 娟 解放军总医院第六医学中心麻醉科 
曹福羊 解放军总医院第六医学中心麻醉科 
李 亮 解放军总医院第六医学中心麻醉科 
李 军 解放军总医院第六医学中心麻醉科 
杨 璐 解放军总医院第六医学中心麻醉科 
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中文摘要:
      目的 探讨经皮穴位电刺激(transcutaneous electrical acupoint stimulation,TEAS)对体外循环(cardiopulmonary bypass, CPB)下冠状动脉搭桥术(coronary artery bypass grafting,CABG)患者肺功能的影响及其相关机制。方法 按照纳入标准选取择期行CPB下CABG患者60例,美国麻醉医师协会(American Society of Anesthesiologists,ASA)分级II~III级,美国纽约心脏病协会(New York Heart Association,NYHA)心功能分级II~III级,采用随机数字表法分为两组(n=30):对照组和TEAS组,TEAS组患者诱导前30 min于足三里,肺俞穴和孔最穴行经皮穴位电刺激至手术结束,分别于切皮前(T0),CPB结束后30 min(T1),术毕时(T2),术后12 h(T3)和24 h(T4),取桡动脉血样行动脉血气分析,测定PaO2和PaCO2,同时记录上述时间点潮气量和气道平台压,计算氧合指数(oxygenation index,OI),呼吸指数(respiratory index,RI)和肺静态顺应性(static lung compliance,Cst),同时于上述时间点取中心静脉血样,测定样本中多形核中性白细胞(polymorphonuclear neurtrophil, PMN)数量,血清中肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、白细胞介素-6(interleukin-6,IL-6)和超氧化物歧化酶(superoxide dismutase,SOD)含量,记录患者术后机械通气时间,ICU停留时间和住院时间。结果 与对照组比较,T组患者T1~2时刻Cst增加,T1~4时刻OI值增加,RI值降低,血清中IL-6和TNF-α含量降低,SOD活性升高,PMN数量减少,且T组患者术后机械通气时间和ICU停留时间显著缩短(P<0.05)。结论 TEAS可减轻CPB下CABG患者全身炎症反应,改善肺功能,具有一定的肺保护作用。
英文摘要:
      Objective To investigate the effects of transcutaneous electrical acupoint stimulation (TEAS) on pulmonary function in patients undergoing coronary artery bypass grafting (CABG) surgery with cardiopulmonary bypass (CPB). Methods 60 patients scheduled for elective CABG under general anesthesia (ASA II~III, NYHA II~III) were randomly divided into 2 groups (n=30): control group (group C) and TEAS group (group T). Patients in T group were treated with TEAS 30 min before induction to the end of surgery at bilateral Zusanli, Feiyu and Kongzui acupoints. Before surgery (T0), at 30 min after CPB (T1), at the end of surgery (T2), and at 12 h (T3) and 24 h (T4) after surgery, blood samples were taken from radial artery for blood gas analysis. PaO2, PaCO2, tidal volume and plateau airway pressure were recorded. Oxygenation index (OI), respiratory index (RI) and static lung compliance (Cst) were calculated. Blood sample from central vein were taken at the same time points mentioned above for determination of polymorphonuclear neurtrophil (PMN) counts and serum concentrations of interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) and superoxide dismutase (SOD). The time of mechanical ventilation after surgery, ICU stay and hospital stay were also recorded. Results Compared to the group C, Cst was significantly increased at T1~2, RI, PMN counts and serum concentrations of IL-6 and TNF-α were significantly decreased at T1~4 in group T. OI and SOD activities were significantly increased at T1~4, and the time for mechanical ventilation after surgery and ICU stay were shortened in group T (P<0.05). Conclusion TEAS could alleviate systemic inflammatory responses, improve pulmonary function and reduce pulmonary injuries.
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