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针刺对心脏手术病人的机体保护作用

王祥瑞,卢中平,许灿然,杭燕南,孙大金

上海第二医科大学附属仁济医院!上海200001,上海第二医科大学附属仁济医院!上海200001,上海第二医科大学附属仁济医院!上海200001,上海第二医科大学附属仁济医院!上海200001,上海第二医科大学附属仁济医院!上海200001

The Protective Effects of Electroacupuncture on Patients Undergoing Cardiac Surgery

Abstract:

Objective:To observe the protective effects of electroacupuncture on patients undergoing cardiac surgey. Methods: Forty patients with atrial septal defect (ASD) were randomly allocated to 3 groups: acupuncture anesthesia (AA) group (n=12) , acupuncture combined with general anesthesia (ACGA) group (n=12) , and general anesthesia (GA) group (n=16) . Medicines used before operation were phenobarbital sodium (100 mg) , pethidine (50 mg) , Scopolamine (0.3 mg) in all three groups. Patients of group AA received acupuncture for 15 min before operation. Bilateral Neiguan (PC 6) , Lieque (LU 7) and Yunmen (LU 2) were employed. After insertion, the needles were connected with an acupuncture anesthesia apparatus for stimulating the acupoints with electrical impulse 3~4 Hz in frequency, 0.5~1 mA in strength and 20~30 min of duration. The stimulation was stopped after heparinization during extracorporeal circulation and continued after neutralization with protaminase. Patients in GA group were induced with dazepam 0.1 mg/kg, vecuronium 0.25 mg/kg, etomidate 0.2 mg/kg and fentanyl 5 μg/kg, and anesthesia was maintained by continuous inhale of isoflurane and intermittent injection of fentany and vecuronium. Patients of ACGA and GA groups were treated with the same methods except for electroacupuncture stimulation in the former group. Hemodynamics parameters including heart rate (HR) , mean arterial pressure (MAP) , cardiac output (CO) , cardiac index (CI) , stroke volume (SV) , SVR were recorded before and after anesthetic induction, making incision, before performing bypass, stop bypass, 30 min after bypass and after operation. Superoxide dismutase (SOD) , malonyldialdehyde (MDA) , creatine phosphokinase isoenzyme (CPKI) extracted from blood samples of internal jugular vein were analysed before bypass, cease of bypass and 1 hour after bypass. Myocardial samples of right auricle were taken for detecting the expression of heat shock protein (HSP 70 ) mRNA at the time of pre bypass, cease of bypass and 1 hour after bypass. Results: CI, MAP and SV of AA group were lower than those of ACGA group and GA group. Compared to values of pre induction, CI, MAP and SV in GA group decreased significantly after operation (P<0.05) , while there were no marked changes in AA group. SOD increased significantly in AA group and ACGA group at the time of 1 hour after bypass compared to values of pre bypass, and decreased notably in GA group.MDA increased significantly in GA group during 1 hour after operation. CPKI increased notably in all the three groups during 1 hour after bypass compared with the values of pre bypass, and the increased extent was higher in GA group than that of AA group and ACGA group.The expression of HSP 70 mRNA was stronger in AA group and ACGA group than that of GA group (P<0.05) . Conclusion: Acupuncture can adjust hemodynamics in patients undergoing cardiac operations, enhance the ability of oxygen derived free radicals clearance and the expression of HSP 70 mRNA, reduce myocardial ischemia reperfusion injury.

目的:观察电针刺激对心脏手术病人机体的保护作用。方法:40例行房间隔缺损修补术病人随机分成针麻组 (组Ⅰ, n=12) , 全麻辅助针刺组 (组Ⅱ, n=12) 和全麻组 (组Ⅲ, n=16) 。所有病人术前用药为肌注苯巴比妥钠0.1 g, 哌替啶50 mg, 东莨菪碱0.3 mg。针麻组术前15 min下针, 针刺穴位取双侧内关、列缺、云门。进针后接针麻仪, 脉冲频率为3~4 Hz, 输出强度以病人耐受为准, 一般诱导时间20~30 min。切皮前15 min静注氟哌利多或安定5 mg、芬太尼0.1 mg, 术中酌情追加芬太尼, 保持自主呼吸。体外循环肝素化时, 留针停止刺激, 待鱼精蛋白中和后恢复刺激。全麻组麻醉诱导安定0.1 mg/kg, 维库溴铵0.25 mg/kg, 依托咪酯0.2 mg/kg, 芬太尼5 μg/kg, 麻醉维持吸入异氟醚, 间断静注芬太尼、维库溴铵。全麻辅助针刺组在全麻方法上加电针刺激。监测方法:① 血流动力学:于术前、诱导后、切皮、转流前、停转流、停转流后30 min和术毕记录HR、MAP、CO、CI、SV、SVR。② 氧自由基及心肌酶谱指标:于上腔静脉插管前 (转流前10 min) 、停转流、转流后1 hr, 经颈内静脉抽血测定心脏超氧化物歧化酶 (SOD) 、丙二醛 (MDA) 、肌酸磷酸激酶同功酶 (CK-MB) 。③ 转流前、停心肺转流机和停机后1 hr分别自右心耳剪下1 cm×1 cm×1 cm标本测心肌热休克蛋白 (HSP70) mRNA基因表达的变化。结果:①组Ⅰ术中CI、MAP、SV明显低于组Ⅱ和组Ⅲ, 和术前值相比, 全麻组术毕时CI、MAP、SV明显降低 (P<0.05) , 而针麻组则无显著变化。②组Ⅰ、组Ⅱ停转流后1 hr SOD较转流前明显增高, 组Ⅲ SOD较转流前明显下降, MDA显著增加, 三组CK-MB停转流1 hr均较转流前明显增加, 组Ⅲ的增加幅度明显大于组Ⅰ和组Ⅱ。③ 针刺组HSP70 mRNA表达高于对照组 (P<0.05) 。结论:针刺对心脏手术病人循环功能有调节作用, 并能增强机体的氧自由基清除能力和热休克蛋白基因表达, 减轻心肌的缺血再灌注损伤。

The Protective Effects of Electroacupuncture on Patients

Undergoing Cardiac Surgery

Wang Xiangrui, Lu Zhongping, Xu Canran, Hang Yannan, Sun Dajin

(Department of Anesthesiology, Renji Hospital Affiliated to

Shanghai Second Medical University, Shanghai, 200001)

Objective:To observe the protective effects of electroacupuncture on patients undergoing cardiac surgey. Methods: Forty patients with atrial septal defect (ASD) were randomly allocated to 3 groups: acupuncture anesthesia (AA) group (n=12) , acupuncture combined with general anesthesia (ACGA) group (n=12) , and general anesthesia (GA) group (n=16) . Medicines used before operation were phenobarbital sodium (100 mg) , pethidine (50 mg) , Scopolamine (0.3 mg) in all three groups. Patients of group AA received acupuncture for 15 min before operation. Bilateral Neiguan (PC 6) , Lieque (LU 7) and Yunmen (LU 2) were employed. After insertion, the needles were connected with an acupuncture-anesthesia apparatus for stimulating the acupoints with electrical impulse 3~4 Hz in frequency, 0.5~1 mA in strength and 20~30 min of duration. The stimulation was stopped after heparinization during extracorporeal circulation and continued after neutralization with protaminase. Patients in GA group were induced with dazepam 0.1 mg/kg, vecuronium 0.25 mg/kg, etomidate 0.2 mg/kg and fentanyl 5 μg/kg, and anesthesia was maintained by continuous inhale of isoflurane and intermittent injection of fentany and vecuronium. Patients of ACGA and GA groups were treated with the same methods except for electroacupuncture stimulation in the former group. Hemodynamics parameters including heart rate (HR) , mean arterial pressure (MAP) , cardiac output (CO) , cardiac index (CI) , stroke volume (SV) , SVR were recorded before and after anesthetic induction, making incision, before performing bypass, stop bypass, 30 min after bypass and after operation. Superoxide dismutase (SOD) , malonyldialdehyde (MDA) , creatine phosphokinase-isoenzyme (CPKI) extracted from blood samples of internal jugular vein were analysed before bypass, cease of bypass and 1 hour after bypass. Myocardial samples of right auricle were taken for detecting the expression of heat shock protein (HSP70) mRNA at the time of pre-bypass, cease of bypass and 1 hour after bypass. Results: CI, MAP and SV of AA group were lower than those of ACGA group and GA group. Compared to values of pre-induction, CI, MAP and SV in GA group decreased significantly after operation (P<0.05) , while there were no marked changes in AA group. SOD increased significantly in AA group and ACGA group at the time of 1 hour after bypass compared to values of pre-bypass, and decreased notably in GA group.MDA increased significantly in GA group during 1 hour after operation. CPKI increased notably in all the three groups during 1 hour after bypass compared with the values of pre-bypass, and the increased extent was higher in GA group than that of AA group and ACGA group.The expression of HSP70 mRNA was stronger in AA group and ACGA group than that of GA group (P<0.05) . Conclusion: Acupuncture can adjust hemodynamics in patients undergoing cardiac operations, enhance the ability of oxygen derived free radicals clearance and the expression of HSP70 mRNA, reduce myocardial ischemia-reperfusion injury.